Eastbourne Grange

Updated 15 December 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector

Service and service type

Eastbourne Grange is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Eastbourne Grange is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We also contacted the local authority market support team for feedback. We used all this information to plan our inspection.

During the inspection

We spoke with four staff including the registered manager and care staff and eight people living in the home, we also spoke to one relative during the inspection. We reviewed a selection of records. This included three people’s care plans in full and a further two to look at specific areas in relation to their care needs. We also reviewed documentation in relation to people’s safety, including medicine administration, fire safety, accidents, incidents and risk assessments. We looked at staff recruitment and supervision and a variety of records relating to governance and the management of the service. Following the inspection, we spoke with the provider and also requested some documents which could not be located during the inspection be sent by email.

Updated 15 December 2022

About the service

Eastbourne Grange is a residential care home in an adapted building, providing personal care for older people including people who were living with dementia and memory loss. The service can support up to 25 people. At the time of the inspection there were 19 people living at the home.

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

Peoples care needs had increased. Eastbourne Grange provided support to people with advanced dementia, some with increased level of care and support needs. This impacted on staff as people needed a higher level of support.

Safe recruitment had not been maintained. Documentation was not in place to ensure the provider could be sure staff were safe to work in the home. There were not enough trained staff to administer medicines in accordance with people’s prescriptions. Only one senior carer and the registered manager were currently able to give people medicines when needed. There were no medicine audits or checks being completed. This meant issues related to safe medicine storage had not been promptly identified.

Accidents and incidents were not being robustly monitored. Actions had not been implemented following a suspected head injury and it had not been identified when an accident had not been reported externally to the local authority

Infection prevention control measures were not being followed in line with current government guidance. Staff were not wearing masks and no rationale or risk assessment had been recorded in relation to this decision.

The provider had not ensured there was adequate oversight of the service or support in place for the registered manager in light of a number of staff vacancies. New staff were not experienced and lacked the skills to provide care without being supported by other staff. This meant the registered manager was having to cover care tasks and administer medicines. This had impacted on the registered manager completing checks and audits to ensure the safety and management of the service had been maintained.

There was not an effective system in place to manage the environment and to review overall maintenance and safety in the home. A number of checks had not been completed in line with required timescales, this included water safety checks and fire safety. Window restrictors had not been checked and serviced. Fire safety systems needed to be improved to ensure people were safe. and staff were appropriately trained to respond to an emergency and evacuate people in the event of a fire.

The provider had failed to ensure there was adequate governance at the home. Auditing was not robust or consistently completed. Required checks had not all been completed. Care documentation needed to be improved to ensure care plans and risk assessments provided the most up to date information. When decisions had been made, for example, regarding medicine administration or in relation to PPE, no risk assessment or rationale had been recorded.

Improvements were being implemented in relation to people’s consent and best interest meetings being recorded when needed. 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. The registered manger had been working with the local authority to ensure best interest meetings and capacity assessments where in place to support decisions made.

Relatives spoke positively about the service and the care their loved one received. People told us they liked staff but would like more consistency as they felt they responded better to staff they knew and trusted.

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 good (published 15 July 2021). At this inspection breaches were identified. The service has now been rated as requires improvement.

Why we inspected

The inspection was prompted in part due to concerns received about staff recruitment and training, moving and handling guidance not being followed, how decisions about people’s care are made and medicine practices. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safety, staffing, recruitment, infection prevention control and good governance. Please see the action we have told the provider to take at the end of this report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.