What life is like for people using this service:

• People were supported by staff who had been trained in safeguarding and who would report any concerns they had about people.

• A new call bell system had improved response times when people needed support and provided statistics which were analysed to improve the service provided.

• People who had no capacity assessment in place had applications made to deprive them of their liberty. We recommended that the provider review all records concerning capacity assessments to ensure all are in order.

• Staff participated in mandatory training which was updated annually. Staff received regular supervision with their line managers. Staff told us they felt supported.

• People told us that staff were kind and caring and supported them in ways that maintained their dignity and were respectful.

• A reduction in the physiotherapy provision meant that some people no longer received input from visiting professionals. The impact of this decision and the fast implementation had left some people unable to source alternate provision in a timely way.

• Several people did not attend activities provided in the onsite day service as they did not believe them to be relevant. There were a number of different activities on offer that people could choose to attend.

• There had been improvements in the oversight of maintenance however there had been faulty emergency lighting for almost one year and action was only taken to obtain quotes to fix the problems after our inspection. This was a continuing breach of Regulation 17 (2) (a) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good Governance.

• The provider had introduced robust audits within each of the houses which were regularly checked by managers and the senior leadership team.

• The service met the characteristics of Good in most areas. More information on our findings is in the full report.

Rating at last inspection: Requires Improvement (Published18 July 2018)

About the service: Enham Care Home Services – William, Michael and Elizabeth are residential care homes that can accommodate up to 60 people. When we inspected it was providing accommodation and personal care to 54 people who had physical and / or learning disabilities.

Why we inspected: This was a scheduled inspection based on the providers previous rating.

Follow up: We will continue to monitor information we receive about the provider until we return as per our re-inspection programme.

The inspection took place on 10th, 11th and 12th April 2018 and was unannounced.

The last inspection of this service took place on 4th, 5th and 6th July 2016 and at that time the service was rated as requires improvement.

Enham Trust – Care Home Services (Elizabeth / Michael and William Houses) 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.

Elizabeth, Michael and William Houses are purpose built care homes which can accommodate up to 60 people. When we inspected there were 56 people living in the three homes. People live in self-contained ‘flats’ all of which have a kitchen area, living room, bedroom and en-suite shower and toilet. There were communal lounges, bathrooms and shower rooms and a large dining area in each of the houses.

The manager of the Care Home Services was in the process of applying to become the registered manager. 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 service was unable to ensure that call bells would be answered in a reasonable amount of time or that the care required by people could be provided when needed.

Changes to staffing had left some people reluctant to use their call bells, others waiting for extended periods for support and at times continence care was missed.

Low levels of legionella bacteria had been detected in the water system of Elizabeth House in late 2017. A risk assessment in January 2017 had identified this risk and a further risk assessment in February 2018 showed that actions had not been taken from the first assessment.

Fire safety procedures did not reflect Enham Trust’s fire safety policy. There were fewer fire drills held than the policy stated there should be.

Fire doors did not provide adequate fire protection, a fire safety report identified that doors should be replaced and current practices around evacuation should be changed immediately. A recent Fire Safety report commissioned by Enham Trust stated that doors should be replaced as soon as possible.

There was no system for people to sign in and out of the buildings this meant that in the event of a fire there was no accurate register of who was in each of the homes.

Medicines were managed safely and people, when possible, were supported to be independent with medicines.

Problems with catering had been dealt with through retaining a new catering provider.

Care plans were clear and covered relevant areas.

There was good use of assistive technologies and communication devices.

Staff were skilled in different communication techniques.

Staff received regular and effective supervisions.

We received a great deal of positive feedback about the quality of the care staff.

The service had, when necessary, supported people with planning for end of life care and will develop this in future as needed.

People accessed on-site day services if built into their care package, there were minimal additional activities provided in the 3 homes for people who did not access day services.

People knew how and to whom to see to make a complaint. Enham Trust dealt appropriately with a complaint during our inspection.

Changes to staffing numbers and structure were not communicated to people or their relatives by the homes management team. Frontline staff had to deliver the message that activities and outings could not go ahead due to having not enough staff.

Though concerns were raised a number of times about the reduction in staff, people had faith in the skills and commitment of the registered manager and head of care.

The inspection took place on 4, 5 and 6 July and was unannounced.

The acting manager is in the process of applying to become the registered manager. 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.

Enham provides residential care and support for up to 60 people with physical disabilities to live independent lives. The location is split into three separate buildings which include Michael House, Elizabeth House and William House.

The provider did not have robust quality assurance systems in place in order to respond effectively to maintenance requests.

The call bell system used to alert staff when people needed help did not always operate correctly and placed people at risk.

Support, supervisions and appraisals require improvement to ensure staff are provided with good opportunity to develop and to discuss their progress.

People told us that they felt safe. Staff had a good understanding about the signs of abuse and had confidence in their manager to take concerns raised seriously.

People were supported by staff that had the skills and knowledge to meet their assessed needs. Staff received a thorough induction before they started work.

The provider had employed skilled staff and took steps to make sure care was based on local and national best practice. Information regarding diagnosed conditions was documented in people’s files.

Recruitment practices were safe and relevant checks had been completed before staff commenced work. Staff worked within good practice guidelines to ensure people’s care and support promoted good quality of life.

The provider had appropriate arrangements in place to assess people’s capacity to make decisions about their care and treatment. Staff were knowledgeable about the requirements of the Mental Capacity Act 2005. One person was subject to DoLS at the time of our inspection and the acting manager was in the process of making more referrals to the local authority for DoLS assessments.

People who required assistance to eat and drink were supported effectively. Appropriate assessments had been conducted for anyone who had difficulty in swallowing their food. Interactions between staff and people during meals times were respectful and dignified.

Multi-disciplinary teams including mental health workers and occupational health were involved in reviewing and updating people’s risk management plans.

Medicines were managed safely. Any changes to people’s medicines were prescribed by the service’s GP and psychiatrist. People were involved before any intervention or changes to their care and treatment were carried out.

People had access to activities that were important and relevant to them. Records showed people’s hobbies and interests were documented and staff accurately described people’s preferred routines. There was a range of activities available within the home and community.

The provider actively sought, encouraged and supported people’s involvement in the improvement of the service. People’s care and welfare was monitored regularly to make sure their needs were met within a safe environment. The provider had systems in place to regularly assess and monitor the quality of the service provided.

People told us the staff were friendly and management were always visible and approachable. Staff were encouraged to contribute to the improvement of the service. Staff told us they would report any concerns to their manager and said the management and leadership of the service very good and very supportive.

At our last inspection in January 2013 we found that the provider did not have an effective system in place to assess the risk of, and to prevent and control, the spread of infection. We asked them to make improvements.

The provider wrote and told us of the improvements they would make. This inspection took place to ensure that these had been completed.

The provider had carried out all the improvements they had identified on the action plan which they had sent to us. These included the publication of a new infection control policy and the appointment of a lead person in infection control. All staff had taken part in training in infection control. Staff we spoke with confirmed that this had been very useful although it was taking time to get used to the new procedures that had been put in place.

Support staff at the home are referred to as personal assistants, this title has been used within this report.

We looked at the care records for four people. People had signed to give consent for various aspects of their care and support. Two of the five people we spoke with confirmed that staff respected their wishes and that they could refuse care if they wanted to: “Staff will stop if I don’t want them to do anything.”

Two of the people we spoke with told us that they had a discussion with staff each month about their care and support, what they had done and if they needed to make changes to their support plan. One person told us: “I am happy with what is in there. We have to update it every month. If I want to say something I can.”

The service had an infection control policy however this was dated 2005 which meant that some of the information it contained was no longer correct. The service was not able to provide us with copies of any infection control audits. By not auditing the infection control procedures they were unable to identify any shortfalls and take action to address these.

One member of staff told us: “I had to wait until I had the results of my CRB before I could start work.” They went on to tell us about the induction process they went through before providing any care for people.

We were able to track a complaint made to the service. The complaint had been fully investigated drawing the complaint to a satisfactory conclusion.

All the people we spoke with said they were happy living at Elizabeth House. They liked the staff and felt they supported them very well to do the things they wanted to. Most people commented on the food that was served in the dining room. They said it was good and they liked having a menu to choose from each week.

One person told us that if there is a problem with any equipment it was dealt with very quickly. Equipment was either repaired by Enham’s maintenance department or the staff arranged for specialist repairers.

People told us about the changes that were taking place at Enham. (These are described later in the report). Some people thought the changes meant they had a lot more choice about how they lead their life and the things they could do. Two people told us that they didn’t know how things would affect them but were concerned that there may not be as much to do within the house.