Eastwood House

We found the following examples of good practice.

¿ Appropriate measures were in place at the entrance and inside the home to prevent visitors from spreading infection. All visitors had their temperature checked.

¿ There were good stocks of personal protective equipment (PPE). There was clear signage on the correct use of PPE and handwashing techniques, and staff had received appropriate training in infection prevention and control.

¿ There were good systems of testing for COVID-19 for people and staff. Appropriate measures were in place when people were admitted to the service to ensure they, and other people, remained safe.

¿ Staff supported people’s social and emotional wellbeing. Measures were in place to ensure they kept in touch with family and friends.

¿ The staff had been innovative in how they had decorated the home for Christmas whilst ensuring safe standards of hygiene could be maintained. They had decorated the garden and exterior of the windows which looked very festive.

¿ The staff spoke positively about the management support and excellent team approach in meeting the challenges they were facing during the pandemic.

Further information is in the detailed findings below.

Eastwood House is a residential care service providing personal care to a maximum of 19 older people, some of whom are living with dementia. At the time of this inspection there were 14 people using the service.

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

People living at Eastwood House were happy and well cared for. Since the last inspection, there had been improvements in the management of risk, safe staffing levels, management of medicines, staff training and the quality of care records.

Consent records mostly demonstrated people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. People’s choices were respected by staff.

The provider had introduced a new quality monitoring system, but some recent improvements needed to be embedded and sustained. For example, the recording of the application of the Mental Capacity Act 2005, environmental safety and staff supervision. More robust audits and monitoring were needed to drive improvements around odour management and furniture renewal.

Staff were safely recruited safely. Staff knew how to recognise signs of abuse and were confident reporting any concerns they may have. People told us they felt safe and well supported.

The home was friendly and welcoming. The provider and deputy manager promoted a very person-centred culture. Staff worked effectively together in supporting people’s needs and preferences, which had a positive impact on all aspects of their well-being.

Staff were kind and caring and encouraged people to engage with their relatives and friends. Staff supported people to be socially included and participate in activities and events.

People were treated with dignity and respect and their independence was promoted. Communication care plans were in place to support people’s communication preferences. Relatives spoke positively about the service.

People ate nutritious, well cooked food, and said they enjoyed their meals. People had access to health and social care professionals when needed and staff followed any guidance provided.

People were given opportunities to express their views and make suggestions, these were listened to and respected.

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 27 June 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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.

At the last inspection in August 2017, we rated the service requires improvement. We found breaches in regulations which related to information in care plans, consent and overall governance of the service. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Responsive and Well-led to at least good. Whilst we found some improvements in aspects of care recording, there were some continued concerns with consent and governance. We identified new concerns in relation to the management of risk, medicines, staffing and notification of incidents. At this inspection, we have rated the service as requires improvement again.

Providers should be aiming to achieve and sustain a rating of 'Good' or 'Outstanding'. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not fully effective. As this is the second time in a row the service has been rated Requires Improvement, we will meet with the provider to discuss their action plan for improvements.

Eastwood House accommodates up to 19 elderly people. The building is a converted domestic house that has been extended. Bedrooms are provided on both the ground and first floors with access via a passenger lift. There is a lounge and conservatory area that is used as a dining room. At the time of this inspection 17 people were using the service.

Eastwood House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service was owned by an individual person and they were the registered manager. They also managed their other care service in Lincolnshire. We have referred to this person as the provider throughout the report. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The provider had appointed a deputy manager to manage the day to day running of the service, this had been a long standing arrangement.

We found the application of mental capacity legislation remained inconsistent. Documentation showed some capacity assessment and best interest decision-making records had not been completed appropriately. It was not clear if some people had legal representatives appointed to support them or make decisions on their behalf. We found some people may meet the criteria for a deprivation of liberty safeguard but this had not been completed.

There was a lack of robust risk management; areas of risk had not been accurately assessed and planned. There was a lack of systems to check on-going concerns. This related to the environment, equipment used in the service and people's individual risk assessments. There were shortfalls with the management of medicines and some people had not received their medicine as prescribed due to staff error.

We found there were shortfalls of staff on duty during the day, this had impacted on observation of communal areas at specific times of the day to prevent accidents and distract people whose behaviour could be challenging.

Although the provider had put a new audit programme in place, we found some continued concerns regarding effective quality monitoring. Shortfalls had been missed when audits were completed or action plans had not been put in place to address all the improvements needed. Examples included care records, the environment and accident analysis. We also found the office and recording systems were disorganised.

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

The provider had failed to ensure all statutory notifications of events in the service had been submitted to the CQC. We are dealing with this matter outside the inspection process.

The staff supervision programme and been inconsistently maintained and not all staff had received their annual appraisal. Staff had access to a range of training. There were some shortfalls and delays with staff completing some courses or refresher training. Although staff had completed training in mental capacity legislation, we found their understanding was limited. We have made a recommendation that the provider follow through with improvements to the training, supervision and appraisal programmes to ensure that identified gaps are addressed quickly.

Staff were responsive to people's needs and supported them in an individual way. They knew people very well and could describe in detail the support they required. People and their relatives had only positive comments about the staff approach and described it as caring and kindly. We observed staff were friendly and attentive to people and their relatives. Improvements were needed with aspects of their communication and how they ensured one person’s privacy as this person was upset with other residents entering their room on a regular basis.

New care plan documentation had been put in place and the quality of person-centred records had improved to support the consistent delivery of care which met people’s preferences.

Recruitment systems remained safe. Staff turnover at the service was low and provided continuity of care for people.

People's health care needs were met and they had access to community health care professionals who visited the service to provide treatment and advice. We received positive comments from visiting professionals about the service and the standards of care. People could remain in the service for end of life care if this was their choice.

People's nutritional needs were met and they liked the meals provided. There was plenty to eat and drink. People were provided with a good range of fortified snacks.

A new activity coordinator had been employed and people had more opportunities to participate in a range of activities and receive social stimulation.

The environment was clean and tidy and staff had access to personal protective equipment to help prevent the spread of infection.

The views of people and their relatives were sought during care reviews, resident meetings and surveys. There was a complaints procedure displayed in the service and people felt able to raise concerns and complaints.

Staff found the provider and deputy manager approachable and felt confident they could go to them for advice and guidance.

The service was owned by an individual person and they were the registered manager. They also managed the organisation’s other service in Lincolnshire. We have referred to this person as the provider throughout the report. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

We found the quality monitoring programme was limited. This had resulted in shortfalls being missed when audits and checks were completed and when some issues were identified, these had not been addressed in a timely way. Areas included care records, incident recording, safety checks, equipment, training and the environment. Accidents and incidents had not been analysed to help find ways to reduce them.

There was some inconsistency with the application of mental capacity legislation. Some people had assessments of capacity and records of best interest meetings when restrictions were in place, but this was not consistent throughout the service.

People had assessments of their needs completed and care plans developed but these were not always thorough and information was missing from them. This meant important care could be missed or care delivered which wasn’t in line with people’s preferences.

You can see what action we told the provider to take regarding consent, care planning and quality monitoring at the back of the report.

The staffing levels were reviewed and increased on the second day of the inspection to ensure there were sufficient staff on duty in the evenings. The provider confirmed they would review and increase the number of hours allocated to the deputy manager to complete the management and administration duties. People were cared for by a stable staff team who knew them well.

Staff were recruited safely which ensured employment checks were in place prior to new staff starting work. Staff understood how to protect people from harm and abuse and were clear about reporting procedures. Generally, there were safe systems in place to manage risks to people’s health and safety although there were gaps in some safety checks and assessments.

People who used the service and their relatives were complimentary about staff approach. They said staff were kind and caring and respected people’s privacy and dignity. The atmosphere was relaxed and we saw staff knew people well. People's views were sought during care reviews, resident meetings and surveys.

Staff had access to training, supervision and support. Gaps in training had been identified, plans made and courses booked to address shortfalls. An appraisal system was scheduled to start the following month. Staff told us they felt very supported by the deputy manager and were able to raise concerns. There were staff meetings which enabled them to receive information and express their views.

Overall medicines were managed safely; we found some minor shortfalls with recording and stock control which the provider was addressing.

People had access to community health professionals for advice and treatment. Staff generally knew when to consult these professionals, we found there had been a delay in requesting an assessment from an occupational therapist for a person’s whose needs around mobility support had changed. This was followed up during the inspection.

People who used the service were provided with nutritious and well balanced meals and had access to drinks and snacks at any time during the day.

A varied programme of entertainment and activities was available and we saw people enjoying group activities. Relatives told us the staff were always welcoming and we saw staff supported people who used the service to maintain relationships with their family.

There were systems in place to manage complaints and people who used the service and their relatives told us they felt able to raise concerns and complaints.

We considered all the evidence we had gathered under the outcomes we inspected. We 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.The summary is based on our observations during the inspection, speaking with relatives and people who used the service and speaking with staff. We also looked at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been maintained and checked regularly. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw an appropriate application had been made about this for one person to ensure their rights were protected.

There were not enough staff always available to meet the needs of all the people who used the service.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring there are sufficient numbers of suitably qualified, skilled and experienced persons available at all times to safeguard the health, safety and welfare of people who used the service.

Is the service effective?

People told us they were happy with the support they received and felt their needs were met. It was clear from what we saw, and from speaking with staff, that they understood people's care and support needs and knew them well.

Is the service caring?

People told us they were supported by kind and attentive staff. We saw that care staff were patient and gave reassurance and encouragement when supporting people.

Is the service responsive?

People's needs had been assessed before they moved into the service. Care records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes.

Is the service well-led?

Staff had a good understanding of the ethos of the service and quality assurance processes were in place. People told us they were asked for their views about the service. We saw people's views about the food served had been listened to and as a result, changes to the menu had been made.

What people who used the service and those that matter to them said about the care and support they received:

A group of visiting relatives told us they had recently made an active choice about using the home and were very happy with the service given.

One relative told us, 'I am more than happy with the patience and dedication shown by staff.' Whilst another told us their member of family had, 'Come to life' since moving into the home

On the day of our inspection, a review of a person's placement in the service was completed by staff from the health authority. We spoke with the health professional involved in the review. They told us they had no concerns and were happy that this person was supported appropriately and the service was meeting their needs.

There was evidence that administrative systems had been developed to enable the provider to monitor the health, safety and welfare of people who used the service. We saw this included regular checks of care plans, incidents and accidents that had occurred.

A programme of regular monthly meetings with staff had been implemented since the last time we visited, to ensure they were aware of their responsibilities and to enable leadership and direction to be provided to them.

We found that surveys which covered different aspects of the home had been recently issued to people who used the service, their relatives, staff and professionals. The outcome from these was overall very positive. We saw comments in these which included, 'Staff very respecting', 'Everyone very friendly', 'Welcoming', 'Bright and cheerful'. We saw that a district nurse had commented in a survey that staff were; 'Very approachable' and that they had 'Never had any problems.

People who used the service told us they were happy with the way they were given their medicines and received these at regular times.

People told us they were, 'Comfortable' and liked their rooms. We found that whilst the home was neat and tidy, the provider may find it useful to note we observed that arrangements to ensure it was kept clean would benefit from further improvement.

People told us staff were, 'A good bunch 'and 'Do a good job'. People said staff supported them well and that they had no complaints. They also told us they were happy with the care and support delivered. People told us they were, 'Confident' that appropriate action would be taken to resolve concerns that were raised and were, 'Satisfied' with the service they received.

Whilst the provider had some systems in place to assess and monitor the quality of service that people received, we found that the operation of these had not been applied in a planned or consistent way. The failure to provide an effective system to regularly assess and monitor the quality of the services limits the provider's ability to identify shortfalls in the quality of the service delivered, which may put people at risk of inappropriate or unsafe care.