We carried out an unannounced inspection of Eshcol House on 4 September 2018. Eshcol House is a ‘care home’ that provides nursing care for a maximum of 31 adults. 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. At the time of the inspection there were 29 people living at the service. Some of these people were living with dementia. The service occupies a detached house over three floors. There was a passenger lift to support people to access the upper floors.

There was a registered manager in post who was responsible for the day-to-day running of 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.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 4 July 2017. In July 2017 we found systems for the management of medicines, the checking of pressure relieving mattresses and the management of risks in relation to people who had lost weight were not robust. There were gaps in charts to monitor the care provided for people and some information about people’s care needs were omitted from shift handover records.

Records of a Deprivation of Liberty Safeguards (DoLS) authorisation were not available at the service. The system for staff appraisals had not provided staff with an appropriate reflective two-way process with a line manager who knew how they worked. There were no pictorial signs for people who might need support to orientate around the premises. The dining room was not used by people, which meant there was no opportunity for meals to be a shared social occasion for people who might like to interact with others. The rating at the last inspection was Requires Improvement.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good overall.

People and their relatives told us they were happy with the care they received and believed it was a safe environment. Comments included, "The staff always call in at least twice a night to make sure I'm alright", "My relative feels safe because she tells me the staff can always spare a few minutes to make sure she is ok" and "There's always somebody around to help if you need it." Staff knew how to recognise and report the signs of abuse.

Care records were personalised to the individual. Risks were identified and included guidance for staff on the actions they should take to minimise any risk of harm. Where some people had been identified as being at risk of losing weight this was being well managed. Care plans and risk assessments were kept under regular review. Staff were provided with information about people’s changing needs through effective shift handovers and electronic daily records. However, care plans were not always updated in a timely manner when people’s needs changed. We have made a recommendation about this.

Records to evidence when people were re-positioned, their skin was checked or their food and fluid intake was measured were accurately completed by staff. Where people had pressure relieving mattresses in place, to help prevent skin damage due to pressure, we found mattresses were set to the correct level.

Staff had developed good working relationships with healthcare professionals to help ensure people had timely access to services to meet their health care needs. These services included tissue viability nurses, community nurses, GPs and spee

This unannounced comprehensive inspection took place on 4 July 2017. The last focused inspection took place on 17 March 2017. The service was meeting the requirements of the legislation at that time. The focused inspection was carried out to follow up on a breach of regulations found at the last comprehensive inspection 17 December 2015.

Eshcol House is a care home which offers nursing care and support for up to 31 predominantly older people. At the time of the inspection there were 29 people living at the service. Some of these people were living with dementia. The service occupies a detached house over three floors. There was a passenger lift to support people to access the upper floors, however, this lift was out of order on the day of inspection visit.

Systems for the management and administration of medicines were not entirely robust. The service had reported a medicine error to CQC in April 2017. The wrong medicine was given to a person. The investigation in to this incident was robust and led to recommendations that specific actions be taken to help reduce the risk of future events. The recommendations seen at the inspection were not in place. Following the inspection the provider sent CQC information that stated it was "Written in retrospect." A meeting was held with the nurses to discuss the implementation of the recommendations. It had been decided not to implement the wearing of a red tabard during medicine rounds as it "Did not mitigate disruptions." The nurse was seen being disturbed during medicine rounds at this inspection. This meant the risk of a further error had not been reduced.

It was not always possible to establish if people had received their medicine as prescribed. There were some gaps in the medicine administration records (MAR). Handwritten entries on to this MAR had not always been signed by two staff to help reduce the risk of errors. Prescribed creams and liquids were not always dated when opened. There was one expired cream stored in the medicine fridge. Regular medicines audits were not being carried out. This meant any errors were not being identified in a timely manner.

Staff were not provided with formal supervision in line with the policy held by the service. Most staff had been provided with annual appraisals. However, many appraisals had been provided by an external consultant bought in by the provider. This did not provide staff with a reflective two way process with their line manager who knew of their practice. Whilst staffing rotas showed there were sufficient numbers of staff on shift and the registered manager monitored dependency scores in order to meet people’s needs, staff reported being ‘under pressure’ and ‘quite stressed’. Throughout the day of this inspection call bells rang constantly. Some people reported having to wait for staff to respond to them at times.

We walked around the service which was comfortable and warm. There was no pictorial signage for people who required additional support to orientate them around the building. Some of the communal areas were in need of redecoration and the carpets were worn and marked in places. Two of the bathrooms were not being used by people and where full of equipment. We were told there was a plan to change the use of these rooms in to a storage room and a wet room. The provider had commissioned a project manager. They were in the process of addressing required actions identified at a fire assessment of the premises. There was a dining area. However, we were told this was not used by people living at the service. The dining table and chairs were used by staff during this inspection. People ate their meals in their bedrooms or at their chairs in the lounge.

The service had applied for appropriate Deprivation of Liberty Safeguards authorisations. We were told one authorisation was in place at the time of this inspection but the documentation relating to this was not available for review. The service did not have a copy of th

Eshcol House is a care home which provides nursing, care and accommodation for up to 31 older people. On the day of the inspection there were 29 people using the service. We carried out this unannounced focused inspection on 18 March 2017.

We carried out an unannounced comprehensive inspection of this service on 17 December 2015. A breach of legal requirements was found. Processes and procedures in place to help ensure the smooth running of the service were not robust. For example, handwritten entries in Medicine Administration Records (MAR) had not been double signed, accidents and incidents were not routinely analysed to identify trends, training records were inaccurate and there were not systems in place to gather people’s views of the service. The auditing systems in place had not enabled the registered manager to identify these issues. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. 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 Eshcol House on our website at www.cqc.org.uk.

The service is required to have a registered manager and at the time of our inspection a registered manager was in post. 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.

Audits took place regularly to enable the registered manager to identify any trends. Where patterns had been highlighted these were further investigated to establish if any action could be taken to minimise risk.

There were systems in place to help ensure staff received regular supervisions and appraisals. Training needs were closely monitored to enable staff to keep up to date with good working practices. Staff meetings took place regularly and staff told us these were an opportunity for them to raise any suggestions or concerns.

The registered manager actively sought out people’s views and those of other stakeholders. Quality assurance questionnaires had been circulated at the end of 2016 and the results were positive. Where people had expressed dissatisfaction with any aspect of the service this had been acted on.

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff told us they felt well supported and had confidence in the management team.

This inspection took place on 17 December 2015 and was an unannounced comprehensive inspection. The last inspection took place on23 June 2014. There were no concerns at that inspection.

Eshcol House is a care home which offers nursing care and support for up to 29 predominantly older people. At the time of the inspection there were 27 people living at the service. Some of these people were living with dementia. The service comprises of a detached house providing accommodation over three levels.

The service had a registered manager in post. 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.

We walked around the service which was clean, comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

Staff were aware of how to report any safeguarding concerns they may have. However, the safeguarding policy held at the service did not contain the local contact details for the local authority multi agency referral unit.

We looked at how medicines were managed and administered. People received their medicines as prescribed. Medicines that required cold storage were stored appropriately and those that required stricter controls were monitored in line with legislation. We saw staff had transcribed medicines for people, on to the Medicine Administration Record (MAR) following advice from medical staff. However, 20 handwritten entries were not signed and had not been witnessed by a second member of staff. This meant that there was a risk of potential errors and did not ensure people always received their medicines safely. The clinical lead assured us they were aware of the concern and would take action with individual staff members to address this.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met.

Staff told us they received support from the registered manager as needed. Staff meetings were held regularly to seek the views of staff and share information. Staff undertook training, however, not all staff had completed mandatory training and this was being addressed by the registered manager through individual meetings.

People were consulted about the meals provided at the service. The cook regularly discussed meal options and choices with people at the service and responded to their requests. Drinks were available to people throughout the service.

Care plans were well organised and contained accurate and up to date information. Some of the handwritten care plans had been amended and reviewed many times and this could make it difficult to find current information.

Group and individual activities were provided to people according to their individual needs.

The registered manager did not have robust processes in place to record and monitor accidents and incidents which took place at the service, staff induction, supervision, appraisal and training.

Quality assurance surveys to seek the views and experiences of people who used the service and their families had not been carried out since 2011, although regular residents meetings took place involving people who lived at the service, who could express their views.

We found a breach of the Health and Social Care Act 2014 (Regulated Activities) 2008 and you can see what action we told the provider to take at the back of the full version of the report.

This inspection was carried by one inspector over one day. During the inspection, the inspector worked to answer five key questions; is the service safe, effective, caring, responsive and well-led?

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

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Yes, at the time of this inspection we judged the service was safe.

People we spoke with were positive about the staff who worked at Eshcol House Nursing Home. People told us staff, were professional and supportive. For example, one person said “the staff are very nice, they are very good.”

The staff we spoke with said they had confidence in colleagues’ practices. For example, we were told “If I need any help or have any concerns I know they will help me. It’s a friendly and a happy, working environment.”

The service had a well organised medication system. The system was well managed and regularly audited. Records were accurate and up to date.

Is the service effective?

Yes, at the time of this inspection we judged the service was effective.

People all had individual support plans, which set out their care and support needs. Support plans contained satisfactory information and were accessible to staff. People said staff met their relatives’ needs and responded promptly when they needed assistance. People said they had access to doctors, community psychiatric nurses, psychiatrists, chiropodists and opticians.

Is the service caring?

Yes, at the time of this inspection we judged the service was caring.

Relatives and documentation by professionals of people who used the service evidenced they were happy with how the service supported people and found the staff to be professional and helpful.

From our conversations with people who had experience of the service and a review of the records we assessed, we judged that individual wishes and needs were taken into account and respected

Is the service responsive?

Yes, at the time of this inspection, we judged the service was responsive.

Everyone we spoke with said the staff treated people with respect and dignity.

The registered manager and provider had good systems in place to monitor and respond to the ongoing improvements within the home. This included systems of survey and audit. There was a system to monitor accidents and incidents. People’s personal care records, and other records kept in the home, were accurate and complete.

Is the service well-led?

Yes, at the time of this inspection we judged the service was well led.

Staff, relatives and professionals were all positive about the management of the service. People told us management would listen and were “really supportive”.

Eschol House Nursing Home provided care and support to a maximum of 31 people. There were 28 people using the service at the time of our inspection. The home was undergoing a number of renovations and redecoration at the time of our inspection.

We saw people’s privacy and dignity were being maintained. People we spoke with told us “They treat me kindly and with respect” and “I have never been spoken to in a patronising way”.

We saw care plans were detailed and gave direction as to the care and support people needed. They had been regularly reviewed.

The premises were well maintained. Peoples own rooms were personalised to their own taste. Ongoing renovation and redecoration was improving the environment for people who used the service.

We saw staff were able to meet people’s nursing and care needs. We were told one of the care workers also acted as the activities organiser and we saw the weekly activity plan. People we spoke with told us “Girls treat me very well; they arrive quickly when I press my call button” and “I feel comfortable in my surroundings”.

There was a complaints procedure available to people who visited the home and to people who used the service.

Records were stored securely and well maintained. They were accessible to people who needed to use them

At the time of the inspection people living at Eshcol House had a variety of nursing care needs for example significant physical health care needs and / or palliative care, or mental health needs such as dementia. On the day of the inspection, we spoke with fifteen of the twenty seven people who lived at Eshcol House. People were extremely positive about the care and support they received. For example one person said “I am extremely happy, I am looked after very well, the staff are very kind and helpful; they cannot do enough for you. They are very professional”. Other people we spoke with all made similar remarks. People said the food was to a high standard, the home was always warm and they felt safe living there.

Care and support were good. The care home environment was pleasant although some redecoration was required. The registered provider was arranging this and some refurbishment on the ground floor had been completed. The bedrooms were decorated and furnished to a good standard. The home was clean and odour free.

Staffing levels were to a good standard. Suitable staff recruitment procedures were in place.There were some gaps in records regarding the provision of training. Staff however were observed working professionally with the people living in the home. The quality assurance system was limited although satisfaction levels from staff, people who lived in the home and their representatives was very high.