Archived: Evergreen Care Home

Evergreen Care Home provides accommodation and personal care to up to 24 people over the age of 65. At the time of our inspection 13 people lived at the home.

People’s experience of using this service and what we found

We found that people were not always protected from the risk of infection at the home. Staff were not always following current government guidance for the use of personal protective equipment. We found that people weren’t being supported with social distancing in communal areas.

Preventative measures to control the spread of infection were not always in place. We found staff and visitors were not routinely screened for symptoms of COVID-19. Systems and processes for maintaining the hygiene of the environment were not robust.

Rating at last inspection

The last rating for this service was requires improvement (published 03 December 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. We had received information that staff were not using personal protective equipment (PPE) in line with government guidance. The inspection was prompted in response to concerns received about infection control practices. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We have found evidence that the provider needs to make improvements. Please see the safe section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Evergreen Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We have written to the provider to inform that we have serious concerns about infection prevention and control processes. The provider has forwarded a detailed action plan about how these concerns will be addressed. We will continue to monitor the service.

We have identified a breach in relation to infection control practices at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Evergreen Care Home is a residential care home providing personal care for 19 people aged 65 and over at the time of the inspection. The service can support up to 24 people.

People’s experience of using this service and what we found

The provider’s governance systems to monitor the delivery and quality of the service provided for people were not consistently robust and required further improvement. For example, ensuring risk assessments and care plans were reflective of all medical conditions and clear protocols in place to support staff on what they need to do to support people effectively.

People living at the home and their relatives had shared concerns about the provider’s management style. Staff reported feeling undervalued and not listened to.

All the people, relatives, and staff we spoke with said the staff provided good quality care.

People were safe using the service. Staff knew how to protect people from harm and reduce the risk of accidents and incidents. There were enough suitably recruited staff on duty to meet people’s needs and to keep people safe. People were supported by staff who knew their needs well. Staff supported people with their medicines and this was done safely. Staff understood how to prevent and control the spread of infection.

People were assessed before being accepted to the service to ensure the provider could meet their needs. Assessments addressed people's physical and health needs, their cultural and language needs, and what was important to them. Staff received training which helped them to deliver personalised care. People were happy with the choice of food available and where appropriate, received additional support with their dietary needs. The provider worked well with external health and social care professionals and people were supported to access these services when they needed them to ensure their health was maintained.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way and in their best interests; the policies and systems in the service required some improvement to ensure the provider continued to support this practice.

Staff were knowledgeable and kind. People and relatives told us how friendly and caring the staff were. Staff enjoyed their work and got on well with the people they supported. Staff encouraged people’s independence, protected their privacy and treated them with dignity.

Some of the people using the service at the time of the inspection could not always tell us about their experiences. However, whilst on site, we saw positive interactions between people and staff and people looked comfortable with the way they were being supported. Relatives we spoke with gave us good feedback on the service and the way the staff supported their family members to remain safe. Staff provided responsive care to people in line with their preferences and choices. If people communicated non-verbally staff knew how to engage with them.

People were supported by staff who knew their preferences. Complaints made since the last inspection had been investigated and families knew who to contact if they had any concerns. Relatives and staff were happy with the way the service was being led and there was a clear culture amongst the staff team in providing person-centred care.

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

Rating at last inspection: The last rating for this service was requires improvement (published 10 April 2019) and there were multiple breaches of regulation. The provider had submitted monthly reports since the last inspection to show what improvements have been made. At this inspection we found some improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

•Evergreen Care Home is a care home providing personal care and accommodation for up to 24 people. At this inspection 16 people lived within the service.

People’s experience of using this service:

• People were not always protected from the risk of harm. New staff did not receive any formal training or competency checks. Staff had limited awareness of how safeguarding issues could be escalated to other agencies. We observed some poor infection control practices as staff did not have easy access to personal protective equipment and there was insufficient sanitary waste bins. The provider had a recruitment process to ensure the appropriate checks were carried out when recruiting staff. People received their medicines as prescribed although the procedures for administering homely remedies were not robust

• There were mixed views about the quality and quantity of the food provided, some people told us the food was good whilst other people’s views were not so positive. Staff supported people to access health care when needed.

• People did not always receive care and support that respected their dignity and privacy. People’s views on the staff that supported them were mixed. Some people thought staff were kind and caring whilst other people’s views were not so positive. People’s equlity and diversity was respected.

• Care plans in place for people were limited in detail about how people would like their care to be provided although staff knew how to care for people in practice. People were not always involved in reviews about the support they received. People told us they felt bored and there were not enough activities. The provider was in the process of recruiting an activities co-ordinator in order to provide more activities for people. People’s views on how complaints were handled varied.

• The registered manager and provider did not understand the legal requirements within the law to notify us of Deprivation of Liberty Safeguards (DOLS). Risk assessments contained conflicting information and though updated did not not give clear information of peoples’ needs. There was a lack of robust oversight of accidents and incidents. Staff consistently reported feeling undervalued and not listened to. Leadership arrangements were unclear. The environment was clean and comfortable. The registered manager and provider did understand the legal requirements within the law to notify us of other incidents of concern, deaths and safeguarding alerts.

Rating at last inspection:

•Rated Good (Report published 17/11/2015).

Why we inspected:

•This was a planned inspection based on the rating at the last inspection.

Enforcement

•Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

•We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

All relative spoken with told us that they felt reassured that their relatives were safe with the staff that supported them. One relative told us, 'No concerns about the care or the staff.' All the people we spoke with who lived there told us they felt safe. One person told us, 'I think staff are very willing to help no matter what you ask for.' Another relative told us, 'The staff are polite and helpful nothing is too much trouble.'

All the staff that we spoke with confirmed that they had received training on how to protect people and understood what safeguarding people meant. They told us that the training was updated when required.

We saw that people had an assessment of their needs and associated risks. A plan of care was completed which enabled staff to offer care and support to people in a safe way. Staff told us and records sampled showed that they had received training and support to enable them to deliver care safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards, which applies to care homes. This is a domiciliary service. No one using this service was subjected to an application to deprive them of their liberty. The manager was aware of what procedures to follow in the event that an application was made.

Records sampled showed that the provider had systems in place to establish whether people had capacity to give consent to care and were able to make informed decisions. Staff spoken with understood about people making decisions and how to respect their rights.

All of the staff spoken with were able to tell us about the needs of the people they were supporting. This meant staff were knowledgeable about how people wanted to be supported.

Is the care effective?

Records sampled showed that people who used the service and their relatives, where possible, had been involved in an assessment of their needs. This meant that people were able to influence the care they received.

Care plans and risk assessments were in place to ensure that people received safe and appropriate care.

Is the service caring?

We saw from daily records sampled that where staff had concerns about people's health, additional support was provided or other health care professionals were made aware and advice sought. We saw that reviews of people's care needs were completed. This ensured that the service provided met people's changing needs. All the people we spoke with told us that they were happy with their care and one person told us, ' We could not ask for better staff than we have here'.

We saw staff responded to people's requests by speaking to them using their preferred name. For example, their chosen name or if they liked to be called a shortened version of their name. We saw that staff interacted well with the people who lived there in a respectful and caring way. This meant people were addressed as they preferred and with respect and kindness

Is the service responsive?

Records sampled showed that there were systems in place to gather the views of people so that the service was developed taking into consideration the views of staff and people who received a service.

Is the service well led?

We saw that there had been a staff team for a number of years so people had continuity of care. There was a manager that had been registered with us and was responsible for the day to day running of the service. This meant that people knew the people that supported them.

Staff told us they were clear about their roles and responsibilities and had regular staff meetings. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This ensured that people received a good quality service at all times.

People were asked about the care they wanted. All the people spoken with told us staff ask them before they do anything. One person told us, 'They ask me what I want, the staff are good like that.' This meant people were consulted about their care.

People received care that met their needs. One person told us, 'This place is smashing, you cannot fault a thing.' People had access to other healthcare professionals when needed. This meant people's health and welfare was monitored.

We saw that systems were in place to keep people safe from harm. Staff received a range of training to support the people who used the service. One person told, 'There's no safer place I think, we are all looked after here'.

The arrangements in place for the safe handling and storage of medicines were not robust and did not ensure people received their medicines as prescribed.

All staff spoken with told us they were supported and received the training they needed to care for people.

There were systems in place to monitor how the service was run to ensure people received a quality service however some audits completed were not robust to ensure all aspect of the service provided was monitored.

Records were stored securely to ensure people's personal information was protected.