CQC report explained · a nursing home
What the CQC found at Ersham House Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Good
- Inspectors found that risks, medicines, infection control, safeguarding and emergency arrangements were managed safely. They also found that staffing shortages had sometimes delayed care and affected people's safety and well-being.
- Effective?
- Requires improvement
- This key question was not inspected during this focused inspection. Its previous rating was used when calculating the overall rating.
- Caring?
- Good
- This key question was not inspected during this focused inspection. Inspectors nevertheless observed and heard that staff were kind, respectful and caring.
- Responsive?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used when calculating the overall rating.
- Well-led?
- Requires improvement
- Leadership and quality systems had improved, but some problems were not identified or sustained. These included staffing oversight, oral health, care plan updates, food and fluid records, and arrangements for camera monitoring.
What inspectors found, June 2023
Requires Improvement overall; inspectors found safe care and kind staff, but staffing and management records still needed improvement.
This was an unannounced focused inspection on 26 and 31 May 2023. Two inspectors spoke with people, visitors, staff and professionals. They observed care, checked six care records, medicines, staff files, training records, rotas and management documents.
The safe rating improved from Requires Improvement to Good. Risks, medicines, infection control and safeguarding were managed safely. However, staffing levels had sometimes been too low, causing delays and affecting people's care, including help with hoisting and meals. Staffing was increased during the inspection.
The well-led rating improved from Inadequate to Requires Improvement. Leadership was more stable and quality systems had improved, but food and fluid records, oral health, care plan updates and camera monitoring still needed work. The home was no longer in breach of regulations, but the overall rating remained Requires Improvement and had done so for four inspections in a row.
Medicines managed safely
Inspectors found that medicines were stored, given and disposed of safely. Staff administering medicines had the required training and checks.
“This inspection found that medicines were stored, administered, and disposed of safely.” from the report
Kind and respectful staff
People and relatives described staff positively. Inspectors found that staff treated people with dignity and respect.
“Staff supporting people were kind and caring. People were complimentary about staff that supported them.” from the report
Improved leadership
A consistent manager had brought more stability. Staff meetings, surveys and learning from incidents were being used to improve the service.
“There was now a registered manager in post which had provided stability and strong leadership for the newly formed team.” from the report
Staffing affected care
seriousStaffing was not always enough to meet people's needs consistently. Inspectors saw delayed care, including delayed help with meals, and a person at risk after food was not monitored properly.
“The staffing levels were not always sufficient to meet peoples' individual needs, there were times when care was delayed or changed because of time limitations.” from the report
Records were not always accurate
needs fixingSome food and fluid records did not match each other or what the person had actually eaten. Some care plans and risk assessments also needed updating.
“There was still some improvements to be made to food and fluid charts, as some were not accurate.” from the report
Oral health improvements were not sustained
needs fixingOral health had been a known issue and earlier improvements had not lasted. New checklists and training were introduced during the inspection.
“Oral health had been identified as an issue in June 2021, improvements had been made in February 2022, but the improvements had not been sustained in the last two inspections.” from the report
Camera monitoring needed clearer agreements
needs fixingCameras were used throughout the building, including communal and staff areas. The provider was asked to show that people and families had been consulted and that the required agreements were recorded.
“We have asked the provider to ensure that people and their families have been consulted” from the report
- 01How many staff are now deployed on each shift, and how do you check that this is enough for my relative's specific needs?
- 02How do you make sure people who need help with eating are monitored after meals and receive food while it is still hot?
- 03How are food and fluid charts checked for accuracy, and what happens when records disagree?
- 04What oral health checks and staff training are now in place, and how will you make sure the improvements continue?
- 05Who has been consulted about the cameras, and how are agreements recorded for people who cannot make this decision themselves?
This was an unannounced focused inspection of Safe and Well-led; the other key question ratings were not inspected and the previous ratings were used in calculating the overall rating. This explanation was written from the published report of 28 June 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, September 2022
Ersham House Nursing Home was rated Requires Improvement, with Inadequate leadership and serious shortfalls in safety, records and oversight.
This was an unannounced focused inspection on 18 and 22 August 2022. Inspectors looked only at Safe and Well-led because of concerns about cleanliness, infection control, care and staffing. They spoke with people, visitors, staff, managers and professionals, observed care, and checked records.
The home was not always safe. Inspectors found problems with pressure-relieving mattresses, wounds, swallowing risks, thickened drinks, medicines, cleanliness, infection control and staffing. Some records were missing or inaccurate, so staff could not always monitor people's needs safely.
Leadership was rated Inadequate. There was no registered manager, and the home had had six managers since registration. Quality checks had not found or sustained improvements in important areas such as care records, staff skills, cleanliness and risk management.
The overall rating remained Requires Improvement. This was the third time the home had received this rating. The report says some changes were made during or after the inspection, but the provider remained in breach of regulations and CQC will continue to monitor progress.
Falls planning
People at risk of falls had assessments describing the risks and actions staff should take. Sensor mats were also used for some people.
“People who were identified at risk from falls had an assessment that highlighted the risk and described the actions staff should take to reduce that risk.” from the report
Basic recruitment checks
The home completed important checks before staff started work, including DBS checks and checks that nurses' registration was current.
“Recruitment checks were carried out before staff started work at Ersham House.” from the report
Learning from incidents
The manager used accidents, incidents, complaints and safeguarding matters to identify learning and actions for staff.
“The manager told us they used accidents, incidents, complaints and safeguarding as learning tools to improve the service.” from the report
Improved professional links
Inspectors were told that communication with health and social care professionals had improved under the new leadership.
“There had been a fractured relationship between the service and GP, however it has been confirmed that communication has improved under the new leadership in the home” from the report
Pressure and swallowing risks
seriousSix pressure-relieving mattresses were set incorrectly. Inspectors also found unsafe support with food and drinks, including incorrect thickened fluids and people being assisted in unsafe positions.
“We found six mattresses set incorrectly. This had been identified at the last inspection and has not been addressed.” from the report
Medicine safety
seriousOne medicine was left on a person's bedside table without staff staying to check it was taken. Another medicine was found on the floor, and some required guidance for as-needed medicines was missing.
“The provider had not ensured the safe storage, management and administration of medicines.” from the report
Cleanliness and infection control
seriousSome bedrooms and bathrooms were unclean, with debris, dust, sticky surfaces and overflowing bins. Cleaning records had gaps, and infection control procedures were not followed consistently.
“The home was not clean in all areas.” from the report
Staffing and competence
needs fixingThere were not enough trained housekeeping staff, and the mix of inexperienced and agency staff affected safe care. The rota was inaccurate and staff competencies had not always been checked.
“Whilst there were sufficient numbers of care staff deployed, the mix of inexperienced and agency staff had not ensured people received the appropriate support to keep them safe and ensure their well-being.” from the report
Weak leadership and records
seriousThere was no registered manager and six managers had been in post since registration. Audits had not identified important risks, and care records and daily monitoring charts were not consistently accurate or complete.
“There was no registered manager in post. There had been six managers since the service was registered in March 2020.” from the report
Mental capacity decisions
needs fixingSome restrictions, including locked doors and close supervision, did not have the required best-interest records or legal authorisation in place. Inspectors made a recommendation about this.
“One person was in receipt of close one to one supervision to prevent them leaving the premises during the day.” from the report
- 01What evidence can you show that all pressure-relieving mattresses are now set correctly and checked regularly?
- 02How do you make sure people with swallowing difficulties receive the correct food and drink texture, and that staff are competent to support them?
- 03How are medicines now given, recorded and checked, including as-needed medicines and medicines that are dropped or refused?
- 04How many trained care, nursing and housekeeping staff will be on duty for my relative, and how do you check their competence?
- 05Who is currently responsible for the home each day, and how are care records, cleanliness and risk management being audited?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive were carried forward from the previous inspection. This explanation was written from the published report of 30 September 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Ersham House Nursing Home
9 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- June 2023Requires improvementcurrent ratingstayed Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2022Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Inadequate
- March 2022Requires improvementSafe: Requires improvementWell-led: Requires improvement
- August 2021Inspected but not ratedSafe: Inspected but not rated
- June 2021Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2020Inspected but not ratedSafe: Inspected but not ratedWell-led: Inspected but not rated
- June 2019Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2018Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- October 2017Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- May 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Inadequate
- August 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2020
Registered with the Care Quality Commission on 25 March 2020.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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Most charge £1,000 to £1,400 a week. 13 can care for a couple. 10 years' experience on average.
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