Archived: Eachstep Blackley

Eachstep Blackley is a nursing and residential care home providing personal and nursing care to 55 people aged 65 and over at the time of the inspection. The service can support up to 60 people.

The home has two nursing households and three residential households for people living with dementia across three florrs. Each household is able to accommodate up to 12 people. Each household has a kitchen, dining and lounge area. All bedrooms have an en-suite shower, with adapted bathing facilities available on each floor.

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

People across the service had person-centred care plans and risk assessments in place. These identified people’s support needs and gave guidance for care staff in how to meet these needs.

Since our last inspection, the quality assurance system had been improved and was more robust. A planned series of audits were undertaken and management reports monitored a range of topics, including people’s weights and pressure area care.

People received their medicines as prescribed. Staff liked the electronic medicines administration record system as they thought it reduced the risk of medicines errors being made.

People and relatives thought they were safe living at Eachstep Blackley. All accidents and incidents were recorded and reviewed to identify any actions to reduce the risk of a re-occurrence.

Equipment was checked, maintained and serviced in line with regulations and guidelines.

Staff were safely recruited. There were sufficient staff to meet people’s needs, but staff were busy at key times which meant there were no staff in the communal areas of the households for up to 20 minutes at a time. This could be a risk if people became anxious. Domestic staff completed all care courses and were visible on the households during the morning busy period.

Staff received the training and support to carry out their roles. Staff were positive about the support they had from the nurses, senior carers and managers.

The home was visibly clean throughout. People and relatives told us it was always clean.

People were supported to maintain their health. Referrals were made to medical professionals appropriately. Medical professionals were positive about the home, saying staff were always available to support the person during their visit and knew the people they were coming to see.

People were supported to maintain their food and fluid intake. Meals were bought prepared and so had the correct nutritional values and consistency. People’s weights were monitored and fortified foods offered to those at risk of losing weight.

People and relatives said that staff treated them with dignity and respect. Staff clearly explained how they maintained people’s privacy and independence when providing support.

People’s cultural needs were recorded and were being met. A range of culturally appropriate meals were available. People’s communication needs were recorded, and staff knew how they communicated and made decisions.

People and their relatives were involved in agreeing the care plans. Meetings were held for residents and relatives to gain their feedback. An annual survey was also conducted.

A planned activity was arranged each day, mainly in the afternoons. We did not observe staff having the time to engage people in activities on the households as they were busy supporting people.

Eachstep had a range of links with the local community, including local schools and students volunteering at the service as part of their health and social care college course. The building was used as a community hub, with a café and space for community groups to meet, for example a dementia support group for people living in the local area.

Many people’s end of life wishes were not recorded. The registered manager said a lot of people did not want to discuss this. A new model to support people at the end of their lives called Palliative Care for Older People (PACE) was being introduced. However, the recording of end of life wishes had not progressed since our last inspection when a model of care called the Six Steps was to be used to encourage people to discuss their end of life wishes.

A relative told us the end of life support for their relative was very good. Staff knew the support they required to be comfortable.

Complaints were responded to appropriately.

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; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 26 June 2018) and there were three breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

Eachstep Blackley is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Eachstep Blackley accommodates up to 60 people. There are five households across three floors. Two households provide nursing care and three provide residential care for people living with dementia. At the time of our inspection there were 54 people living at the home.

There was a registered manager who had managed the service since it opened in 2012. 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.

At this inspection we found breaches in the regulations for person-centred care, safe care and treatment and good governance.

Care plans and risk assessments for people living in the residential households did not contain sufficient information and guidance for the staff to follow to meet people’s identified needs. Where risks had been identified there were no associated care plans on how these risks would be managed. Care plans and risk assessments for people living in the two nursing units did contain the required information and guidance.

A care plan champion had been appointed whose role was to support the senior carers on the residential units to review and update the care plans.

A quality assurance system was in place which reviewed a range of areas in the home. Accidents and incidents were reviewed by the registered manager to identify any patterns. Audits were completed for health and safety, care plans and medication. The provider’s area manager visited the home regularly and completed their own observations and checks. However this had not identified the issues we found with the care plans on the residential units.

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

Call bells and requests for support were answered promptly; however we noted the lounge / kitchen areas were left unattended at times and we saw people enter other people’s rooms uninvited. We have made a recommendation for current staffing deployments to be reviewed, including the use of domestic staff, to ensure communal areas are not left unattended for long periods during the busy morning period.

People received their medicines as prescribed; however the recording of any medicines carried over from one month to the next was not always clear. We have made a recommendation that national guidelines are followed to record how people will communicate, verbally or non-verbally, that they require an ‘as required’ medicine to be administered.

People’s confidential care files were stored in lockable cupboards in a quiet area of each household. We have made a recommendation that these cupboards are kept locked when not being accessed by the care staff.

People and their relatives said they felt safe living at Eachstep Blackley and that staff were kind, caring and treated them with dignity and respect. People said they were supported to maintain their independence by completing the tasks they were able to do themselves.

A robust recruitment system was in place. Staff received the training and support to undertake their roles through supervision meetings and staff meetings. New staff completed their initial training and shadowed experienced staff so they were able to get to know the people they would be supporting and their needs.

Staff told us that the management team were approachable and supportive.

There was a calm atmosphere at the home throughout our inspection. People were able to get up whenever they wanted, with staff members providing breakfast for people throughout the morning. The home was clean throughout. Equipment was checked and serviced according to national guidelines and the manufacturer’s instructions.

People were supported to maintain their health and nutrition. Culturally appropriate food was prepared for those people who wanted it. Visiting health professionals were positive about the service, said staff had the information they asked for and followed any guidance they were given. Referrals to health professionals, such as GPs and district nurses were appropriately made.

The service was working within the principles of the Mental Capacity Act (2005). Capacity assessments and best interest meetings were completed where required and applications made for a Deprivation of Liberty Safeguards (DoLS) where a person was found to lack the capacity to make a decision.

People and their families were encouraged to be involved in their care through residents meetings and surveys. A families forum had been established which provided an opportunity for family members to meet to discuss any issues or concerns they may have about the home.

Information about people’s life history, likes and dislikes was recorded, although this varied in detail depending how much information was provided by people’s families if they were not able to provide it themselves.

A programme of activities was in place which people could choose to be involved in. Many of these took place in the ground floor. The service also had a café, which was also open to members of the public. However we saw people had little stimulation on the individual households.

The home had made many links with their local community, including the local primary school and cubs. Eachstep facilitated a dementia café. The home was actively involved in research projects. A new project in conjunction with Lancaster University aimed to assess if involving people in everyday tasks, such as cleaning their room or setting the tables, could delay the progression of the person’s dementia.

The service had a registered manager in place as required under the conditions of their registration with CQC. 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 had been in post since June 2012.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly.

The home was clean and tidy. The environment was maintained at a good level and homely in character. We saw there was a maintenance person to repair any faulty items of equipment.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

We saw that where people had behaviours that may challenge others staff had the skills to safely diver their attention.

We saw staff were kind and patient with the people they cared for and sat and talked to them.

There were many opportunities for people and their families to attend activities. The activities included sessions provided by experts to help care for people with dementia.

Staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

People were given information on how to complain with the details of other organisations if they wished to go outside of the service.

Staff and people who used the service all told us managers were approachable and supportive.

Meetings with staff gave them the opportunity to be involved in the running of the home and discuss their training needs.

The manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

The service asked people who used the service, family members and professionals for their views and responded to them to help improve the service. Their views were obtained in meetings, forums and surveys.

The service liaised well with other organisations and took part in research to help improve the lives of people who had a dementia.

During the inspection we spent time in all areas of the home. We observed people being supported in a timely manner and with dignity and respect.

We viewed documentation which showed us the staffing provision was planned in advance and when gaps were identified, extra staff were provided. We spoke with staff and relatives of people who lived at Eachstep Blackley and we were told they had no concerns regarding the numbers of staff available to meet people's needs.

We looked at a sample of three care records and saw people's needs were assessed and care planned to meet those needs. We saw staff were attentive and patient when interacting with people who lived at the home and we spoke with four relatives who expressed no concerns regarding the care and welfare provided at Eachstep Blackley.

Before our inspection we received information of concern that people living at Eachstep Blackley were not receiving safe and appropriate care. During our inspection on 13 March 2014 we found that care plans and risk assessments were in place for each person. Records showed that people had regular access to a range of other health care services such as their GP, district nurses and community psychiatric nurses.

Before our inspection we received information of concern that safeguarding incidents were not being reported to the relevant authorities and were not being fully investigated. During our inspection we found that safeguarding incidents were reported to the local authority safeguarding team and the provider engaged with a range of health care professionals to ensure incidents were investigated fully.

We had also received information of concern that general incidents were not being responded to and investigated appropriately and that the management team were not open and approachable. During our inspection we found that incidents and near miss events were being reported and responded to appropriately. Relatives told us that they would feel comfortable approaching the manager if they wanted to raise a concern. We saw that where complaints had been received there was a process in place to investigate and respond to them. Staff told us that they enjoyed their job and felt supported to fulfil their role.

One relative told us 'It is awesome here' and that 'They (the staff) have put the light back in her eyes.' Another told us 'It is the best place I have been in.' And another told us 'It is brilliant here, the staff are very very caring.'

Staff working at Eachstep said they enjoyed their work. Comments included 'It feels good coming to work here' and 'I love working here.'

We found that consent for care and treatment was sought from the person who used the service or their relative and that choices were offered. Staff told us 'I read the care plans so that I know what each person requires.'

We found the home to be very clean and well maintained with a variety of environments for use by service users and their families.

We found that complaints were taken seriously and thoroughly investigated and responded to.

We checked whether the provider had improved their processes to ensure that all necessary information was held within staff files. We found that the provider had taken appropriate action and was now meeting the standard on the recruitment and suitability of staff.

We found that the home was meeting the essential standards and people were very well cared for. The only exception was that there was a minor issue in that it was not clear that appropriate information was available for all staff who worked for the home.