The inspection took place on 26 and 27 September 2016 and was unannounced. East Hill House Residential Care Home is registered to provide residential care for up to 34 older people. At the time of the inspection there were 31 people living there.The home has a dementia care unit 'The Willow's' on the third floor of the main house which provides care for up to eight people with dementia. There is a smaller unit opposite the main house 'The Court' which provides accommodation for up to 10 people.
The service had a registered manager. 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.
People and their relatives told us the service was safe. Staff had undergone safeguarding training and had access to policies and guidance to enable them to safeguard people.
People and professionals told us risks to people were well managed. Risks to people had been assessed in relation to falls, choking, skin care and moving and handling. There were care plans in place to say how identified risks would be managed and staff understood how to manage risks to people. Risks to people from their environment were managed safely. Incidents were reviewed and measures taken to reduce the risk of repetition for people.
People and their relatives said there were enough staff on duty. The registered manager used a staffing dependency tool to determine the safe level of staffing for the service. There were enough staff rostered to meet people’s needs. People were safe as they were cared for by staff whose suitability for their role had been assessed by the provider.
People and professionals told us medicines were well managed for people. People’s medicines were ordered, stored and disposed of safely. Where people lacked the capacity to consent to their medicines, legal requirements had been met. Staff had completed medicines training and updated their internal medicines training, but had not all updated their on-line medicines training within the past year, as required by the provider. There was no impact of this on people who received their medicines safely. The registered manager took immediate action once the issue was identified to ensure staff updated their training and implemented a process to ensure that in the future they would be made aware of upcoming expiry dates for staffs’ on-line medicines refresher training.
People told us the staff were well trained. People were cared for by staff who had received suitable training, on-going support and professional development to ensure they were competent to deliver peoples’ care effectively.
People reported that their consent was asked for when care was being given. Staff told us they had undertaken Mental Capacity Act (MCA) 2005 training, which records confirmed. They were able to demonstrate how it applied to their day to day work with people. The forthcoming introduction of new MCA paperwork by the provider will enable staff to more clearly document the outcome of best interest decisions for people in relation to Deprivation of Liberty Safeguards applications.
People were happy with the quality of the meals provided. People were appropriately supported by staff wherever they were eating within the service. People’s weights were monitored and appropriate action was taken if people were at risk from weight loss.
People and relatives reported there was good healthcare provision. Staff arranged for people to see a range of health care professionals as required.
People and relatives said the care delivered was very good. They thought staff were friendly, kind, caring, helpful and respectful. People experienced positive relationships with the staff who cared for them.
People’s communication needs were documented to enable staff to understand how to interact with them. People were supported to express their views and to make decisions. People were provided with relevant information about the service.
People reported that staff upheld their privacy and dignity when providing their care. Consideration had been given in regards to how people’s dignity could be positively promoted by staff.
People and their relatives told us they received the care they needed. People’s care plans had been regularly reviewed to ensure they remained relevant and up to date. People were cared for by staff who had information about how to respond to their individual needs.
People told us and our observations showed that a variety of activities took place. People including those on the dementia unit were supported and encouraged to be involved in activities both within the service and in their local community.
People’s complaints were investigated, responded to and any required actions taken. Various forums and processes were in place to seek feedback on the service from people and their relatives.
Throughout the inspection staff were observed to apply the provider’s values in the course of their work. People were encouraged to be involved in the service for example, with staff recruitment and staff recognition. Staff told us there was an ‘open’ culture within the service and they were provided with opportunities to speak out if required.
People and relatives were complimentary about the manager and staff and the management of the service. The service was well-led by a visible and supportive management team.
A range of aspects of the service were audited in order to identify areas for improvement for people. In addition to audits completed at the service level, the provider’s regional manager and quality team audited the service. Feedback from people, their relatives and stakeholders was sought and acted upon to improve the service for people.