Archived: Easthill Home for Deaf People

We found the following examples of good practice.

There were procedures in place to support safe visiting by family members or professionals. Staff undertook screening of all visitors including temperature checks and a questionnaire to determine risks posed by visitors. Rapid response lateral flow tests (LFT) were undertaken for visitors before they entered the home. Visitors were provided with Personal Protective Equipment (PPE) and guided to its safe use.

People and staff were regularly tested for COVID-19. Staff had LFT testing twice a week as well as standard Polymerase Chain Reaction (PCR) tests weekly. The registered manager understood the actions they needed to take should any tests return a positive result.

The service had a good supply of PPE to meet current and future demand. Staff were using this correctly and in accordance with current guidance and disposal was safe at the time of this inspection. The home supported Profoundly Deaf BSL users. Special face masks were in use which enabled staff mouth’s to be visible via a plastic ‘window’ enabling communication via lip reading to continue.

New admissions to the service were supported in line with best practice guidance. All new admissions were expected to provide recent COVID-19 test results, were further tested by the service following admission and isolated upon arrival for 14 days to minimise the risk of potential infection to existing people. These procedures were also followed when existing people returned to the home following a hospital stay.

Staff had undertaken additional training to administer insulin meaning there was a reduced need for community nurses to attend the home.

Staff had been trained in infection control practices and individual risk assessments had been completed for vulnerable staff members.

The home was kept clean. Staff kept detailed records of their cleaning schedules, which included a rolling programme of continuously cleaning high touch surfaces, such as light switches, grab rails and door handles.

At our last inspection in November 2015, we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. The service was meeting all relevant fundamental standards of care. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

This inspection took place on 14, 15 and 29 June 2018 and was unannounced.

The home accommodates up to 15 people and specialises in supported older deaf people whose primary means of communication is British Sign Language (BSL). At the time of our inspection 10 deaf people, were living at the home. The home was based on three levels connected by stairwells, a passenger lift and a stair lift. All bedrooms had sink facilities and bath or shower rooms were available on each floor, together with communal areas where people could socialise.

There was a registered manager in post at 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.

People felt safe living at the home. Staff knew how to identify, prevent and report abuse. They assessed and managed risks to people and risks posed by the environment effectively.

Arrangements were in place for the safe management of medicines. People received their medicines as prescribed. The home was clean and hygienic and staff followed best practice guidance to control the risk and spread of infection.

There were enough staff to meet people’s needs in a timely way. Appropriate recruitment procedures were in place and pre-employment checks were completed before staff started working with people.

People’s needs were met by staff who were competent, trained and supported in their role. Staff acted in the best interests of people and followed legislation designed to protect people’s rights and freedom.

People’s dietary needs were met and they received appropriate support to eat and drink enough. Adaptations and improvements had been made to the home to make it supportive of the people living there.

People were supported to access healthcare services when needed. Staff made information available to other healthcare providers to help ensure continuity of care and supported communication between people and health professionals.

People were cared for with kindness and compassion. Staff knew people well and built positive relationships with them. They were skilled at communicating and engaging with people and adapted BSL to effectively meet people’s communication needs.

Staff protected people’s privacy and dignity. They encouraged people to remain as independent as possible and involved them in planning the care and support they received.

People’s needs were met in a personalised way. Each person had a care plan that was centred on their needs and reviewed regularly. Staff empowered people to make choices and responded promptly when people’s needs changed.

People had access to a range of activities based on their individual interests, including regular access to the community. They knew how to make a complaint and an accessible complaints procedure was in place.

Staff took account of people’s end of life wishes and preferences. They supported people to remain comfortable and pain free.

People and professionals who had regular contact with the home felt it was run well. Staff were organised, motivated and worked well as a team. They enjoyed working at the home and told us they felt valued.

There was an open culture where people were consulted and staff enjoyed positive working relationships with health and social care professionals. There were effective quality assurance systems in place to help ensure the safety and quality of the service.

At this inspection, on 9 and 17 September 2014, we looked at outcomes relating to the compliance actions. We also looked at outcomes relating to: care and welfare; infection control; and staffing to assess whether the provider was meeting the requirements of the regulations.

The inspection was carried out by an adult social care inspector and an expert by experience in dementia. This is a person who has personal experience of using or caring for someone who uses this type of care service.

At the time of our inspection there were 13 people living at the home. We spoke with six people, using British Sign Language (BSL) interpreters, spoke with a visiting community nurse, three members of staff and the registered manager. We also spoke with staff from: the community dental clinic, the risk office of the local hospital and the fire and rescue service. Following the inspection we discussed our concerns with the local safeguarding authority.

We considered all the evidence we had gathered under the outcomes we inspected and used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found:

Is the service safe?

We found the service was not safe. There were not enough skilled and experienced staff to meet people's needs at all times. The manager told us they needed three members of care staff during the day, but this was not achieved regularly. A member of staff described staffing levels as 'very poor' and said this put people at increased risk. One person told us they sometimes had to wait for assistance. They said, 'They help [another person], but sometimes I get forgotten'.

People were not protected from the risk of infection because appropriate guidance had not been followed. Infection control risk assessments and audits had not been completed and not all staff had been trained in the prevention and control of infection.

There were arrangements in place to deal with foreseeable emergencies, but these were not robust. The effectiveness of these arrangements when there were no hearing members of staff on duty had not been tested and staff had not been trained in fire safety.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service had policies and procedures in place in relation to MCA and DoLS, although these were not understood well by staff. During the inspection the manager made an application for a DoLS authorisation for one person and staff were due to receive training in MCA in the week of our inspection.

We saw an example of a decision that had been taken in the best interests of a person who lacked mental capacity. However, other decisions taken on behalf of people were not documented and it was not clear why or how these decisions had been made. These included decisions relating to medicines and access to the keypad code to allow people to leave the building.

Is the service effective?

Not all aspects of the service were effective. Staff did not receive appropriate and timely training. Approximately half the courses where staff were due to receive initial training or refresher training in core subjects, such as infection control, health and safety, and food safety were overdue. A system of supervisions and appraisals for staff had not been implemented, so staff did not receive appropriate support.

There was a lack of information in care plans about when staff needed to administer medicines that were prescribed on an 'as required' basis. For people who had their blood sugar levels monitored, there was no information about the range of levels that was normal and safe and what action staff should take if their levels were outside of this range.

The arrangements for ensuring people were supported to access healthcare were not always effective. A dental appointment for one person had been cancelled and another person had not been supported to attend an appointment following surgery and an appointment to have a blood test.

Is the service caring?

People told us staff were caring. One person described staff as 'good people'. We observed staff interacting positively with people, for example by kneeling down so they communicated on the same level as people in chairs; they also used touch, where appropriate, to calm, relax and show empathy with people.

However, parts of the environment were not conducive to people's welfare. For example, some areas needed decorating; some carpets were worn; the curtains in one person's bedroom were hanging off the rail, so they were unable to close them fully. For those people who were living with dementia, the d'cor did not support them to navigate around the home, as there was a lack of colour contrast and few signs.

Is the service responsive?

The service was responsive. More deaf staff had been recruited to help people communicate their needs and wishes better using BSL. People told us this was a positive step. One person said staff used BSL 'to talk to me about help and care'.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were personalised and had been developed either with the person concerned or their family members. They included plans to meet the person's physical and emotional needs and information about how to communicate with the person.

People told us they were happy with the quality of care and support they received. A visiting community nurse told us they had 'no concerns' about the home.

Is the service well-led?

The service was not well-led. The action plan developed to achieve compliance following our last inspection had not been completed. People were not asked for their views about their care and treatment and the provider did not have a system in place for obtaining the views of staff.

We found audits of medicines were conducted and the findings used to ensure medicines were managed safely. However, the manager told us there had been no audits to assess and monitor the quality of any other aspects of the service and they had not identified all the concerns we found during our inspection. Therefore, people could not be sure that shortcomings in the service would be identified and corrected in a timely manner.

We saw most actions detailed in a fire safety action plan had been completed; however, some actions were still outstanding, including the training of staff and the completion of work to bring a fire door up to the required standard.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to consent; care and welfare; infection control; staffing; supporting workers; and assessing and monitoring the quality of service provision.

We found people's care and support were provided in an environment where the specific needs of deaf people and deaf culture were understood. Suitable adaptations had been made to the building so people were living in a safe environment. Staff were aware of people's care needs and supported them in a caring manner. Care and support were delivered with people's consent. However where people did not have the capacity to consent, there was incomplete awareness of the legal requirements. Staff were not supported by an effective system of appraisal and supervision, and training in compulsory topics was not refreshed regularly. The provider's systems for monitoring the quality of the service were not effective or comprehensive.

We carried out this inspection with an expert- by-experience who was a counsellor and advocate for deaf people, and a BSL interpreter. They found it to be 'a nice home" where people received appropriate care according to their needs and where they were safe from harm.

In this report the name of a registered manager appears who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. An interim manager was managing the regulated activity and is referred to as 'the manager' in this report.

We spoke with three out of 14 people using the service and a social worker who was visiting one of their clients. They told us Easthill was a friendly place with 'good relationships between staff and residents'. They said that care and support were delivered according to people's needs, and that they were given choices. People's care was adapted to the individual and their independence and privacy were respected.

We found that people were involved in their care and support, which was delivered according to person centred care plans. People using the service were protected against the risk of abuse. The provider had effective recruitment and induction processes and made the necessary checks before new staff started work. There were systems in place to monitor and improve the quality of the service.

We carried out this inspection with an expert-by-experience who was an advocate for deaf people. They found it to be a 'nice home where residents received appropriate care and [attention to their] needs to make sure they were safe from harm.' There were members of staff who understood deaf culture because they were themselves deaf or had deaf family members.