We inspected the service on 29 November 2018. The inspection was unannounced. Eaves Hall Rest Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. The service accommodates up to 15 people.

On the day of our inspection 14 people were using the service.

At our last inspection on 27 July and 1 August 2016. We rated the service as 'good.' At this inspection we found the evidence continued to support the rating of 'good' overall. Although we did find areas of practice that required improvement in order to maintain a safe service, there was no evidence or information from our inspection and ongoing monitoring which demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People did not always receive a safe service. We found that there were no hand sanitizers in place on entering the home to reduce the risk of infection. We also found that hand towels and swing bins were in use in some bathrooms and toilets, instead of paper towels and pedal bins. This meant that there was the potential for viruses to spread. We raised this issue during inspection and immediate action was taken. Risks to people’s individual safety were assessed but information around people’s specific health conditions was not always documented. Although we were told fire drills were taking place, there were no formal records to evidence this. Discussion took place with the registered manager who assured us they would document these and arranged an external fire safety check to take place.

Staff knew how to keep people safe and reduce the risks of harm from occurring. Staff had completed training in safeguarding vulnerable adults and understood their responsibilities to report any concerns. There were enough staff to meet people's needs and safe staff recruitment processes were used, to further reduce risks to people. Staff supported people to have the medicines they needed to remain well. The administration of people's medicines was checked, so the registered manager could be assured people received these safely. However no formal medication competency assessments were completed for staff. This was discussed with the registered manager who assured us that these would be completed.

People continued to receive an effective service. Some staff training was outdated and we found one isolated incidence where a staff member had not received moving and handling training. This was addressed promptly and the training was booked during the inspection. People were supported to have enough to eat and drink, based on their preferences. Staff had developed good systems for working with other health and social care professionals, so people's health needs would be met promptly. People were 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. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were compassionate and caring and people were treated with dignity and respect. Staff understood people's preferences and knew what mattered to the people they cared for. People were encouraged to be as independent as possible, with support from staff. There was a welcoming and homely atmosphere at the service.

People continued to receive a responsive service. People's needs were considered before they came to live at Eaves Hall Rest Home, and care plans were developed to meet their needs. People's relatives and other health and social care professionals had been consulted about planned care. People had told us they had opportunities to engage in some activities.

Systems were in

This inspection took place on the 27 July and 1 August 2016 and the first day was unannounced.

Eaves Hall Care Home is registered to provide personal care and accommodation for 15 people. The home is a large Victorian style property set in it’s own grounds in a rural area near to the town of Burnley. Accommodation is provided in 9 single and 2 shared rooms. There are two lounge/dining rooms, adapted bathing facilities, and a stair lift. There is a large well maintained garden area to the rear of the property and parking facilities to the front.

The registration requirements for the provider stated the home should have a registered manager in place. There was a registered manager in post on the day of our inspection. 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.

At the last inspection on 15 April 2014 we found the service was meeting the regulations which were applicable at the time. During this inspection we found the service was meeting the current regulations.

At the time of the inspection there were 11 people living at the home

People using the service told us they felt safe and well cared for. They expressed a high level of satisfaction with the service provided and of the staff that supported them. They considered there were enough staff to support them when they needed any help.

The registered manager followed a robust recruitment procedure to ensure all new staff were suitable to work with vulnerable people.

The staff we spoke with knew how to recognise signs of abuse and were clear about their duty of care to report any concern they may have. They had been trained in safeguarding people and had policies and procedures regarding this for reference.

Arrangements were in place to make sure staff were trained and supervised at all times.

Medicines were managed safely and people had their medicines when they needed them. Staff administering medicines had been trained to do this safely.

Risks to people’s health and safety had been identified, assessed and managed safely.

We found the premises to be clean and hygienic and appropriately maintained. Regular health and safety checks were completed on the environment and on equipment used within the service. Fire safety was managed well and people had a personal evacuation plan staff were familiar with.

Staff felt confident in their roles because they were well trained and very well supported by the registered manager. All carers had a Level 2 or above NVQ (National Vocational Qualification) in care. People using the service had confidence in the skill and knowledge of staff who cared for them. Staff were highly motivated and expressed their committment to provide a high quality of care.

Staff understood the importance of gaining consent from people and the principles of best interest decisions. Routine choices such as preferred daily routines and level of support from staff for personal care was acknowledged and respected.

The home provided a well maintained very pleasant and homely environment for people who had created their own “home from home” with their personal possessions they had brought with them. People told us they were very satisfied with the accommodation and facilities provided.

People were provided with a nutritionally balanced diet that provided them with sufficient food and drink that catered for their dietary needs. Fresh produce was used and meals were homemade. People told us they enjoyed their meals.

People’s care and support was kept under review, and people were given additional support when they required this. Referrals had been made to the relevant health and social care professionals for advice and support when people’s needs changed.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found-

Is the service safe?

Staff had the necessary employment checks to ensure they were suitable to work with vulnerable people. People’s care needs were assessed and risks were identified. We monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, there were policies and procedures in place to make an application. We found evidence that relevant staff have been trained to understand when an application should be made and how to submit one. Assessments had been completed on people’s ability to make decisions about their care needs.

Arrangements were in place to monitor the quality or safety of the service.

Is the service effective?

People told us they were happy with the care that they received and that their needs were met by staff. It was clear from our observations and from speaking with staff that they understood the needs of people using the service. One person told us. “Staff are good they talk to me about what help I need.”

People’s health and care needs were assessed with them, their family members and with health and social care professionals.

Is the service caring?

People using the service were supported by kind and attentive staff. We observed staff showing patience and taking time to talk to people when they provided support. People told us they could choose how they spent their day. People’s preferences and needs were recorded and their care was provided in line with their wishes. We spoke with one person who told us staff supported them when they needed it and were kind and helpful. “I like the staff, they are promptly there when I need help.”

Is the service responsive?

People had their needs assessed before moving to the service. Support plans were put in place to show how people wanted to receive their support. A visitor told us. "The staff do care about each individual. The care is provided in a thoughtful and dignified manner."

People participated in a range of activities to meet their needs. We found the manager had responded to suggestions made within the residents' meetings and incorporated new ideas to meet the individual choices of the service users.

Is the service well-led?

The registered manager undertook regular audits to continually improve the service. The records we looked at showed any shortfalls were addressed promptly. We found equipment was regularly serviced therefore not putting people at unnecessary risk.

We spoke with three people living in the home who told us they were happy with the care and support they received. Comments included, “It's a lovely place; I'm very comfortable", "I can do what I want to do and can get help if I need to" and “I'm very well looked after; they are lovely girls”.

A range of activities were available. People told us they were able to participate in one to one or group activities that met their diverse needs.

People told us they enjoyed the food. Comments included, "The food is very good; I've really enjoyed my meals since coming here homemade and tasty", "We get plenty to drink through the day with cakes and biscuits" and "I like the food; I can choose what I want".

We saw that staff interactions with people were inclusive and appropriate and people's individual wishes were respected. Throughout our visit staff worked hard to promote people's independence and maintain their dignity.

People told us they were satisfied with the quality of care and support they received. We were told the staffing levels were sufficient to meet the needs of people living in the home and that the staff were professional, caring and friendly.

People made various positive comments about the staff team, saying they thought they "were excellent staff", "very caring" and "the staff are always considerate even when they are really busy".

People were provided with care plans which were reviewed regularly and updated when

required.

People said they felt safe living in the home and were able to discuss concerns or issues

with the staff if they wished to. We were told that the service provided enjoyable and varied activities for people.

There were comprehensive auditing and reviewing procedures in place to identify any

areas where improvements could be made.