This inspection took place on 30 October 2018 and was unannounced.Eagle House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
Eagle House is registered to provide accommodation for people who require nursing or personal care. The service can accommodate 46 people and predominantly provides care and accommodation for people who have enduring mental health needs or require nursing care. Accommodation and nursing care is provided over two floors in the main building. There are also four bungalows for people who are more independent. Each bungalow can accommodate up to four people. At the time of our inspection there were 38 people living at Eagle House.
Our last inspection of Eagle House took place on 13 November 2017. We rated the service requires improvement and we found there were two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was a breach of Regulation 9; person-centred care because people’s care records did not always accurately reflect their needs and staff did not adequately document the support they provided to meet people’s needs. There was a breach of Regulation 17; good governance because the provider had not acted upon feedback provided by stakeholders to drive improvements to the service and the provider’s own audits were not always effective in identifying issues which needed to be acted upon.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the service to at least good. Although the service had started to make some improvements since the last inspection, at this inspection we found the service continued to be in breach of Regulations 9 and 17. We also identified a breach of Regulation 18; staffing.
There was a registered manager employed at Eagle House. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People and their relatives told us staff were kind and caring. Staff knew people living at Eagle House very well. People told us staff responded promptly when they needed support, however, some staff told us they felt more staff were needed on each shift.
The provider had failed to ensure staff received appropriate training, supervision and support to enable them to carry out their role effectively. The provider had not taken adequate steps to ensure staff were up to date with their training and staff did not receive regular supervision. The provider’s recruitment procedures required improvement, to ensure staff employed were thoroughly assessed as suitable to work at the service.
People told us they felt safe at Eagle House and people’s relatives raised no concerns about their family member’s safety. However, the risks involved in receiving and delivering care were not consistently assessed and kept under review.
Staff understood what it meant to protect people from abuse. They knew how to report unsafe practice. Staff were required to complete safeguarding vulnerable adults training however, at the time of this inspection, not all staff were up to date with this training.
Medicines were stored safely and securely, and procedures were in place to ensure people received their medicines as prescribed.
People told us they enjoyed the food served at Eagle House. The cook was flexible and accommodating and considered people’s dietary needs and preferences.
People's care needs were not always accurately assessed and some people’s care records needed updating to help promote the delivery of person-centred care. We saw plans were in place to improve care records.
Some people had not received appropriate care to meet their personal care and hygiene needs.
Staff were required to complete training in the Mental Capacity Act 2005, however most staff were not up to date with this training. We observed staff support people to make decisions about their care and they obtained people’s consent to care and support throughout the day of this inspection. The provider's policies and systems supported this practice.
The provider had a complaints procedure in place. People told us they were confident in reporting any concerns to staff and the registered manager.
The provider had employed an activities coordinator since the last inspection. We observed various activities taking place during the inspection which people enjoyed. The activities coordinator supported people to participate in a range of activities, both in groups and on an individual basis.
Staff understood their roles and responsibilities in relation to infection control and most areas of the building were clean, however, some areas needed to be checked more frequently. We have made a recommendation about cleaning schedules.
The provider had various quality assurance and audit systems in place to monitor and improve service delivery. Some of these audits were effective at driving improvements to the service, however, others did not ensure satisfactory actions were taken. Some key areas of the service were not audited or reviewed.
The registered manager had recently started using satisfaction surveys to obtain feedback from people using the service, however, this system was not yet embedded.
The provider did not always act on feedback about the service from stakeholders such as the local clinical commissioning group and local council.
This is the second consecutive time the service has been rated requires improvement. You can see what action we told the provider to take at the back of the full version of the report.