Eagle House provides personal care and support to up to 40 older people some of whom are living with dementia. The service is centrally located in a town, close to local facilities. On the day the inspection took place, there were 24 people living in the service and one person was attending the service for day care.

The service had a registered manager in post. 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. Following the last focused inspection in January 2016, the registered provider took the decision to appoint the registered manager from another of their services locally, to manage Eagle House. An assistant manager and a new deputy manager provided support with the day-to-day administrative and management duties.

At the rated comprehensive inspection in September 2015, we found there were shortfalls with the staffing levels, environment, infection control and governance systems and there were breaches in regulations. We rated the service as ‘requires improvement’ in the effective, responsive and well-led domains, ‘good’ in the caring domain and ‘inadequate’ in the safe domain. We rated the service as ‘requires improvement’ overall. We then completed a focused inspection in January 2016 to review the safe domain and found the necessary improvements to the staffing levels and infection prevention and control systems had been made. Following the focused inspection in January 2016, the rating for the safe domain improved to ‘requires improvement’. We undertook this unannounced inspection on the 1 and 2 December 2016.

People and relatives spoke positively about the service and said it provided good quality care in a personalised and friendly way. We observed a positive and inclusive atmosphere within the home and people told us they felt safe living in the service. We saw staff interacting with people and they did so in a kind, caring and sensitive manner. Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people.

We saw there were enough skilled and experienced staff on duty to meet people’s needs. We found staff had been recruited using a robust system that made sure they were suitable to work with vulnerable people. They had received a structured induction and essential training at the beginning of their employment. This had been followed by regular refresher training to update their knowledge and skills.

We found staff ensured they gained consent from people prior to completing care tasks. The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People praised the food provided by the home and improvements had been made to the menus to offer more choice. Staff provided a person centred approach at mealtimes and people’s nutritional needs were met by the service.

People’s privacy and dignity were respected and staff provided people with explanations and information, so they could make choices about aspects of their lives. People and their relatives said staff were always kind and caring and treated them well. Staff demonstrated a good understanding of the people they were caring for. Information on people’s lives had been sought to help staff provide individualised care.

People’s healthcare needs were assessed and met by the service in conjunction with a team of health professionals. The care files we checked were individualised and reflected people’s needs and preferences in detail. Care plans and risk assessments had been reviewed and updated on a regular basis.

We found people received their medicines as prescribed. Medicines were obtained, stored, administered and recorded appropri

This inspection was completed as part of the national themed inspection programme looking at dementia care. We left comment cards at the home for a week but we did not receive any completed cards.

The manager told us that of the 31 people who used the service 19 had been diagnosed with dementia. We found there was a clear focus on dementia care in the home. The manager and staff were aware of good practice guidelines and these were incorporated into the care provided at the home. Sufficient and suitably trained staff were provided to ensure people with dementia received all the care and support they required.

A detailed assessment of people needs was completed prior to admission to the home and personalised care plans were developed using this information. This meant staff had all the information they required to provide individualised care for people with dementia. It also enabled staff to be able to recognise any changes in the persons presentation or behaviours.

The staff worked well with other agencies and were proactive in ensuring that people received all the care and support they required from the appropriate agency. People were supported if they required hospital admission and information was provided to hospital staff to assist them to care for the person with dementia.

The manager had good systems in place to monitor the quality of the care provided and to ensure that people who lived in the home had their views heard.

The environment had been developed in line with some of the best practice guidance for people with dementia. For example, For example, toilets were easily distinguishable as doors were painted a bright colour and signs had been used in picture format.

People we spoke with during our visit were very satisfied with the care and activities within the service. They told us “There are varied activities in the afternoon and I get visits from my family”, “I cannot fault the place at all, the care is very good and the staff are lovely” and “The laundry service is very good and staff ask me what I want to wear when they help me get dressed.”

We spoke with people about the food provided in the service and they told us, ‘It is very good, I have no complaints” and “The food is lovely, there is plenty of it and it tastes nice.”

People we spoke with said that they had good access to their GP’s, chiropody, dentist and optician services, and they were satisfied with the level of medical support given to them. People who used the service were satisfied with the care they received and said that they did not have to wait too long for staff to come when they needed assistance. Individuals told us “Staff are friendly, helpful and supportive.”

People we spoke with were confident of using the complaints system in place and satisfied that staff or the manager would take action to solve their problems.

People we spoke with were very positive about the care and support they received. They told us they liked living at the home and confirmed they were supported to make choices and decisions about the care they received. They told us they were assisted to be as independent as possible. Comments included “It’s excellent here,” “I couldn’t be anywhere better,” “I can choose what I want to do such as where to sit, and what time to go to bed,” and “The staff are lovely.”

People we spoke with were very positive about the care and support they received. They confirmed they were supported to make choices and decisions about the care they received. They told us they were assisted to be as independent as possible. Comments included “It’s nice here”, “It’s very pleasant, you get everything you want”, “It’s great, we get lovely food” and “They don’t rush us we can take our time”.

They told us they felt safe. Comments included “I feel safe enough”, “We all get on, I would tell the staff if I wasn’t”, “They are very good to us” and “I feel safe, you can go to any of the girls or the manager”.

They told us they liked the staff and described how key workers supported them. Comments included “They are always talking to us”, “They are OK, I can’t fault them”, “They are nice girls, we couldn’t get any better attention” and “There are always enough to help me”.

They told us they liked living at the home. Comments included “Its good in all ways, the staff are always there, they listen to us and improve things if necessary” and “They look after us great, you can’t find anywhere any better” .

Eagle House Care Home provides personal care and support to up to 40 older people some of whom are living with dementia. The service is centrally located in the town close to local facilities. On the day the follow up inspection took place, there were 23 people living in the service and two people using the day care service.

This inspection was unannounced and undertaken on 7, 8 and 25 January 2016. We had previously inspected the service in September 2015; it was rated as Requires Improvement overall but we issued three requirement notices for breaches in regulations for staffing, maintenance of the environment and governance. We also issued a warning notice for the breach in regulation for maintaining standards of hygiene (this was a continued breach as concerns were first identified at the inspection in January 2015). The acting manager sent an action plan in response to this inspection telling us what measures the registered provider was going to take in order to address the issues. The inspection visit was to check the improvement action taken in respect of staffing and standards of hygiene had been sustained, that staffing levels were sufficient to meet the needs of people who used the service and Eagle House was clean and fresh. The findings of this inspection have not changed the service’s overall rating; however it did improve the rating of the specific question ‘Is the service Safe?’ from ‘Inadequate’ to ‘Requires Improvement’.

The service is required to have a registered manager. 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. The registered manager was not present during our inspection. The deputy manager had been appointed to the role of acting manager in May 2015 and was present throughout the inspection.

We found improvements had been made to the standards of cleaning and hygiene throughout areas of the service and further improvements were made during the inspection. To support more effective hygiene practices in the service, we found new furniture, furnishings, bedding and flooring had been provided. A new quality audit tool and more comprehensive cleaning schedules and systems of daily checks had been put in place which helped the acting manager to monitor the standards of hygiene in the service and identify any shortfalls.

The care staffing levels were further reviewed and increased during our inspection and we found there were sufficient staff on each shift to meet people’s individual needs and support them safely. New dependency assessments had been introduced and the information was used to inform the staffing calculations. One person was now provided with one-to-one support. The domestic hours had been increased and new care, domestic and laundry staff had been recruited. Two new senior care staff had been appointed and 16 (supernumerary) hours were provided to senior care staff to assist the acting manager with her role. The acting manager confirmed they were in the process of recruiting a new activity co-ordinator to facilitate the activity programme.

We are keeping these areas under review and monitoring them to make sure the improvements are consistent over time.