Emsworth House 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 home provides accommodation and nursing care for up to 79 older people some of whom live with dementia. At the time of our inspection 73 people were living at the home.

The home comprises single room accommodation arranged in two separate sections of the home; the residential unit provides accommodation with personal care and the nursing unit provides accommodation with nursing care. Each unit is based over two floors with inter-connecting passenger lifts. Each unit also has a wide range of communal areas where people can spend time and socialise.

This inspection took place on 14 and 17 May 2018 and was unannounced. At our last inspection in February 2016 we did not identify any concerns and rated the service ‘Good’ overall.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

The provider had clear recruitment procedures in place, although some pre-employment checks were not completed for staff appointed during a recruitment event held earlier in the year.

People and their relatives had mixed views about the staffing levels, commenting that they sometimes had to wait for support. However, the registered manager was in the process of recruiting additional staff to cover busy periods.

There were appropriate arrangements in place for obtaining and administering medicines safely. However, risk assessments for some high risk medicines were not put in place until we brought this to the attention of the registered manager and some medicines were not stored safely.

Staff sought verbal consent before providing care or support and acted in people’s best interests, although they had not always recorded decisions they had taken on behalf of people.

People expressed mixed views about the quality of the meals, Some people complained that the meat was tough and we found people did not always receive they support they needed to eat.

We observed that one staff member did not always treat people with consideration and respect. However, most people told us they were supported by kind, caring and compassionate staff and we observed other staff treated people with kindness.

Staff also told us people could choose the gender of the staff member who supported them with personal care, but we found these arrangements were not robust and people’s preferences were not always met.

There was a comprehensive quality assurance system in place, but this was not always effective as it had not picked up the concerns we identified.

People received personalised care from staff who understood their individual care and support needs. Care plans provided comprehensive information and were reviewed regularly, although information was not always clear and easy to find.

Effective systems and processes were in place to protect people at risk of abuse. The registered manager conducted thorough investigations in allegations of abuse when required.

All areas of the home were clean and there were systems in place to protect people from the risk of infection.

Risk assessments had been completed for all identified risks to people, together with action staff needed to take to reduce the risks. Staff knew what to do in the event of a fire and had been trained to administer first aid.

Staff were supported appropriately in their roles and completed a comprehensive training programme to help ensure they had the skills to support people. Registered nurses demonstrated an e

We carried out an unannounced inspection of this home on 11 and 12 February 2016. Emsworth House provides accommodation and nursing care for up to 79 older people some of whom live with dementia. Single room accommodation is arranged in two separate sections of the home; one area of the home provides accommodation and care and the other area providing nursing care. Lift access is available throughout the home and there are several large communal areas inside and outside the home which can be accessed by people. At the time of our inspection 77 people lived at the home.

A registered manager was 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.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Processes to recruit staff were in place which ensured people were cared for by staff who had the appropriate checks and skills to meet their needs. Staffing numbers were sufficient to meet the needs of people.

Medicines were administered, stored and ordered in a safe and effective way.

Risk assessments in place informed plans of care for people to ensure their safety and welfare, and staff had a good awareness of these. External health and social care professionals were involved in the care of people and care plans reflected this.

Systems in place to manage the cleanliness and infection control in the home were very good.

Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005. Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed.

People’s nutritional needs were met in line with their preferences and needs. People who required specific dietary requirements for a health need were supported to manage these.

People’s privacy and dignity was maintained and staff were caring and considerate as they supported people. Staff involved people and their relatives in the planning of their care.

The service had received an award for their end of life care. This empathetic and caring approach to the care of people who were close to the end of life was embedded in the service.

Care plans in place for people reflected their identified needs and the associated risks. Staff were caring and compassionate and knew people in the home very well.

Complaints had been responded to in an effective and timely manner and this work needed to be sustained.

The service had effective leadership which provided good support, guidance and stability for people, staff and their relatives. People, their relatives and staff spoke highly of the registered manager and were involved in the running of the home. Audits and systems were in place to ensure the safety and welfare of people.

Emsworth House offers personal care and nursing to up to 79 people. The home is divided into two with personal care only offered on one side and nursing the other side. During our inspection of Emsworth House we spoke to six people who used the service, three relatives of people who used the service, eight members of staff and the registered manager.

There were policies and procedures in place for staff to use to assist them to provide care and support to people in line with their needs and wishes for example confidentiality, supervision, cleanliness and infection control and mental capacity.

One person who used the service gave us positive comments. They said, “Staff here are really lovely and helpful”. One relative told us “Dad really likes it here and staff are friendly”.

We found that the service placed the needs, wishes, preferences and decisions of people who used the service at the centre of assessment, planning and delivery of care treatment and support.

We were shown a number of different assessments that were carried out which reflected people’s needs and preferences. However it was unclear when the information had been reviewed.

We were told that before people received any care or treatment they were asked for their consent. We looked at seven people’s care plan files and found most had been signed by the person who uses the service.

Where people did not have the capacity to consent the provider acted mostly in accordance with legal requirements.

We found that there were systems in place to reduce the risk and spread of infection. Although we saw that the audits were undertaken, we could not see that where an action had been highlighted as needed, there had been a follow up to ensure the action had been taken.

The provider had policies and procedures in place for supporting staff and induction training was provided. We found that training records were kept and some members of staff required training updates. We found that supervisions were completed regularly and in line with the policy and included individual performance plans (IPP). One member of staff told us they felt supported and that they were offered lots of training.

We found a number of different quality monitoring tools that were used to regularly assess the quality of the service being provided. They were effective in the monitoring of the service.

We last visited Emsworth House Care Home with Nursing 1 May 2012.

In order to check that the home remains compliant with the regulations we carried out a desk top review of the service on 26 March 2013. At this review we looked at two outcomes and associated regulations:

In order to check compliance we used information given to us by the service in their Provider Compliance Assessment (PCA). This is a statement from the provider as to how they are complying with the outcomes and the associated regulations. We looked at records of visits to the service by Hampshire County Council who are the registered providers. We also looked at information held in the Care Quality Commission’s records and in the Commission’s Quality Risk Profile (QRP) of the service.

We have not visited Emsworth House Care Home with Nursing as part of this review because they were able to demonstrate that they were meeting the regulations without the need for a visit.

On April 24 2012 we received some anonymous information that people living at Emsworth House were often put to bed by 4pm for the convenience of staff. We were also told that the home was short staffed, and relied on poorly or untrained agency staff to cover these shortages. When we visited the home at 5.30pm on May 1 2012 we saw that those people who were already in bed were either being nursed in bed and this was clearly documented or they had chosen to go to bed. We spoke to five people living there and to two visitors. They told us they had no complaints about the home and that there were no rules about going to bed. One person living in the home said “there are no restrictions whatsoever” and another said “it’s a home from home”. A visitor told us he had once asked staff to help him put his wife to bed at 4pm because he could see she was tired and they had done so. He said “I have no complaints as such”.

When asked about staff people said that they were kind and patient and they had not noticed any staff shortages in particular. They said agency staff were sometimes used but there were no problems with this. However, two people mentioned that they had on occasion had difficulty communicating with some agency staff.

During our visit we spoke with five people who live at the home, two visitors, five staff and the manager. People told us that they were happy at the home; it was easy for them to move about the home if they are able and access facilities such as the bathroom and garden. They like the interaction with the staff and were very fond of some of the staff. They said they are able to give their opinion for example about the food and they feel respected and heard. They are able to have visitors at any time and even ask that their visitor has a meal with them.

Many people need a lot of support so activities usually take place in the afternoon. People said that they do like to go the lounge and meet others but they are not always able to speak with their fellow residents who have lost use of their communication skills. People said that although they would not choose to spend their final days in a care home they are content with the care and facilities at Emsworth and their family is able to “rest now”.

Generally people who live in the home told us that the home was clean and tidy. One relative said the cleanliness of the home was ‘brilliant’. Another relative told us that they were not happy with the standard of cleanliness in their relative’s bedroom. They also told us that their relative had a wound infection and they had not been given any information relating to the infection and the precautions they needed to take to prevent the spread of their relative’s infection.