The inspection took place on 18 May 2016 and was unannounced. Three inspectors carried out the inspection. Echelforde provides accommodation and personal care for up to 50 older people, some of whom are living with dementia. There were 43 people living at the service at the time of our inspection. There are five units, each accommodating up to ten people.
There was 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 and associated Regulations about how the service is run.
At our last inspection in October 2015 we found breaches of Regulation 9, Regulation 12, Regulation 17 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued warning notices in relation to Regulation 12, Regulation 17 and Regulation 18. We required the provider to have met the warning notices by 15 January 2016.
The provider also sent us an action plan telling us how they would make improvements in order to meet the relevant legal requirements by 15 January 2016.
Following the last inspection the service was placed into special measures. This inspection found the quality of care people received had improved sufficiently to change the service rating from inadequate to requires improvement. This meant the service was removed from special measures.
Although action had been taken to address the concerns identified at our last inspection further improvements were needed.
At this inspection, we found the number of staff on duty reflected the staffing rota. People, relatives and staff told us this had improved the care people received. People told us they no longer had to wait unacceptable lengths of time to receive their care. Staff said they had more time to spend with people.
Although the numbers of staff deployed had increased since our previous inspection, staff told us people would benefit from a further increase in staff. The registered manager told us the provider was actively recruiting to enable additional staff to be deployed on each unit.
The provider had taken action to maintain the safety of people who tried to leave the service. The security of the premises had been improved.
The leadership of the service and the support provided to staff had improved. A new manager had been appointed and had achieved registration with the CQC. The registered manager was clear about the areas in which the service needed to improve and recognised the importance of seeking the views of people, relatives and staff to achieve improvements in the service.
People, relatives and staff told us the registered manager had improved communication with them. They said they had been encouraged to contribute their views and that these were listened to. Quality monitoring checks had been more effective in identifying areas of the service that needed improvement.
Staff did not always use appropriate moving and handling techniques when supporting people. Equipment used to transfer people was not being used as identified in one person’s care plan.
The majority of staff were caring in their interactions with people but some staff did not act in a way that maintained confidentiality.
Opportunities for people to take part in activities had increased and were provided in the service’s day centre. However, there were limited opportunities to access activities for people who chose to stay in their individual units.
Assessments and care plans did not record details about people’s lives before they moved into the service, which meant staff did not have the information they needed to engage with people about their life history or their interests and hobbies.
Staff understood safeguarding procedures and were aware of their responsibilities should they suspect abuse was taking place. Risk assessments had been carried out to identify any risks to people and measures implemented to address them. A fire risk assessment had been carried out and staff had been trained in fire safety. People’s medicines were managed safely.
The provider’s recruitment procedures were robust, which helped to ensure that only suitable staff were employed. Staff attended an induction when they started work and had access to ongoing training and supervision.
People were cared for in line with the requirements of the Mental Capacity Act 2005 but information recorded about some people's capacity was inconsistent.
People told us they enjoyed the food provided. They said they had a choice of dishes at each meal and had access to drinks and snacks outside mealtimes. Relatives told us their family members’ dietary needs were known by staff and that their family members were encouraged to maintain adequate nutrition. Staff monitored people’s health and supported them to make a medical appointment if they became unwell.
People had been given information about how to complain. Any complaints received had been investigated and responded to in line with the provider’s complaints procedure.
We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.