Archived: Eden Grange

Updated 1 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by the information we held about the service and notifications of incidents at the service. Information shared with CQC via stakeholders and people working at the service was also taken into account.

The inspection took place on 12 December 2017, 24 and 26 January 2018 and was unannounced.

The inspection was carried out by three adult social care inspectors, a pharmacist inspector (who assessed the safety of medicines management at the home) and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience had expertise of the care of older people and people living with dementia.

Prior to our inspection visit we reviewed the information we held about the service, for example notifications. A notification is information about important events which the service is required to send us by law. In addition we spoke with representatives from the local authority, the clinical commissioning group and the local safeguarding team.

We did not ask the provider to complete a Provider Information Return (PIR) on this occasion as they had given us an action plan during the registration process. The provider had also given us an updated action plan in respect of the service. A PIR is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

We planned the inspection days taking into account all of this information.

During the inspection we spoke with two of the people who used the service and four relatives. A high proportion of the people who lived at Eden Grange were unable to communicate with us. We informally observed staff supporting people with their needs (in communal areas), to help us understand the experience of people who could not talk with us.

We spoke with 15 members of staff including the registered manager, the regional manager, the home manager, deputy manager, carers, cleaners, kitchen staff and maintenance staff.

After the first day of our inspection, we met with the provider, director, operations manager and registered manager to discuss our concerns, give the provider the opportunity to review their action plan and revise this where necessary.

We reviewed the care records of five people and looked at the medicines and medicine records of nine people who used the service. We looked at a sample of the policies, procedures and records that related to the service. We looked at the personnel files of two recently recruited members of staff. We sampled a selection of the staff appraisal records which had been carried out by a manager at the home. We also reviewed the staff training records that were available at the time of our inspection, including the staff training matrix.

During the inspection we asked the registered manager and the operations manager to send us information relating to staff meetings, residents meetings and policies and procedures relating to keeping people safe, complaints and quality assurance reports. These documents were sent to us as requested.

Updated 1 June 2018

The inspection took place on 12 December 2017, 24 and 26 January 2018 and was unannounced.

This was the first inspection of Eden Grange. The home had previously been owned by a different provider, who had failed to meet the legal requirements. Cinnabar Support and Living Limited purchased this service in October 2017 and provided us with an action plan as part of the registration process. The action plan outlined what the new provider would do and when it would be done by in order to make improvements to the service and meet the legal requirements.

Eden Grange 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.

The care home is registered to accommodate up to 33 people, over two floors in one building. The home provides care mainly to older people, some of whom are living with dementia. People living at the home have their own bedroom and access to shared (communal) facilities such as bathrooms, toilets, dining room and lounge areas. At the time of our inspection there were 19 people living at Eden Grange.

The management of the service was shared between several people, although there was a registered manager for the service who was in attendance on the first day of our inspection visit to the home. 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 registered manager was not based at Eden Grange as they were also the registered manager for another care home operated by the same provider. At the first inspection visit a new manager had been appointed who stated they intended to apply for registration with the Care Quality Commission. At the time of the last visit to the service the new manager had left their employment. At that time the home was being managed by two senior managers, each covering part of the week.

On the first day of our inspection we identified a number of concerns at the home including the lack of person centred care plans, out of date risk assessments, poor management of some medicines, nutritional needs and governance systems. We were also concerned about the general environmental standards at the home. We wrote to the provider about these concerns, requesting a revised action plan. On 16 January 2018 we also met with the provider’s senior management team to discuss our findings and concerns. We asked for information about the actions they would take to make improvements quickly. The provider gave us the information we asked for including timescales for completion. However, on the subsequent inspection visits we noted that some improvements had been made but there were areas that still required attention.

We found that people had access to health and social care professionals when needed, although their advice and instructions were not always recorded in care notes or followed by staff. This was particularly evident with regard to nutritional support and supporting people with their mobility.

Medicines had not always been managed in a safe way, particularly in relation to when required medicines such as pain killers and skin care ointments.

The care plans that we reviewed had been updated and mostly reflected people’s needs in a person-centred way.

Staff skills, knowledge and numbers were not always sufficient to meet the needs of the people who lived at Eden Grange. On the days of our inspection visits the staff on duty were continuously busy. We observed that people had to wait for staff to help them. Communal areas were left unattended and the service of the lunchtime meal was disorganised. We were unable to assess whether there were a sufficient number of staff on duty. The provider had not yet introduced a system to calculate how many staff were needed throughout the day and night in order to meet the needs of people using the service. There was a continuous staff recruitment process in place. The recruitment process was mostly operated in a way that helped to protect people from unsuitable staff.

A staff training plan was in the process of being developed to help improve staff skills and knowledge. Most staff had started to receive some training and updates.

We noted that the provider had started to make improvements to some of the bedrooms that were not in use at the home and a new laundry had been installed. However, the general condition of the environment and communal areas such as toilets and bathrooms was poor. There were areas of the home with an unpleasant odour and some of the communal rooms had been used as storage areas for handling equipment.

We asked the provider for a schedule of works to help us understand how, and by when the improvements to the home and the environment would be made. The provider has not given us this information.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible. Policies and systems at the service did not support the requirements relating to consent. The human and legal rights of people who used this service were not protected because staff did not have a good working knowledge of the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The provider was in the process of developing systems to help identify and manage quality assurance and safety at the service. There were gaps in the governance and performance management at the home and this impacted on the provider’s ability to effectively target areas requiring improvements.

We observed that staff treated people with kindness and were mindful of their privacy and dignity. Staff were attentive and worked hard to try and support people in a timely manner. The people who lived at Eden Grange looked cared for and well groomed. No one at the service raised any concerns with us during our visits to the home.

We found that the provider was not meeting the regulations. People did not always receive care and treatment that was person centred or that reflected their needs and preferences. People did not receive safe care and treatment and were not always protected against the risks of harm or abuse. People did not always receive the support and monitoring they needed to ensure their nutritional needs were met.

Effective quality assurance systems had not been implemented and monitored to help ensure the wellbeing and safety of people who used the service were protected. Although the provider had developed plans to help bring about improvements to the service, they failed to take effective action in a timely fashion.

We found that there were multiple breaches of the regulations, People did not receive safe care and treatment that was person centred or that reflected their needs and preferences. The human and legal rights of people who used this service were not protected because staff did not have a good working knowledge of the principles of the MCA 2005 and DoLS. Quality assurance systems were ineffective and had not fully identified and addressed the impact on the wellbeing and continued safety of people who used the service

You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will normally be kept under review. However, in the case of Eden Grange, during the inspection process the provider made the decision to close the home and applied to the Commission to remove this location from their registration.