Eastleigh Care Homes - Raleigh Mead Limited

Eastleigh Raleigh Mead is a residential care home providing personal and nursing care to 61 people aged 65 and over at the time of the inspection. The service can support up to 61 people. Most people living at the service are living with dementia and have nursing needs.

The service is purpose built with communal areas and bedrooms on three floors, all accessed by a lift and stairs.

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

Most people were unable to give an informed view about their experiences of living at Eastleigh Raleigh Mead. Those who could were positive about their experiences in the main. Comments included “I’ve never been so well looked after, I want for nothing”. Also, “Safer than I would be at home, I call it the ‘little fortress” One relative commented “I’ve no complaints at all. I’m extremely happy with the way they treat me and my family.”

Our observations showed us people were being treated with kindness, respect and dignity. Staff were attentive and understood people’s individual needs.

At the last inspection we found medicines were not always managed safely. We issued a requirement in relation to this as people were at risk. We asked for and received an action plan which showed what the provider was doing and implemented to ensure this requirement was met. At this inspection we found medicines management had improved since our previous inspection. People received their medicines safely and in the way prescribed for them.

At the last inspection we found specialist mattresses were not always at the correct setting for the person using this equipment. Following feedback the provider implemented daily checks of the mattresses. During this inspection we found this was working well and mattresses were being checked daily.

At the last inspection we found quality audits had not identified issues of concern and in particular those relating to medicines. We issued a requirement in relation to this as people were at risk. We asked for and received an action plan. This showed what the provider was doing and had implemented to ensure this requirement was met. At this inspection we found audits had been updated and there was clearer overall oversight of the service.

At the last inspection we found staff morale was low and there were mixed reviews about the management approach within the home. Since this inspection a new manager had been appointed. They were not yet registered with CQC. Staff were positive about the new manager and described the staff morale as being good, and the new manager being inclusive. Despite the pandemic and staff having to work in exceptional circumstances most described the working environment as supportive and having a good team spirit. One staff member said “We are very well supported here. They take the time to listen. I had a really bad year and the management team were invaluable in supporting me.”

There were sufficient staff with the right skills and support to provide safe and effective care to people. Staff recruitment was robust and ensured only staff who were suitable to work with people who may be vulnerable were employed.

Quality audits, systems and record keeping were being reviewed and updated to ensure a consistent approach, which could be easily monitored, was being implemented. This included the introduction of a new electronic system which would allow for remote auditing of key areas such as people’s nutrition and hydration.

We were assured that the infection control measures, PPE and guidance on working in a pandemic were being followed to keep people safe. The provider had invested in some key improvements which included a temperature sensor at the main entrance to check all visitors temperatures. There was also a self contained visiting hub near the main entrance. This allowed visitors to meet with their families in a secure and risk reduced setting. There was a floor to ceiling screen and a sound system to allow for better communication through the screen. There is a staff member designated for these visits. They take responsibility for getting people ready for the visits, supporting them if needed during the visit and the cleaning in between visits.

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 February 2020)

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 focussed inspection based on the previous rating.

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 coronavirus and other infection outbreaks effectively.

This inspection looked at the key areas of safe and well led as this is where previous breaches had been identified.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Eastleigh Raleigh Mead on our website at www.cqc.org.uk.

Eastleigh Raleigh Mead is a residential care home providing personal and nursing care to 61 people aged 65 and over at the time of the inspection. The service can support up to 61 people.

Eastleigh Raleigh Mead is a purpose-built nursing home with separate units on each of the three floors. The ground floor and second floor provide nursing care for people living with dementia. The first-floor supports people with complex physical nursing needs. Each unit has their own kitchen area, lounge and dining areas. All bedrooms are en-suite and the corridors are wide to accommodate wheelchairs and mobility aids.

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

The management of medicines was not always effective. There were medicines which were out of date and one had been administered. Audits had not identified out of date medicines. We have issued a requirement in respect of this breach.

Records were made of the administration of medicines and people received their medicines as prescribed. Staff had received training and their competencies were checked to ensure they were following the medicine processes and procedures to keep people safe.

Safety monitoring was not always robust. We found some specialist mattresses on the wrong setting. Essential instructions for some specialist equipment was not always easily accessible for staff to find. Following feedback, these areas were immediately actioned. The provider had identified that their fire risk assessment and equipment for evacuation needed updating and had commissioned an independent company to risk assess and make recommendations regarding this.

Not all staff had received training needed to keep people and themselves safe if they presented with distressed or expressive behaviours. The registered manager explained that because they had been short staffed due to some staff leaving, newer staff had been asked to work in their complex dementia unit, where normally they would have had training prior to this. They said they would now include some training in working with complex needs in staff’s initial induction training.

Not all staff felt they were listened to or fully consulted in the everyday practice and development of the service. The registered manager and Nominated individual (NI) said they would immediately offer group and individual meetings to discuss staff concerns around staff morale, and having the views heard.

The NI had introduced some bespoke training for people with complex needs and this had resulted in positive outcomes for people. Staff said training was good and they had the right skills to ensure they could do their job effectively.

People said they felt safe, comfortable and well cared for. Comments included “I get on very well with the staff. They are very approachable and respectful. I feel very cared for and have no complaints.”

People and their relatives spoke highly of the support and care they received. People felt their dignity, privacy and diversity were fully respected. They described staff as being kind and caring. One said, “I do feel cared for and they will do anything for me.”

Staff knew people’s needs and wishes and worked in a way which showed compassion and caring was embedded into their everyday practice.

The service had maintained a good reputation for working well with people with complex needs. There had been some very positive outcomes for people who had been able to gain their independence and return home. The service worked well in partnership with commissioners and healthcare professionals to ensure people had the right package of care with the right equipment. Comments from professionals included “They deal with very complex cases in a professional and caring way. Staffing levels generally are very good and they provide lots of 1-1 for our complex cases.”

There were sufficient staff to ensure people’s needs could be met in a timely way.

Care and treatment was planned in a way to ensure individuals received a person-centred approach taking into account any protected characteristics and particular healthcare needs.

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.

People were supported to eat and drink enough to meet their needs. Mealtimes were seen as an important part of the day and staff made sure people had the right support in a relaxed and unrushed atmosphere.

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 Outstanding (17 May 2017)

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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

Enforcement

We have identified breaches in relation to the safe management of medicines at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Eastleigh Raleigh Mead is registered to provide nursing and personal care for up to 60 people. The home is divided into three units; the ground and second floor provide nursing care for older people living with dementia. The first floor unit supports people with higher physical nursing needs. There were 58 people living at Eastleigh Raleigh Mead at the time of the inspection.

The service had 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.

People received care, treatment and support which was really effective. This was because the registered manager and provider had a real commitment to ensuring staff at all levels had the right training and support to do their job well. This included specialist dementia training, end of life care and national training in care. Staff were encouraged to use reflective learning to develop their skills and areas of interest.

People benefitted from a service which was extremely well run. The registered manager, director and provider all operated an open and inclusive approach. They listened to people and staff to help improve the service. They showed commitment to learning from audits and feedback. One relative said ‘‘From the moment I spoke with the provider and met with the manager and lead nurse, I knew I had made the right decision. They were so caring and understanding. Nothing was too much trouble. I can’t praise them enough. They were outstanding- all of them and each staff member.’’

The service had used innovative assistive technology to promote the most effective way to support people. For example, using blue tooth technology to ensure people’s personal playlists of music which was important to them could be played at any time and in any area of the home.

The design, layout and furnishing of the service had fully considered the needs of people and staff to provide the most effective care. For example, a lighting system had been installed in all communal areas which mimicked natural light and was turned down after lunch to allow a rest period then turned back up as afternoon tea was being served.

Care and support was well planned. Risks had been assessed and measures put in place to mitigate those risks. People’s healthcare needs were well met and staff understood how to support people with changing healthcare needs. Staff understood people’s needs and knew what their preferred routines and wishes were. This helped them to plan care in a person centred way.

Medicines were well managed and kept secure. People received their medicines in a timely way and where errors were noted, staff acted quickly to ensure people were not at risk. People were offered pain relief and received their medicines on time.

There were enough staff with the right skills, training and support to meet the number and needs of people living at the service. Staff said they felt valued and were encouraged to contribute to how the service was run and how care and support was being delivered

People were supported to express their views and were involved in decision making about their care and were offered day to day choices. Staff sought people’s consent for care and treatment and ensured they were supported to make as many decisions as possible. Staff confidently used the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, capacity relatives, friends and relevant professionals were involved in best interest decision making.

People and relatives said the staff were caring, kind and compassionate. People were treated with respect and dignity. This included assisting people at the end of their life. One relative said ‘’During the last few weeks he declined rapidly and all staff attended to his needs in a very professional manner. Every consideration was shown to ensure his needs were met. At the end of my Father's life he was treated in a very dignified manner. In our opinion this has to be one of the finest homes in Britain.’’

People were kept safe because staff understood what constitutes abuse and who to report any concerns. The service had a safe recruitment process so that only staff who were suitable to work with vulnerable people were employed.

People’s emotional, social and diverse needs were considered. There was a comprehensive activities programme which people said they enjoyed taking part in.

Systems and audits ensured the service was well maintained, safe and considered the views of people and their relatives. Complaints were taken seriously and investigated. People and staff were confident their views were taken into account in the running and development of the service.

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

We completed this responsive inspection as we had received some anonymous concerns about how care and support was being delivered on the ground floor dementia care unit. This inspection therefore only relates to this one unit and covers two main areas. These were; ensuring people had safe and effective care and ensuring staff had the right skills and new staff had the right checks in place to ensure they were suitable to work with vulnerable people.

On the days of our inspection there were 15 people living on the ground floor dementia care unit at Eastleigh. The summary is based on conversations with three relatives of people living at the service, nine staff including senior staff working for the provider. We looked at records of people's care and quality monitoring systems used with the home. We also spent time observing how care and support was being delivered to people.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found the service was safe because there were sufficient staff with the right skills and experience to meet the needs of people they supported. The service had robust recruitment processes in place to ensure only staff who were suitable to work with vulnerable people had been employed.

Is the service effective?

We found the service was effective because they had planned people's care and support in line with their assessed needs. Where people had increased needs due to their dementia, this had been clearly identified and risk assessed to ensure staff had the right information to support people effectively. We saw staff had training and further training had been planned to ensure staff had the right skills to work with people with complex needs. This included understanding the Mental Capacity Act and restraint techniques.

Is the service caring?

Our observations of how staff interacted with people on the dementia unit showed they provided care and support in a kind and respectful way. Staff were conscious of ensuring people's dignity and respect was upheld throughout the day. Relatives of people we spoke with confirmed that in their view staff were ''Kind and respectful''.

Is the service responsive?

We found the service was responsive because it had ensured people's needs were continually reviewed and where needs had changed their care plan had bee updated to inform staff about how they should address any increased needs. We saw where people had showed signs of distress but were unable to say why, their general health was considered and GPs and CPN's were regularly consulted.

Is the service well led?

We found the service was being well led because we saw evidence of people, their relatives and staff being consulted about various aspects of the service. We saw that senior management had responded positively to our last inspection report and had made some improvements to staff training and support to ensure their team were well equipped to do their job.

This inspection was a follow up inspection to check on whether the provider had achieved compliance in five outcome areas. Two inspectors spent 7 hours at the service, speaking to people living at the home. We also spent time observing how care and support was being delivered. We looked at some key records. These included care plans and risk assessments, staff rotas and accidents and incident records. We also received some further information following the inspection, which included quality audits and staff training matrix. This helped us judged how well the home was being managed.

We spoke with 10 people who lived at the home and with six relatives. Overall their views were positive. Comments we received included ''very good'' and ''caring and helpful''. One person's relative who had a bad experience in another home said ''its works extremely well here, staff know how to diffuse situations''. They said they liked the spacious floor areas which gave people space to move around without being cramped.

We also spoke with a range of staff including the registered manager, three nurses, director of human resources, group support manager, eight care staff and two housekeeping staff. We heard how since the last inspection, more time and resources had been agreed and used to update and review all care plans and risk assessments. We also heard a review of staffing levels had taken place and more nursing time had been allocated. In particular the middle floor, which has people with complex nursing needs, now had two nurses on duty for the main parts of the day. This enabled the team to ensure medications were delivered in a timely way and that nursing staff could work with care staff to ensure good care was being delivered.

We heard from staff how safeguarding training and workshops had been provided since the last inspection. We also saw how care plans and risk assessments included more detail about how people should be supported when they were resistive to their needs being met. This meant they were protected from unsafe or inappropriate care being delivered, as instructions and training for staff were now in place.

We heard how more time and resources were being implemented to ensure there were robust quality monitoring systems in place, which checked and reviewed accident and incidents so care plans and delivery of care was more responsive to people's changing needs.

Three inspectors each spent time on each of the three separate units that form Eastleigh nursing home. The 'top' floor provided care for people with nursing needs and mild to moderate dementia; the 'middle' floor provided nursing care for people with complex needs and the ground floor dementia suite provided nursing care for 15 people with advanced dementia. We spent time talking to people who lived at the home, to staff and to visiting relatives and friends. We looked at some key documents, including electronic care files, risk assessments and daily records.

We asked the provider to send us some additional information. This included records about staff training completed, staff rotas and any audits or records of systems relating to how they reviewed their quality of care provided.

People who lived at the home, who were able to give an informed view, said they were happy with the care and support. One person told us 'Of course I would prefer to be in my own home, but the staff here are marvellous, I couldn't ask for better.'

Most relatives also gave us a positive view, particularly on the top floor. One family visitor told us 'this is quite a drive for me, but I know x is getting the best care possible. I wouldn't want him to go anywhere else'. One relative with family member using the dementia suite service told us staff were kind and regular staff understood the person's needs and ways. Another relative was concerned about communication with them and aspects of the care provided.

We found staff understood the needs and wishes of the people they cared for. However we found care was not always being well planned. This placed people at risk of not receiving the right care.

Staff had training, but lacked support via formal supervisions. We found there were not always sufficient qualified and competent staff available on the middle floor.

Although the provider had done some work to improve the systems in place to review the quality of care, there was not an effective system in place to consistently monitor the quality of the service.