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Inspection Summary


Overall summary & rating

Good

Updated 8 November 2016

This inspection took place on 27 and 28 September 2016 and was unannounced. Eastbrook House provides accommodation and personal care for a maximum of 37 older people, some of whom are living with dementia. At the time of the inspection there were 37 people using the service.

There was a registered manager in post. 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 our last inspection in June 2015 we found that some aspects of medicines management were not safe. The provider had not submitted any applications, where relevant, for a Deprivation of Liberty Safeguard (DoLS) authorisation and accurate records had not been kept in relation to people’s care and treatment. These resulted in breaches of Regulation 12, 13 and 17 of the Health and Social Care Act 2008.

Due to the serious nature of the breach of Regulation 12, relating to unsafe medicine management, we had taken enforcement action against the provider. We issued a warning notice to the provider detailing the issues we found and requiring them to become compliant within a specified timescale. An unannounced focused inspection took place in August 2015 to check that this significant breach of legal requirements had been addressed. During the inspection it was found that all legal requirements for medicines had been met.

During this inspection we again found there to be some aspects of medicines management that were not safe. Care staff were not signing the Medicine Administration Record (MAR), once a medicine had been administered to confirm that the person had received their medicines. We also found two examples of where people had not been given a particular medicine for a number of days due to poor communication and poor management of medicines.

Risks associated with people’s care and support needs had been identified and these had been assessed, giving staff instructions and directions on how to safely manage those risks. However, where records were needed to be kept in relation to monitoring food and fluid intake and turning charts to monitor people’s skin integrity, these had not been completed to ensure that these areas were safely monitored and that people were protected from those identified risks.

We found the home to be clean and tidy. However, on the second day of the inspection we noted a significant odour originating from the main lounge on the ground floor. We highlighted this to the registered manager who told us that they would address the issue.

Systems were in place which monitored the quality of service provision with a view to making improvements. It was positive to note that the provider had identified some of the same issues as identified as part of this inspection. However, the provider had not recorded what actions had been taken as a result of identifying the issues and had not put in place improvement plans to minimise re-occurrence.

People told us that they felt safe and were happy with the care that they received at Eastbrook House. Care staff were aware of what constituted abuse and the actions they would take if abuse was suspected.

The provider ensured that safe recruitment practices were observed which included obtaining criminal record checks from the disclosure and barring service, previous employment history and references from previous employment confirming past conduct especially when working with vulnerable adults.

Food looked appetising and the chef was aware of any special diets people required either as a result of a clinical need or a cultural preference. People and relatives spoke positively about the food at the home. However, we found that people, especially those living with dementia were not offered any meal choices.

Care plans were specific to each person and their needs. These were detailed and person centred. People’s likes and dislikes and care preferences had been noted.

Senior managers, head of care and care staff demonstrated a good level of understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager had submitted applications to the local safeguarding authority for each person who required an authorisation to ensure that people were legally being deprived of their liberty which was in their best interest.

Care staff enjoyed working at the home and were positive about their experiences and the support that they received from the registered manager and their colleagues. Staff confirmed that they received regular training which enabled them to care for people with effectively. Care staff received regular supervision and had also gone through their annual appraisal with the registered manager.

We spoke with a number of professionals during the inspection and also obtained feedback from local commissioners and health professionals. Feedback received was positive and no concerns were noted in relation to the care and support people received.

At this inspection we found breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to people receiving safe care and treatment and the safe management of medicines. You can see what action we told the provider to take at the back of the full version of the report.

Inspection areas

Safe

Requires improvement

Updated 8 November 2016

The service was not always safe. Medicines were not managed properly which may have put people at risk. Issues identified included incomplete recording of medicines which had been given. Some people did not have particular medicines administered to them for a number of days.

Risks to people were identified and assessed so that people were safe. However, food and fluid charts and turning charts were not completed properly, in line with recommendations noted on the care plan in order to protect people from those identified risks.

People who lived at the home told us that they felt safe and were happy with the care and support that they received. Care staff knew about safeguarding adults and the actions they would take to report any signs of abuse.

Safe recruitment practises were followed and the required checks were undertaken prior to staff starting work.

Effective

Good

Updated 8 November 2016

The service was effective. All care staff confirmed that they received regular training. Care staff also confirmed that they were well supported by senior managers and received regular supervision. Appraisals had been completed with all staff.

The service was following the principles of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS). All staff demonstrated a good understanding of the MCA and DoLS.

People had access to health and social care professionals to make sure that they received appropriate care and treatment.

Caring

Good

Updated 8 November 2016

The service was caring. We saw people were treated with kindness and compassion. The atmosphere in the home was warm, calm and relaxed.

People were treated with dignity and respect. We observed care staff respecting people’s privacy and dignity during the inspection.

Care plans detailed people’s likes and dislikes as well as their choice and preferences on how they received their care and support.

Responsive

Good

Updated 8 November 2016

The service was responsive. Care plans were person centred, detailed and specific to each person and their needs. People and relatives confirmed that they were consulted and their preferences were responded to.

The home had a complaints procedure. People and relatives confirmed that they knew whom to approach if they had any concerns or queries and these were responded to promptly and appropriately.

There was a weekly activities schedule on display. We observed a number of activities over the two days of the inspection. People had opportunities to take part in the activities that they chose to.

Well-led

Good

Updated 8 November 2016

The service was well-led. Relatives and professionals informed us that the registered manager was approachable and that the service was managed well.

The quality of service was monitored. Regular audits had been carried out by the registered manager and a senior manager especially in relation to medicines management, health and safety. However, where issues were identified, there was no record of what actions were taken to resolve the issues so that improvements could be made.

Care staff felt well supported by the registered manager and other senior managers who were always available and visible around the home. Regular handover and staff meetings were taking place which were recorded.