Archived: Eastbourne Care Home

Eastbourne Care Home provides care and accommodation for up to 42 people. It provides 24 nursing places on the first floor and 2 nursing places on the ground floor. It has a separate unit on the ground floor with 15 intermediate care places that are funded by the Clinical Commissioning Group. These places are for people who require a short rehabilitation service to recover following an illness or injury. On the day of our inspection there were 35 people using the service.

At the time of our inspection the home had a temporary manager in place managing the service. The service was going through a process of change. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We carried out this focussed inspection in direct response to concerns raised with us about staffing levels at the service.

During our inspection we found that there was enough staff to meet people’s needs and that recent action had been put in place by the manager to improve the staffing levels.

We looked at falls monitoring and recording information and found this to be appropriate.

In this report the name of a registered manager appears who was not managing the location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time of inspection. The service had a peripatetic manager in post.

As part of this inspection we spoke with nine people who used the service and five visitors. We also spoke with the director of operations, regional manager, acting regional manager and the peripatetic home manager, two nurses, nine care staff, one activity coordinator and one domestic staff.

We also reviewed records relating to the management of the home which included nine people's care records, staff rotas, outcome 16 quality assurance records, a range of other audits and staff training records.

Is the service safe?

Although people were treated with respect and dignity by the staff, concerns were raised by the staff we spoke with and two residents about staff attitudes. There were enough staff on duty during the day to meet the needs of the people living at the home but staff raised concerns about the quality of the staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. At the time of our inspection they had one DoLS safeguarding's in place. The majority of staff had received training in relation to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions they needed to take to protect people's rights.

Is the service effective?

The majority of people who used the service told us that they were happy with the care they received and felt their needs had been met. The main activity coordinator was on long term sick, the part time activity coordinator worked on a weekend, and was trying their best to support people with activities by working extra throughout the week. Therefore activities were not taking place on a regular basis.

Not all staff had received training to meet the needs of the people living at the home and staff providing care for people who were living with dementia required more training around dealing with behaviour that challenges.

Is the service responsive?

People's needs had been assessed before they moved into the home. However, people who moved from the rehabilitation unit into the residential unit were not assessed. This meant information from the rehabilitation unit was not included in the new care records and staff would not be aware of their history.

Care records we looked at were very confusing and lacked attention to detail, we found that information was duplicated, incorrectly dated and did not provide staff with clear, accessible information about people's care needs.

Where people had issues with weight loss there was no consistency in weight monitoring. Monthly reviews were not being carried out, with one person's file had not been reviewed since the 5th March 2013.

Each care file had a lot of blank papers, for example risk assessments for something that was not needed or relevant to the person using the service. Care files also had paperwork from 2012, making it more difficult to find current information.

Is the service well-led?

Staff files we looked at showed that staff were recruited correctly. We found induction training to be poor. Staff told us they were not clear about their roles and responsibilities and due to staff leaving, they were short staffed.

We saw that the manager had no effective quality assurances or processes in place. Staff said the manager spent too much time in the office and is not aware of what was going on, on the floor. Staff at the service told us that they did not feel adequately supported by the service's management. The majority of staff spoken with told us that they did not feel listened to. There was the perception that staff who raised concerns would be victimised and as a result staff had not been able to raise concerns within the service. This meant that whistleblowing procedures were not effective.

What people told us:

People who used the service told us 'It's a nice place I like it here.' And 'I have a lot of waiting, especially during handover, if I ring my buzzer it could be an hour I have to wait,' 'They struggle to change my ileostomy bag, it can be uncomfortable, I don't think they have been trained,' 'They must think I am a moaner, they can be a bit sharp,' 'All the girls are very good,' 'I cannot grumble,' 'I admire them for what they do, they are very gentle and kind, I love them to bits,' 'They seem to have to learn on the job,' and 'I have never regretted coming here.'

One person who used the service expressed concern about rough handling by certain staff and not wanting to ask for the bathroom so restricted their fluid intake We referred this serious concern to the local authority safe guarding team. We also discussed this serious concern with the manager and regional manager, all staff were to undertake moving and handling refresher training. We were told on our second visit that this had happened for the night staff.

Relatives and/or visitors we spoke with said 'Staff are always friendly,' and 'communication is very good,' 'We have found no faults, staff are always cheerful, no complaints,' 'They keep us informed, no problems at all,' 'They do the best with what resources they have,' 'Things are ok,' 'We did have an issue with the washing, we had to keep buying new clothes, because their clothes were going missing, we do the washing ourselves now.'

There were some employee issues raised by staff regarding certain individuals working at the service. Concerns were also raised by staff about the lack of induction and training. These issues were discussed with the management and the appropriate action taken to address the issues raised

There was a specialist unit on the ground floor of the home which catered for people receiving intermediate care. One person receiving intermediate care told us; 'The care I get here is fantastic the staff are always there when you call and nothing is too much trouble for them'.

We saw staff interacting with people in a friendly and caring manner and observed staff upholding people's privacy and dignity by ensuring they knocked on doors and explaining to people what was happening next.

We saw that people's views were taken into account in the planning and delivery of their care and that people were kept informed about developments in the service.

There was a system in place for the manager to check the quality of the service being provided and this was shared with staff and people using the service.

There was a specialist unit on the ground floor of the home which catered for people receiving intermediate care. One person receiving intermediate care told us; 'They make you walk better' and 'I've been here four times, there is good food and accommodation'.

People were positive in their views about the home. They told us; 'The staff here are lovely' and 'We have a laugh every day'.

We observed lunch in one of the dining rooms and saw staff spend time with people and they supported them with dignity and respect. There were sufficient staff on duty to support people for their care needs.

We spoke with relatives and visitors to the home who were very positive in their comments about the care their relatives received. One person told us; 'The staff are very helpful'.

We saw the provider had a complaints process in place with records to show issues had been responded to in a timely way. People told us they knew they could speak to the manager or staff if they had any concerns.