About the service:

Enbridge House is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided. Both were looked at during this inspection.

The service supported older people, some of whom were living with dementia. At the time of our inspection there were 14 people living in the service and one person attending the home for daily respite care.

People’s experience of using this service:

¿ We received positive feedback about the service and the care people received. The service met the characteristics of good in four areas but was requires improvement in well-led.

¿ Medicines were stored and dispensed safely. However, audits of medicines records (MARs) were not completed. There were some unexplained gaps in people's medicines administration records and no record of actions taken by staff to address this.

¿ Systems and processes were in place for monitoring quality and safety in the service. However, these were not always effective, as they failed to identify errors and omissions, such as the gaps in MARs, lack of medicines audits and the lack of records of actions taken following accidents. We recommended that the service seek advice and guidance from a reputable source about auditing MARs and making records of actions taken to prevent accidents.

¿ There were enough staff to support people and keep them safe. People were supported by skilled staff with the right knowledge and training.

¿ Staff had respectful caring relationships with people they supported. They upheld people’s dignity and privacy, and promoted their independence.

¿ People’s care and support met their needs and reflected their preferences. The provider upheld people’s human rights.

¿ There was a positive, open and empowering culture. Staff roles and responsibilities were clear. Staff worked in partnership with professionals to deliver care and support and maintained links with the local community.

Rating at last inspection:

¿ At the last inspection the service was rated good overall with a rating of requires improvement in safe. At this inspection the service was rated good overall with a rating of requires improvement in well-led.

Why we inspected:

¿ This was a planned, comprehensive inspection of the service.

Follow up:

¿ We did not identify any breaches at this inspection. We will therefore re-inspect this service within the published timeframe for services rated Good. We will continue to monitor the service through the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This was an unannounced inspection which took place on 02 August 2016.

Enbridge House Care Home is registered to provide care (without nursing) for up to 17 older people. There were 14 people resident on the day of the visit. The building offers accommodation over two floors in 14 single and two double rooms. The double rooms are generally used as singles, unless shared by a married couple. One room is currently used to provide short term care. This meant that the service had one vacancy on the day of the inspection. The second floor is accessed via a staircase or lift. There is a small flight of stairs on the second floor leading to the lift from two bedrooms. Only people who are fully mobile are allocated these bedrooms. The shared areas within the service are spacious and meet the needs and wishes of people who live in the home.

The service has a registered manager running 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 2008 and associated Regulations about how the service is run.

The management team, generally, kept people, visitors to the service and staff safe. However, there were areas of safety that required improvements. These included developing a more comprehensive emergency plan and ensuring people were protected from the risk of burning themselves on hot water tanks and pipes. Most risks were identified and managed to make sure that people and others were kept as safe as possible. Staff were provided with training in the safeguarding of vulnerable adults and health and safety. Staff were able to describe how they kept people safe from all forms of abuse.

There were enough properly trained staff who had the necessary skills to provide people with safe care. The service’s recruitment procedure ensured that as far as possible, all staff employed were suitable and safe to work with vulnerable people. People were given their medicines in the right amounts at the right times by staff who had been trained to carry out this task.

The management team and staff protected people’s rights to make their own decisions and consent to their care. The staff team understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. People in the home had the capacity to make their own decisions and choices and no one was deprived of their liberty.

Staff were properly trained and supported to enable them to meet people’s health and well-being needs. People were supported to make sure they received health and well-being care from appropriate professionals. Staff were trained in necessary areas so they could effectively meet people’s diverse and changing needs.

Staff built relationships with people so that they were able to provide caring and compassionate support. Staff encouraged people to make as many decisions and choices as they could to enable them to keep as much control of their daily lives, as was possible. People were treated with kindness, dignity and respect at all times. The service had a strong culture of person centred care which recognised that people were individuals with their own needs and preferences

People benefitted from a well-managed service. The management team was described by staff as supportive and helpful. The registered manager worked directly with people and was very knowledgeable about their individual needs. The service made sure they maintained and improved the quality of care provided. Some improvements were needed with regard to sending the appropriate notifications to Care Quality Commission and addit

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

On the day of the inspection there were 17 people using the service. As part of this inspection we spoke with three people, two people’s relatives, the registered manager, the registered provider and three staff. We also reviewed records relating to the management of the home which included, five care plans and daily care records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found the service to be safe because the home had been cleaned to an adequate standard. We spoke with people and one told us “Yes, the home is clean” and a person’s relative commented “Cleanliness is fine.” The provider had identified that two carpets required replacement and arrangements had been made for this work to be completed.

At the previous CQC inspection on 24 January 2014 issues had been identified in relation to the heating of the home and the maintenance programme. At this inspection we found that the heating had been resolved and there were processes in place to ensure that adequate maintenance of the home took place. People told us “Yes, it is adequately decorated and maintained” and “It is warm enough.”

There were adequate numbers of staff on each shift. The provider was recruiting extra staff but arrangements had been made to ensure that shifts were covered whilst recruitment took place.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper procedures were in place. Relevant staff understood when an application should be made, and how to submit one.

Is the service effective?

We found the service to be effective because people’s care needs had been assessed. Care plans provided staff with guidance about how people’s assessed needs were to be met. One person told us “Staff did an assessment to find out about my needs.”

The service had worked with the district nurses to ensure that the risks of people developing pressure areas had been assessed. When people were identified as at risk and required specific equipment to manage this risk, it had been obtained.

Is the service caring?

People and their relatives told us “Care is brilliant” and “Staff are caring.” We found the service to be caring as we observed that staff understood people’s care needs and were kindly and caring to people in their interactions. They did not rush people’s care and they listened to their requests. One person’s relative told us “Staff respect X’s wishes and work with X.”

Is the service responsive?

The service was responsive as we found that they had responded to changes in people’s care needs. On the day of the inspection a person became unwell and staff responded promptly to ensure that this person received medical attention. A person’s relative told us “If X is poorly, staff respond promptly. The GP is arranged smartly.”

Is the service well-led?

We found the service to be well-led. Both the registered manager and the provider were present at the service daily. This enabled people to speak with them as they wished to. One person’s relative told us “I can raise issues as required.” Audits of the service had been completed to ensure that the quality of the service provided had been monitored.

People we spoke with told us they were happy living in the home and felt safe, cared for and listened to by staff. Comments included, “staff are very nice, kind and helpful” and “they are very attentive of you when you need help or advice”.

People’s care plans detailed how they wanted their needs to be met and supported choices they had made. However, full assessments of people’s nutritional needs were not completed to promote their wellbeing.

Staff received support and training to be knowledgeable of people’s specific health and personal care needs and how they wanted those needs to be met.

The provider had not taken appropriate measures to improve and monitor the heating system and temperatures throughout the home to maintain a safe and homely environment. Checks were not completed to promote infection control and maintenance safety of the home. Some of the fabric and furnishings of the home were in need of replacement or repair.

People had opportunities to contribute their views about the quality of the service and knew who to contact should they have a concern or complaint about the services provided.

During our visit we saw that people who used the service were treated in a dignified manner and their consent was sought regarding various aspects of their care.

Observation of peoples care during our inspection confirmed people were receiving effective, safe and appropriate care. One person told us that “it’s rather like a hotel here and I would recommend it to anyone”.

Staff we spoke with were able to demonstrate an understanding of abuse issues and knew what to do if they suspected that someone was being abused.

Staff we spoke with confirmed that they had regular supervision from senior staff.

People we spoke to confirmed that if they wanted to change anything in their room or in their routines the staff would act upon them.

As part of this inspection we contacted relatives of people who live at Enbridge house.

People told us they visited Enbridge House before deciding if it was the best place for them.

Staff respected people’s dignity and rights.

Everyone we spoke to were very complementary about the staff.

People told us that they had plenty of opportunities to get involved in having their say about how the service is run. They also told us that they were confident that if they reported any problems, they would be dealt with promptly and effectively.