Engleburn Care Home offers accommodation and personal care for up to 76 older people, including those who are living with dementia.

The inspection was unannounced and was carried out on 11 and 13 April 2017. The lead inspector returned on 18 April 2017 to check an issue identified the previous week had been addressed and to provide written feedback about the inspection.

At our previous inspection in April and May 2016 we identified that some improvements were required to identifying and managing risk to people, monitoring the quality of the service, record keeping, dignity and respect, safeguarding and submitting notifications. Following the inspection, the provider sent us an action plan telling us the steps they were taking to make the improvements required.

At this inspection we found significant improvements had been made and the provider was meeting the regulations.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Individual and environmental risks relating to people’s health and welfare had been identified and assessed to reduce those risks. Care planning had been improved to provide more detailed guidance for staff.

Systems were in place for the storage and administration of medicines, including controlled drugs. Staff were trained and their competency assessed to ensure they remained safe to administer medicines.

People and relatives told us they felt the home was safe. Staff had received safeguarding training, understood the different types of abuse and explained the action they would take if they identified any concerns. There were sufficient staff deployed to meet people’s care, emotional and social support needs.

The registered manager had identified and implemented a number of audits and monitoring systems. Incidents and accidents were recorded and actions taken to reduce the risks of similar incidents happening again. The environment and equipment was regularly checked and servicing contracts were in place.

People’s rights were protected because staff understood the principles of the Mental Capacity Act 2005 and ensured decisions were made in their best interests. The registered manager understood the Deprivation of Liberty Safeguards and had submitted requests for authorisation when required.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs.

People were supported to maintain their health and well-being and had access to healthcare services when they needed them. People were supported to have enough to eat and drink and their specific dietary needs were met.

Staff were kind and caring and treated people with dignity and respect and ensured their privacy was maintained. People had access to a choice of planned activities throughout each week.

Initial assessments were carried out before people moved into the home to ensure their needs could be met. People, their relatives or other representatives were involved in decisions about their care planning.

People and relatives confirmed they knew how to make a complaint and would do so if they needed to. People and relatives were encouraged to give their views about the service.

Staff felt supported by the registered manager and were confident to raise any issues or concerns with them.

We inspected Engleburn Care Home on 28 and 29 April 2016 and 6 May 2016.

Engleburn Care Home is registered to provide nursing care for up to 76 older people, some of whom live with dementia. There were 68 people living at the home at the time of our inspection. The home is separated in to two units. Engleburn provided support for people who were more independent. Foxholes provided care and support for people with more advanced dementia.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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. The registered manager currently managed the home with the support of two deputy managers. They also managed a second home belonging to the provider and had identified that it was difficult covering two large homes. New management arrangements had been put in place to take effect from June 2016 which included the appointment of a new manager to take full time responsibility for Engleburn Care Home.

We received mixed feedback from people and relatives during the inspection, with some saying they had a positive experience of receiving care whilst others less so. We also identified inconsistent quality in the delivery of care, safeguarding, record keeping and monitoring systems within the home.

People were not always protected from possible abuse. Staff were able to identify some signs of abuse and understood who to report concerns to within the home. However, staff had not identified that unexplained bruising could be a sign of abuse and a number of such incidents had not been investigated and had gone unreported to the local authority and to CQC.

We received mixed feedback about the level of staffing and whether it was sufficient to meet people’s needs. Staff told us they thought there were enough staff most of the time but some staff said there could sometimes be pressure points in the day, such as early mornings. People and relatives said they thought there were times when there were not enough staff and gave examples of times when care had been delayed.

Staff interacted positively with people when they delivered care. We observed staff showing kindness and re-assurance to people when they became upset or worried and people’s dignity was respected by most staff. However, we observed other care practices and written notices around the home which did not always refer to people with dignity and respect.

Staff regularly involved people or their relatives in reviewing their care plans. Reviews took place on a regular basis or when someone’s needs changed. However, we found some examples of care plans which were out of date and did not reflect people’s most current circumstances or support needs. Health professionals visited the home regularly to provide advice and treatment when necessary. However, it was noted that not all staff were able to identify when people needed medical advice or treatment in a timely way.

Staff received induction and training in a range of areas to support them to meet people’s needs. However, there were some key areas of training which had not been kept up to date by all staff, such as safeguarding people from abuse.

The home worked with health and social care professionals and family members to ensure decisions made in people’s best interests were reached and appropriately documented. However, some staff were not sufficiently knowledgeable about the requirements of the Mental Capacity Act 2005 (MCA) to be able to explain how to safeguard people’s best interests and the MCA was not always implemented correctly.

The management team understood about the deprivation of liberty safeguards (DoLS) and submitt

We visited Engleburn Care Home in response to some concerns we had received. These concerns related to staffing levels and responsiveness, daily activities, the quality of staff interaction with people living at the home and their involvement in care planning. We gathered evidence in a number of ways. We spoke with five people who lived at the home and one relative who was visiting. We observed staff interaction with people throughout the day and spoke with nine members of staff, which included the registered manager and the two deputy managers.

During this inspection we looked at evidence to help us answer four key questions: Is the service safe? Is the service caring? Is the service responsive?

Is the service safe?

We found that the service was safe. We spoke to staff who understood the safeguarding vulnerable adults policy and knew how to report any concerns. We saw throughout the day that people were supervised and support was available when needed, such as when getting up from their chair.

Most staff felt there were enough staff on duty. Two members of staff told us there had been problems with low staffing levels but these were being addressed and had improved. We saw that, on the day of our inspection, staffing levels were adequate and based on the complexity of people’s needs.

We observed an emergency situation occur and saw that staff attended immediately. Risk assessments were carried out verbally between the staff involved throughout the emergency and safety procedures were communicated to reduce the risk of any injury to the person.

We spoke with one person who told us that a member of staff could sometimes be abrupt with them. We reported this back to the registered manager, with permission from the person, and saw that it was investigated immediately and reassurance was given to the person.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Relevant policies and procedures were in place and staff were knowledgeable about DoLs. Applications for DoLs had been made when required, and others were in progress.

Is the service caring?

We found the service to be caring. During our observations we saw that staff were kind, compassionate and attentive to people. The atmosphere in the home was calm and relaxed, and people seemed happy and content. People we spoke with told us “Staff are smashing. Wonderful” and “We always have a laugh” and “They’re always smiling. It makes a lot of difference.”

Is the service responsive?

We found the service to be responsive. We observed staff responding to people’s needs in a timely way. Call bells were answered promptly and people who chose to stay in their rooms, or were unable to get out of bed, were checked regularly to see if they were okay, or if they needed anything.

At lunchtime, we saw that staff were vigilant and attended to people who kept getting up and wandering around, and who were at a risk of falling.

People we spoke with told us “If I want anything I just ask” and “ You don’t see staff ambling along. They’re all walking briskly. They know what they’re meant to be doing and do it exceptionally well.”

We carried out a late evening inspection between 10pm and 12.30pm because of concerns we had received about the care of people living at the home during the night time. We were assisted by the staff on duty and also by the registered manager, who came in from home to assist with this inspection.

We spoke with five members of staff, one person who lived at the home and with the registered manager. We looked at two people’s care planning records, staff duty rosters, records about people’s menu and meal choices and other documents relating to people’s care.

At this inspection we found that people’s care needs were being met, including their dietary and fluid intake needs.

There were sufficient numbers of staff on duty to meet the needs of the people accommodated.

At this inspection we were assisted by the registered manager and deputy manager. We spoke with five people who lived at Engleburn who were able to tell us about what it was like to live there. We also spoke with five members of staff and six relatives of people who lived at the home.

People were consulted about how they should be looked after where they were able to be involved. For people who lacked the mental capacity to be involved in these decisions, we found their relatives were consulted and their views taken into account. We also found that health professionals were involved in these best interest decisions for people who lacked mental capacity.

People were well cared for in the home. Their needs had been assessed and care plans put in place to minimise risks of receiving inappropriate or unsafe care.

The design of the premises took account of the needs of people with dementia and provided a safe environment in which to care for people.

There were well publicised complaints procedures. Complaints were investigated and people responded to within the timescale set out in the procedure.

Appropriate staffing levels were maintained to look after people. We also found that there were systems in place to alter these levels when this was necessary.

We spoke with people who told us that they found the home “warm” and “comfortable.” Another person told us that “people here go out of their way and nothing is too much trouble for them.” People told us that members of staff were “kind” and “helpful” and they helped them in their daily activities. We spoke with two people who told us the home was cleaned every day and that their rooms waere “clean and tidy.”