This was an unannounced comprehensive inspection, to make sure the service was providing care that is safe, caring, effective, responsive to people's needs, and well-led.

Eleanor Palmer Trust Home, also known as Cantelowes House, is a ‘care home’. The accommodation is purpose-built with passenger lift access to the first floor. People living in this care home receive accommodation along with nursing and 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 had a registered manager, which 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 service is registered to provide accommodation for up to 33 people. There were 28 people using the service at the start of this inspection. The service specialises in the care of adults including those with dementia. It is operated by The Eleanor Palmer Trust, a voluntary organisation.

The service’s registration was altered to allow nursing care in the Spring of 2018. However, the registered manager informed us that nursing care had not been provided in practice so far, and would not start until they were confident that aspect of the service could be successfully maintained.

At our last inspection of this service in September 2017, we found one breach of legal requirements. These was in respect of duty of candour following serious injuries to people using the service. The provider completed an action plan to show what they would do and by when, to address this breach and so improve the rating of the service to at least ‘Good.’ At this inspection, we found the necessary improvements had been made to addresses the previous regulatory breach. This has helped to improve the service’s overall rating to ‘Good.’

However, the rating for ‘Is it Safe?’ remains ‘Requires Improvement.’ This is because we identified some concerns about upholding infection control and health and safety standards. The lounge carpet was significantly stained, and the kitchenette near the lounge and some equipment used by people had signs of wear and tear. This compromised infection control standards. We also found one person being hoisted in a sling that was not the most appropriate for their needs. The service had not undertaken effective audits in these areas to identify and address these shortfalls. The registered manager sent us information during and after the inspection visits to show these matters were being addressed.

We have recommended the provider review and implement best practice guidance on infection control in care and nursing homes.

People using the service spoke positively about it, describing it as “wonderful” and “the best care home in the world” for example. Everyone said they would recommend it to friends and family. People’s relatives and representatives provided similarly positive feedback.

There was a comfortable and engaging atmosphere at the service. Staff spoke in a positive manner about different people using the service, and had time for them. People were treated with kindness, respect and compassion, and were given emotional support when needed, sometimes from other people using the service.

The service provided people with a range of mental and physical stimulation. People were supported to develop and maintain relationships that mattered to them, and there were no restrictions on visitors.

People were supported have access to healthcare services and receive ongoing healthcare and nutritional support. This included through the proper and safe use of medicines.

The service enabled people to receive personalised care that was responsive to their needs. This was based on comprehensive initial

At our last inspection of this service, on 1 July 2017, we found three breaches of legal requirements. These were in respect of safe care and treatment, person-centred care, and good governance. The service was placed in ‘Special Measures’ and we undertook further enforcement action because of the potential impact on people using the service. The provider sent us an action plan in respect of the three breaches. We undertook this inspection to check that the action plan had addressed the breaches. This was also a comprehensive inspection, to make sure the service was providing care that is safe, caring, effective, responsive to people's needs and well-led.

Eleanor Palmer Trust Home, also known as ‘Cantelowes House’, is a care home that is registered to provide accommodation and personal care for up to 33 people and specialises in dementia care. The home is run by The Eleanor Palmer Trust, a voluntary organisation. There were 20 people using the service at the time of this inspection. This was because, following our December 2016 inspection, the provider had made a decision to temporarily stop admissions into the service until care delivery concerns were addressed.

The service had a registered manager, 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.

We found significant improvements in people’s care and service quality at this inspection. This matched the overall feedback we received from people and their relatives, most of whom praised the capability and approach of staff and the effectiveness of the management team.

Risks to people were appropriately managed so as to keep them safe. This included for pressure care management, unexplained bruising, and for falls. People were supported to move around safely.

Everyone was supported to gain health professional input when needed. The service paid good attention to people’s health, nutrition and hydration needs. People were supported to have regular baths and showers. People’s medicines were properly managed so that they received them safely and as prescribed.

Feedback and our observations showed people were treated in a kind, friendly and respectful manner. Attention was paid to supporting people with their appearance. Choice and independence was promoted.

There were enough suitable staff to keep people safe and meet their individual needs. Whilst there was some reliance on staff from a specific care agency, many of these staff had worked at the service for a while. Staff at the service knew people’s individual needs and preferences, and treated them well.

The service had worked hard at setting up extensive care plans that encompassed a range of individualised needs and preferences and guided staff on providing responsive care. Feedback and our observations showed people received individualised care.

Staff reported an open and empowering culture, good teamwork, and an approachable management team. There were improved standards of record-keeping, which helped document people’s care and helped communicate key information to incoming staff. There were also audits of care quality and risk management, to help ensure good quality care was being delivered.

However, the service required improvement in a few areas. There was an inconsistent approach to documenting health and safety checks and ensuring actions took place as a result of a professional fire safety risk assessment.

Duty of Candour requirements had not been formalised and documented in respect of two incidents of people being admitted to hospital with injuries. Whilst there was no suggestion these injuries were avoidable, this did not demonstrate an open culture of learning from incidents so as to minimise the risk of reoccurrence.

The service was a

We last inspected this service on 1 June 2017 when we found improvements in the safety of the service and how well-led it was. After that inspection we received information of concern about people using the service experiencing unexplained bruising and injuries, unsafe moving and handling support, infrequent personal care, and health concerns that were not being reported to community healthcare professionals. We were also told people’s monitoring charts such as for fluid intake were being filled out late, and there were some fire safety concerns. As a result we undertook this unannounced focused inspection of Saturday 1 July 2017 to look into these concerns. This report covers our findings in relation to these matters and any other concerns we identified. You can read the reports from our previous inspections by selecting the 'all reports' link for Eleanor Palmer Trust Home on our website at www.cqc.org.uk.

Eleanor Palmer Trust Home, also known as ‘Cantelowes House,’ is a care home that is registered to provide accommodation and personal care for up to 33 people and specialises in dementia care. The home is run by The Eleanor Palmer Trust, a voluntary organisation. There were 20 people using the service at the time of this inspection. This was because, following our December 2016 inspection, the provider had made a decision to temporarily stop admissions into the service until care delivery concerns were addressed.

After the last inspection, the provider paid a Fixed Penalty Notice we served on them in respect of failing, without reasonable excuse, to comply with a condition of their registration about having a registered manager at the service since May 2016. 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. A new manager had been appointed in February 2017 and was registered in that role shortly after this inspection.

At this inspection, we found that a number of the concerns raised with us were valid. There were cases of unexplained bruising and injuries which the manager told us they were not aware of. Referrals were made to the local authority’s safeguarding team as a result.

We found the manager had not reviewed and signed off some incident forms, nor were they aware of some other safety matters relating to people using the service that had not been recorded as incidents. Risks relating to these matters had not therefore been properly assessed and addressed.

We found people were not being supported to have baths or showers regularly. This put people at unnecessary risk of developing health concerns. One person’s hearing aid was not working properly but staff had not identified this. Another person’s repositioning records, in support of helping pressure ulcers to heal, were not consistently written at night and were not occurring during the day. People’s care was not therefore sufficiently meeting their needs or reflecting their preferences.

The service was liaising well with community healthcare professionals for some matters, for example, where concerning weight loss had been identified or if someone was showing symptoms of an infection. However, monitoring systems were not working where people were experiencing constipation, as contact with healthcare professionals was not occurring in a timely manner when needed. The process took four extra days for one person, who ultimately needed an enema which may have been avoidable if the service had identified and addressed the welfare risk faster. People were not experiencing safe care and treatment as a result of this.

We found that medicines were not safely managed on a consistent basis. One person missed four days of a prescribed twice-daily medicine due to insufficient stock bein

We carried out an unannounced comprehensive inspection of this service on 29 November and 13 December 2016. Breaches of legal requirements were found. We rated the service as Inadequate, placed it in ‘Special Measures,’ and served three enforcement Warning Notices on the provider because of the potential impact on people using the service. These were in respect of safe care and treatment, meeting nutrition and hydration needs, and good governance.

We undertook a focused inspection on 7 March 2017 to check that the Warning Notices had been addressed. We found this had not occurred in respect of safe care and treatment, and good governance. Additionally, we identified a further breach of legislation regarding staffing levels. The service remained in ‘Special Measures’ and we undertook further enforcement action. The provider sent us an action plan in respect of the three breaches.

We undertook this focused inspection, of 1 June 2017, to check that the provider had followed their plan and to confirm that they now met the legal requirements relating to the three breaches. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Eleanor Palmer Trust Home on our website at www.cqc.org.uk .

Eleanor Palmer Trust Home, also known as ‘Cantelowes House,’ is a care home that is registered to provide accommodation and personal care for up to 33 people and specialises in dementia care. The home is run by The Eleanor Palmer Trust, a voluntary organisation. There were 21 people using the service at the time of this inspection. This was because, following our December 2016 inspection, the provider had made a decision to temporarily stop admissions into the service until care delivery concerns were addressed.

There had been no registered manager in post since May 2016. 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. A new manager had been appointed in February 2017 and had applied for registration as manager of the service.

At this inspection, we found that breaches of legislation identified from our last inspection had been addressed. There were now enough staff deployed to work at the service. This helped keep people safe and enabled their needs to be met. There was better interaction with people, and greater activity provision. People were hoisted safely. There was now documented guidance on when to offer people their as-needed medicines, in support of these being provided when needed. The lounge was also kept at an appropriate temperature.

People were receiving good support with their nutrition and hydration needs. We generally found that healthcare professional advice was being acted on, to support the health and welfare of those the advice related to. Staff were being supported to uphold appropriate skills to help ensure effective care.

There were improved governance systems in place including new auditing processes and refinements of other processes, which helped identify and address service risks. The effectiveness of the management of the service was evident through improvements to the overall care provided to people.

There were some areas requiring further improvement. Records of the care provided to people were more accurate and complete. However, there was insufficient consistency of records in support of effective care evaluation. Systems of individual risk assessing and care planning were improved, but the process had not yet been completed for everyone using the service. We also found that a sensor mat was not in one person’s room to help prevent night-time falls, despite this being part of their care plan.

Due t

We carried out an unannounced comprehensive inspection of this service on 29 November and 13 December 2016. Breaches of legal requirements were found. We rated the service as Inadequate, placed it in ‘Special Measures,’ and served three enforcement warning notices on the provider because of the potential impact on people using the service. These were in respect of safe care and treatment, meeting nutritional and hydration needs, and good governance. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection of 7 March 2017 to check that the provider had followed their plan and to confirm that they now met the legal requirements relating to the warning notices. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Eleanor Palmer Trust Home on our website at www.cqc.org.uk .

Eleanor Palmer Trust Home, also known as ‘Cantelowes House,’ is a care home that is registered to provide accommodation and personal care for up to 33 people and specialises in dementia care. The home is run by The Eleanor Palmer Trust, a voluntary organisation. There were 22 people using the service at the time of this inspection. This was because, following our last inspection, the provider had made a decision to temporarily stop admissions into the service until care delivery concerns were addressed.

There had been no registered manager in post since May 2016. 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 manager at our last inspection, who had been in post from April 2016, left the service at the start of February 2017. A new manager had been appointed shortly afterwards and was in post for a month at the time of this inspection.

At this inspection, we found that the provider had followed their plan to address our previous concerns relating to meeting nutritional and hydration needs. However, they remained in breach of legal requirements relating to safe care and treatment, and to good governance, despite some evidence of addressing matters relating to our Warning Notices. We also found an additional breach of legal requirements relating to staffing levels.

Individual risk assessments were not kept consistently up-to-date so as to help keep people safe. This included for one person who was being hoisted, where their moving and handling risk assessment stated they were independent. Despite two recent falls, their falls risk assessment had not been reviewed and updated.

Another person had recently left the premises unsupervised, contrary to their care plan. However, this incident had not been reviewed, to minimise the risk of reoccurrence.

One person was sometimes aggressive to staff. However, there was no care plan in place about this, to help keep them and staff safe. Incidents were not consistently recorded and were not kept under review.

One person experienced pain whilst being hoisted. There was no care plan to manage this, or guidance for their as-needed pain management medicine. There were no guidelines in place for anyone’s as-needed medicines.

One person had a care plan in place to help manage their risk of falling, as they experienced frequent falls. However, their care records and our observations did not show that the plan was being followed.

There were not enough staff deployed to work at the service, as staffing levels had been cut without checking that people’s needs could still be safely met. Consequently, at lunch we saw some people waiting in the dining room for over half an hour to receive thei

This was an unannounced inspection that took place on 29 November and 13 December 2016. Eleanor Palmer Trust Home, also known as ‘Cantelowes House’, is a care home that is registered to provide accommodation and personal care for up to 33 people and specialises in dementia care. The home is run by The Eleanor Palmer Trust, a voluntary organisation. There were 28 people using the service at the time of this inspection.

The inspection was prompted in part by four people raising recent concerns with us, and notifications of two incidents where people using the service fell, following which one person died and the other sustained a serious injury. These incidents may be subject to criminal investigations and as a result this inspection did not examine the circumstances of the incidents. However, the information shared with CQC about the incidents indicated potential concerns about the management of risk of falls. This inspection examined those risks.

At the last inspection on 23 February 2016, we asked the provider to take action to make improvements, to ensure staff received sufficiently regular supervision and appraisal, and training in a format that supported them to meet people's needs effectively. The provider subsequently wrote to us to say what they would do in relation to this breach of legal requirements.

There had been no registered manager in post since May 2016. 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. A new manager had been appointed shortly after our last inspection, whom we met during this inspection. They had not started the process of applying to be the registered manager.

Most people using the service provided good feedback about it. They felt the service was safe, that staff were caring, and that there was good food and drink. There were mixed views on whether there were enough staff.

However, we found some significant concerns about how the service was operated that particularly undermined people’s ongoing safety and welfare.

We found that prescribed medicines were not safely managed. At both visits medicines had not been given to people without reasonable explanation. This included medicines left in the monitored dosage packaging, for which there was no improvement by the time of our second visit despite us informing the manager of our concerns at our first visit.

One person was having a phased change of anti-psychotic medicines following psychiatrist advice. At our first visit, we found that the phased approach had not occurred as planned, and that the new medicine had run out the day beforehand with no plans to acquire more of the medicine. Despite the manager being informed of this, at our second visit, the medicine remained out of stock with no reasonable explanation, meaning the person had gone over two weeks without the prescribed medicine. Care and treatment was not provided to this person in a safe way.

Where people were experiencing falls, there were not often documented reviews of their falls risk assessments and adjustments to their care plans so as to minimise the risk of reoccurrence. One person had a fall during our first visit. At our second visit, we found there was no updated falls risk assessment in place for them since February 2016, despite this fall and another three months earlier that resulted in a check at a hospital due to a swollen eye.

The service did not have consistent systems for keeping people’s individual risk assessments and care plans up-to-date. One person was assessed under their old care plan in February 2016 as being at risk of absconding. This was not transferred over to their new care plan. A recent incident of them being found outside the building had not resulted in

This inspection took place on 23 February 2016 and was unannounced. Eleanor Palmer Trust Home is a care home that is registered to provide accommodation and personal care for up to 32 people. The home is run by The Eleanor Palmer Trust, a voluntary organisation. There were 30 people living in the home at the time of this inspection.

The home did not have a registered manager as the previous registered manager was no longer working at the home. 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. There was an acting manager in place who advised that recruitment was being undertaken to appoint a new manager to register with the Commission.

At the previous inspection in July 2014, the home was not found to be sufficiently clean. We found that the home was clean and there was a deep cleaning programme in place during the current visit. The home was also in a good state of repair, and equipment was maintained appropriately.

There had been an increase in staffing numbers since the previous inspection. Safe systems were in place for recruiting staff. However staff had not receive sufficiently regular supervision meetings and training was not always provided in a format that they found useful, within the last year. A variety of activities were available to people, however no activities were available to people in the afternoons.

People told us that their care needs were met, and their views were taken into account. They were provided with their medicines safely. People who were unable to consent to care had best interest decisions recorded for them, and deprivation of liberty safeguards were in place for people who required this.

Detailed care records were in place regarding people’s care however this was not always easy to access due to the formats for recording. Accident and incident records did not include a section for learning from what had happened, and improvements were needed in the recording of bruising and skin marks for people living at the home.

Staff showed a good knowledge of people’s life histories and preferences regarding their care and support needs. They were clear about the procedures for reporting abuse and felt that management listened to their views.

People were provided with a choice of food at meal times, and were supported to eat when this was needed. They spoke positively about the food provision in the home. People’s health needs were met, and they were supported to consult with health and social care professionals as needed without delay. They had the opportunity to be involved in decisions about their care and how they spent their time at the home. They and their relatives attended meetings or spoke directly to a manager to raise any issues of concern.

The provider had systems for monitoring the quality of the service and engaged with people and their relatives to address any concerns. When people made complaints they were addressed appropriately.

At this inspection there was one breach of regulations, in relation to staff supervision and training. You can see what action we told the provider to take at the back of the full version of the report.

We followed up on compliance actions made at the previous inspection regarding care and welfare of people who use services, and requirements relating to workers, and observed issues relating to cleanliness and infection control during the course of the current inspection. We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

This inspection was carried out on a Sunday. There were thirty-one people living at the home at the time of the inspection. We spoke with eight people living at the home and six people visiting people at the home.

Is the service safe?

People told us that they felt safe within the home, with appropriate staff support. They told us “I’m alright,” and “Everything’s alright.” It was a hot day on the day of our visit, and we saw staff offering people drinks on a regular basis.

At the previous inspection a compliance action was made regarding the home’s recruitment procedures. During the current visit we found that recruitment systems were sufficiently rigorous to ensure that new staff were of good character for the protection of people living at the home.

Is the service effective?

People living at the home and their relatives told us that staff were competent at meeting their individual needs effectively. Comments included “Staff are always around,” and “They look after me at night.” Staff said that they received appropriate support to enable them to deliver care to people to an appropriate standard. People were supported to undertake some activities within the home and join in social groups outside of the home. They were satisfied with the food provided to them.

However during our visit we found that some areas of the home were not sufficiently clean. These included the carpets in some bedrooms and communal areas and the dining room chairs. We received mixed comments from people about the home’s cleanliness, with some praising the standards, whilst others were concerned about particular issues. There were no cleaning schedules or checklists available, and no infection control audits had been undertaken. We were told that there were some domestic staff shortages due to sickness and annual leave. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to providing effective infection control within the home.

Is the service caring?

People were very satisfied with the way they were cared for at the home. They told us “The staff are lovely, I’m generally very happy here,” “I find it very nice,” “Everything’s done for you,” “If you are worried about something, talk to someone and they put it right,” and “They can’t do enough for me.”

Is the service responsive?

At the previous inspection a compliance action was made regarding insufficiently rigorous assessment of people’s needs, and planning and delivery of care to meet them. During the current visit we found that there were improvements in recording of repositioning charts for people when required to protect them from pressure sores. There were also improvements in recording people’s weights on a regular basis, and updating their nutritional assessments. Records of people at risk of falls now included updates following falls to prompt further actions to address risks.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities. Staff we spoke with showed that they understood the needs of individual people they cared for. People living at the home had confidence in the home’s management. They told us “No complaints,” “The manager is very good,” and “If you have a complaint its dealt with in two to three days.”

We spoke with nine people who use the service and a relative. They indicated that people had been treated with respect and dignity. Their views can be summarised by the following comment, “staff are very kind, you get a choice of food, I wouldn’t want to move.”

People told us that their care needs had been attended to and they were well cared for. Assessments, including risk assessments had been carried out. Care plans had been prepared and these were reviewed regularly. The home had a varied programme of social and therapeutic activities. We noted that there was a high incidence of falls in the home. However, action was being taken to reduce falls.

There were suitable arrangements in place to manage medicines. The medication records examined indicated that people had been given their medication as prescribed.

People spoke well of staff and indicated that staff were capable. Staff had been provided with essential training and support. We noted that there were some shortcomings in the way a recent safeguarding incident was handled. However, action had been taken to ensure that future safeguarding incidents would be handled more effectively.

People who use the service were satisfied with the care provided and they indicated that their care needs had been attended to. They also informed us that they had been consulted and staff had discussed their care with them. They felt safe in the home and they were also happy with their accommodation and the facilities provided.

They spoke positively of staff and stated that staff had treated them with respect and dignity. Their views can be summarised by the following comments:

“I am satisfied with the care. Staff are very, very good.”

“To all the staff. Thank you from the bottom of my heart for all the help, kindness and understanding you’ve shown my relative and I, we are both very grateful." (relative)

“I think this is a lovely home. My relative always looks clean and tidy.” (relative)

We observed that staff were constantly supervising and assisting people who use the service. They were also observed to be offering drinks to people who use the service.

We were able to speak to relatives in the home. The feedback received was positive and indicated that people who use the service were well cared for and their needs had been met. They also informed us that they had opportunity to express their views

and consumer surveys had been organised by the home.

We spoke with eight people who use the service and four visitors. People praised the service and the care provided. Comments included, “I find it excellent”, "a lovely atmosphere" and “it’s a life of luxury here.” Everyone talked positively about the staff. “The staff here are lovely,” one person said.

People told us there were different activities provided every day. Comments included, “you can’t get bored here.” We found that people were treated with respect and dignity, and were supported in promoting their independence.

There was positive feedback about how the service worked with healthcare professionals. We found that the provider worked in co-operation with others to help meet people’s individual needs.

People informed us that staff and the manager were approachable. Comments included, “they always listen.” We found there were systems to assess and monitor quality at the service, and to address people’s comments and complaints.

However, we found that systems of planning and delivering care in respect of weight and nutrition, falls, and pressure care management, were not always meeting people’s individual needs and ensuring their welfare and safety.

We also found that recruitment procedures did not establish the good character of applicants before they began employment. Some newer staff were employed before any aspect of a Disclosure and Barring Service check had been acquired. This put people using the service at unnecessary risk.