Esther Care Home

Esther Care Home is a residential and respite service that provides personal care and accommodation for adults with learning disabilities. At the time of inspection, the provider had created an additional room creating capacity for 12 people. However, the additional room was not being used and the service remained registered for a maximum of 11 people. When we inspected there were 11 people using the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. The service was a large home, bigger than most domestic style properties. This was larger than current best practice guidance. However, the building fitted into the residential area and the other large domestic homes of a similar size. There were no identifying signs, intercom, cameras, or anything else outside to indicate it was a care home. Staff did not wear anything that suggested they were care staff when coming and going with people.

Our inspection focused on the two questions of safe and well led. We did not look at the key questions of effective, caring and responsive. We considered the conditions in place on the day of our inspection with 11 people using the service and this report reflects our findings.

Right Support

Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. For example, staff were aware of people’s healthcare needs and associated risks so they supported people to take part in activities in a safe way.

The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. Staff supported people with their medicines to achieve the best possible health outcome.

Right Care

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

Right Culture

Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Esther Care Home is a privately operated residential and respite service that provides personal care and accommodation for up to 11 adults with learning disabilities. At the time of the inspection there were 11 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission 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.

Although staff confirmed they received a comprehensive induction programme upon commencement of employment; and they were given competencies to complete and have signed off by senior staff, the service did not have clear records of this that were easily accessible. We shared our concerns with the administration manager who confirmed this was being addressed.

Care plans were not always easy to navigate as records were not always kept in one format. The service had an electronic care planning system in place since November 2016, however had not ensured all information was transferred. This meant it was difficult for staff to navigate and ensure they were delivering up to date care.

People were safe, staff had sufficient knowledge of the providers safeguarding policy and procedures to identify and report suspected abuse. Staff received on-going training in safeguarding and whistleblowing to keep people safe.

People were protected against identified risks. The service had robust risk management plans in place that gave staff clear guidance on how to keep people safe.

The service deployed sufficient numbers of staff to keep people safe. The service had systems and processes in place to ensure suitable staff were employed. Staff reflected on their working practices through supervisions and appraisals.

People’s medicines were managed in line with good practice. Staff were aware of the correct action to take in response to any errors and how to seek guidance on minimising the impact on people. The service carried out daily medicine audits to identify any errors.

Staff reflected on their working practices through supervisions and appraisals. Staff were supported to undergo regular training to effectively meet people’s needs. Staff told us they received sufficient training and could request additional training if required.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People confirmed their consent was sought prior to care being delivered.

People were encouraged to make healthy choices and had access to sufficient amounts of food and drink that met their dietary needs and requirements. The service supported people to access a wide range of healthcare services to ensure their health and well-being was maintained and monitored.

The service encouraged people to maintain relationships with people that were important to them. People were supported to make decisions about their care and had their decisions respected by staff.

Staff treated people with respect and encouraged their dignity. People confirmed staff respected their privacy. Staff understood the importance of maintaining people’s confidentiality and embracing people’s diversity and promoting their equality.

The service had developed comprehensive care plans in place that were person centred, reviewed regularly and where possible people were supported to develop their care plans.

People were supported and encouraged to participate in a wide range of in-house and community based activities. People told us they knew how to raise concerns and complaints.

The service carried out audits of the premises, care plans, medicines and other records to assess the quality of the service provision.

People were encouraged to give feedback on the service to drive improvements. Issues identified were then acted on in a timely manner and implemented into the care provided.

The registered manager actively sought partnership working with other healthcare professionals and their services, to enhance people’s lives.

We telephoned the registered manager on 2 February 2014 and discussed the appraisal system. The registered manager confirmed that formal, recorded appraisals were now being conducted. These were up to date for all staff members and monitored regularly. This was later confirmed by the registered manager in writing.

We used a number of different methods to help us understand the experiences of people using the service because most of the people who lived at this care home had complex needs, which meant they were not always able to communicate with us. The people who did speak with us all said that they were happy living at the home. We received positive responses from people about the staff who cared for them; one person told us "the staff are nice I can do what I want".

Through the use of Short Observational Framework for Inspections (SOFI) we were able to observe that people's experience of the service was a positive one. During our inspection we saw staff always treated people with respect and dignity and people were supported to make informed decisions about how they lived their lives. We also gathered evidence of people's experiences of the service by speaking to the registered manager and other staff who worked in the home and reviewing various records the provider is required to keep.

We saw staff were supported and supervision was undertaken by senior support workers. However we found there was no formal appraisal system in place for the provider/ registered manager to support staff, promote professional development and progress learning and development plans.

The people we spoke to said that they liked living there. We spoke to two relatives who praised the care provided by Esther Care Home. They felt people were safe, well cared for and their health and wellbeing had improved since they moved in. We saw that people were respected and their dignity was protected and the care and support provided seemed to be appropriate to their needs. The provider had good mechanisms for monitoring the quality of the environment and has recently introduced systems inviting feedback from people's representatives.

We noted that a lot of people required fairly high levels of staff attention and we had concerns about whether the staffing level was adequate to ensure people were safe and that their choices were respected. We also had concerns about the degree to which staff understood safeguarding policies and procedures. We have asked the provider to provide an action plan stating how they will address these two concerns.