The inspection took place on 14 November 2016. Eglantine Villa Care Home provides care and accommodation for up to 51 older people in two adjoining buildings. Jasmine Lodge provides residential and nursing care and Lavender Cottage provides residential care. There were 41 people living in the service at the time of our inspection, some of whom lived with dementia.

When we last inspected in April 2014, we identified a breach in regulation 20 HSCA 2008 (Regulated Activities) Regulations 2010, because accurate and appropriate records were not consistently maintained. We had requested the provider to take action. At this inspection, we found that improvements had been carried out.

There was a manager in post who was registered with the Care Quality Commission (CQC). 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.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow and to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff knew each person well and understood how to meet their support and communication needs. They communicated effectively with people and treated them with utmost kindness and respect. Staff received essential training, additional training relevant to people’s individual needs, and regular one to one supervision sessions.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them. People’s mental capacity was assessed when necessary about particular decisions. When applicable, meetings were held to make decisions in people’s best interest, as per the requirements of the Mental Capacity Act 2005.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People told us they enjoyed the food and their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.

People’s individual assessments and care plans were person-centred, reviewed monthly or when their needs changed. Clear information about the service, the facilities, and how to complain was provided to people and visitors. People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People or their legal representatives were actively involved with the review of people’s care plans. People’s care was personalised to reflect their wishes and what was important to them and staff paid particular attention to their emotional wellbeing, their preferences and specific requirements. The delivery of care was in line with people’s care plans and risk assessments.

There was a wide range of person-centred activities that were inclusive, flexible and suitable for people who lived with

The inspection was conducted by one inspector. The home is divided into two separate units. We focussed our inspection on the Lavender unit in order to follow up areas where we had found areas of non-compliance at our visit on 29 October 2013. The provider sent us an action plan following that visit outlining improvements they had made. During our visit we found that the shortfalls we had found had largely been addressed.

During this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

People who lived in on the Lavender unit were experiencing dementia. This meant they were not always able to tell us about their experiences. The report is based on our observations during the inspection, talking with people who used the service, and the staff supporting them, and looking at records.

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect and dignity by the staff.

There were systems in place to make sure that the manager and staff learned from events such as accidents and incidents and the risks associated with the environment. Risks to people’s health and welfare were identified or managed to ensure people were protected from risk of harm.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. There were personal emergency evacuation plans for staff to follow in the event of a fire.

We looked at staff rotas and found they take people’s care needs into account when making decisions about the numbers of staff on duty, their qualifications, skills and experience. This helps to ensure that people’s needs are always met.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved as far as possible in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans. However, people’s individual care records were not always accurate or up to date.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to maintaining accurate, up to date and person centred care plans.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We saw that people were comfortable with the staff who were working with them.

Staff knew people well and were able to describe people’s preferences, interests and diverse needs. This meant that care and support was provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities regularly. An activities coordinator provided a programme of activities for people to choose from. The home had access to an adapted minibus, which meant that people were able to take part in outings.

Staff responded quickly when people needed support or reassurance.

Is the service well-led?

The service had an effective quality assurance system, records seen by us showed that identified shortfalls were addressed promptly.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

People’s needs were assessed, but care and treatment was not always planned and delivered in line with their individual care plan to protect people’s welfare.

We talked with people who used the service or their relatives about what they had experienced. One said “Staff are so very helpful, this is an excellent home” another said “I am impressed with the home, the staff are helpful and they have a good attitude”. People told us that they felt the home provided safe care.

We found that people who used the service were not always protected from the risks of inadequate nutrition and dehydration. We found that the registered person could not provide evidence that they were meeting people’s assessed needs around eating and drinking. There were records in people’s care plans called lifestyle profiles; these provided information about peoples likes and dislikes around eating and drinking that supported hydration and nutrition. We noted that the corresponding information was not being recorded in people’s food diaries.

We found that the registered person was not always ensuring there were sufficient numbers of staff available to support the effective delivery of the service.

We found that the prescriptive staff routine did not promote a caring and needs led culture.

We saw from the staff records that staff were receiving supervision and that there was a supervision schedule. We saw that the manager of the home kept records of staff training and we noted that recent staff training had included but was not limited to administration of medication, nutrition and hydration, first aid and fire training. This meant that staff were being supported to update and develop their skills.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

We saw a copy of the complaints procedure and that complaints were monitored under the governance structure of the BUPA Group. Staff told us that they were aware of the complaints procedure. This meant that the provider had an overview of complaints about the service and how they were resolved.

We found that records were not always accurate which did not protect service users from inappropriate care or treatment.

There were 46 people living there on the day we visited. We spoke with five people living there, four relatives that visited, five members of staff, the manager and regional manager. Due to their needs, some people were unable to communicate verbally with us their experiences of living there. So, we spent time observing how staff supported and interacted with people during the day.

The people living there could make choices about their lives. We observed people making choices about what ate and drank, what they did and where they spent their time. Two relatives spoken with told us that their relative had chosen to live at the home because they thought it was homely.

We saw that people were encouraged to do things for themselves so promoting their independence skills and self esteem.

We saw that people were supported to have regular health checks to ensure their well being. Other professionals were involved in people’s care and staff followed their advice to help to meet people’s needs.

Systems were in place to ensure that people were safeguarded from harm. We saw that people were comfortable in the company of staff. One relative said, “The staff put care into caring here.”

We saw that more staff had been recruited to work there which meant that people were supported to meet their needs.

People were asked for their views about the home and these were listened to. Audits were completed and action taken where needed to make improvements.

We talked with eight people living in the home during the visit, and met others briefly. Some of the conversations were not meaningful due to people having dementia; and some people had limited communication due to medical conditions. We received the following comments:

“I am looked after really well.”

“I cannot remember how long I have been here, but it is all okay.”

“The staff look after us well, and come if I call them.”

“I am quite happy here.”

We spoke with three relatives, and one said “I cannot speak too highly of the staff; they look after my mother wonderfully, and have also supported me through the process of having her in a care home.”