Eastcotts Care Home with Nursing

Eastcotts Care Home with Nursing provides accommodation, nursing and personal care for up to 59 older people. There were 38 people living in the home when we visited on 17 May 2022. The home is situated in a rural area on the periphery of the village of Calford Green, Haverhill in Suffolk. We have referred to the home as Eastcotts Care Home within this report.

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

Relatives and people were complimentary about the support provided by staff. Their comments included, “I’m very happy with Eastcotts [Care Home], the way they look after [family member], they really pamper [family member].” And “Their care and compassion is amazing. I was a nurse, so I know good standards.”

People were protected from the risk of harm. Safeguarding policies and procedures were in place. Staff had received training and understood how to keep people safe and who to report to if they had any concerns.

Staff were safely recruited and received a comprehensive induction from the provider. People told us there were sufficient staff to meet their needs.

People received their medicines safely. Safety checks of the premises and equipment had been undertaken. People had personal emergency evacuation plans (PEEPs) in place.

People were supported to have maximum choice and control of their lives and staff supported /did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The quality and assurance systems in place were used to monitor the safety and care provided to people. The management team used auditing to identify further areas and opportunities to continuously improve the service.

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 Good published 3 December 2019

Why we inspected

This was a planned 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 COVID-19 and other infection outbreaks effectively.

Eastcotts Care Home with Nursing provides accommodation, nursing and personal care for up to 59 older people. There were 36 people living in the home when we visited on 30 October 2019. The home is situated in a rural area on the periphery of the village of Calford Green, Haverhill in Suffolk. We have referred to the home as Eastcotts Care Home within this report.

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

We had significant and multiple concerns at our last inspection and rated the home inadequate in all key questions and overall. However, at this inspection we found significant improvements. The home had clear leadership and there was a stability which was commented on by everyone we spoke with.

Immediately following our last inspection, the provider took action to begin making the necessary improvements. A care consultancy company was engaged to help address the significant concerns and to put in place a plan of action to make the necessary improvements. A registered manager was also recruited, and they had immediately begun to address the shortfalls. This involved making improvements to governance and oversight arrangements, implementation of systems and processes to safely assess and manage risks to people. Staffing levels were reviewed and immediately increased. Improved governance and oversight arrangements were in place.

Some improvements were needed to the safe recruitment of new staff, however immediate action was taken by the provider and registered manager to address this.

People were supported by staff who were available when they needed them and who had time to spend with them. People felt safe in the care of the staff.

People were protected from the risk of abuse and avoidable harm by staff who understood how to recognise and respond to concerns.

The environment was clean and well maintained. A number of aesthetically appealing improvements had been made.

Medicines were stored and managed safely. Policies and procedures supported the safe administration of medicines. People received their medicines when they needed them and staff who gave medicines were trained and had their competency to do so checked.

People's needs were assessed, and care and support had been planned proactively and in partnership with them. People were provided with a nutritious and varied diet and a choice of food to meet their preferences. Staff received training, support and supervision to care for people safely.

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 happy with how the service was managed and the significant improvements made. Staff felt very well supported by the registered manager. The registered manager and provider completed regular audits and checks, which ensured levels of quality and safety were maintained at the home. The registered manager understood and met their regulatory responsibilities.

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 (published 3 May 2019) for this service was inadequate and therefore the service was in placed in ‘Special Measures’ There were multiple breaches of the regulations at that time.

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 significant improvements had been made and the provider was no longer in breach of any regulations. This also means the service is no longer rated as inadequate overall or in any of the key question and is therefore no longer in ‘Special Measures’.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Eastcotts Care Home with Nursing on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

¿ The culture in which people were living required significant improvement; there was institutional and unsafe practices, which went unnoticed and unchallenged by senior staff.

¿ People were not supported by staff who were sufficiently skilled in their roles. The provider also failed to ensure that people were supported by staff who were all of good character.

¿ People were not always cared for by staff who promoted their rights to be treated with dignity and respect.

¿ Interaction between some care staff and people was poor and disrespectful. There were times when people's privacy and dignity were compromised. There was little social stimulation provided to people on occasions.

¿ People’s personal records were not always stored securely to protect their privacy.

¿ The service was not acting in line with the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. This meant that people were at risk of having their liberty unlawfully restricted and inappropriate decisions could be made on a person's behalf if they lacked capacity to make the decision for themselves.

¿ The provider's quality assurance systems were not effective in identifying, responding and maintaining a good standard of service.

¿ People had a choice of meals and regular drinks were available. People were happy with the food they were served.

Rating at last inspection: The service was rated ‘Requires Improvement’ at our last inspection on 24 and 29 January 2018. The report following that inspection was published on 11 April 2018.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

¿ The service met the characteristics of ‘Inadequate’ in all five key questions of safe, effective, caring, responsive and well-led

¿ 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 continue to monitor the service closely and discuss ongoing concerns with the local authority. The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC.

¿ Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

¿ If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

¿ For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

¿ Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

¿ For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Eastcotts Care Home with Nursing is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This inspection took place on 24 and 29 January 2018 and was unannounced.

There was a registered manager in post at the time of our inspection. 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 comprehensive inspection in February 2017, we had concerns about the management of clinical risks. We found that people at risk of pressure ulcers were identified and had been provided with specialist mattresses. However, some of these were at the wrong setting for people, which meant that they did not work effectively. We also found people’s health needs were not always well managed and staff were not always following best practice. We were also concerned that medicines were not securely stored and checks on clinical equipment were not adequate. We found these concerns were a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We received an action plan from the provider on 10 May 2017 telling us the improvements they intended to make to become compliant. At that inspection, we were also concerned that whilst there were enough staff they were not always effectively deployed. We rated the home ‘Requires Improvement’ overall and in three of the key questions we ask. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Eastcotts Care Home with Nursing on our website at www.cqc.org.uk

We found at this inspection that improvements had been made and the home was no longer in breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The management of clinical risk had improved, we checked that specialist mattresses were set correctly; clinical equipment was now being stored correctly and regularly audited. Medicines were also now being stored securely. We checked the deployment of staff and whilst we received mixed feedback about the levels of staff the deployment was effective. As a result of this inspection we have made one requirement. This is where we have identified a statutory breach of regulations. The regulation requires the registered persons to notify us of key events and incidents and they had not done so. Because of this, we have rated the home ‘Requires Improvement’ in well-led and overall.

Notifications of events and incidents were not always submitted in accordance with statutory regulations. Registered managers and providers are required to submit to CQC statutory notifications in accordance with regulatory requirements however we found a number of serious injuries that had occurred at the home which we had not been notified of. This was a breach of Regulation 18 of CQC (Registration) Regulations 2009.

The home mostly had sufficient staff to meet the needs of the people living there. Staff had received training in how to recognise and report abuse. The registered manager knew how to report any safeguarding concerns to the appropriate local authority if necessary.

People received appropriate support to meet their needs. Risks relating to people's medical conditions were routinely assessed and appropriate plans were implemented to keep people safe. Staff had access to appropriate training and support. Nurses received clinical supervision to keep them up to date with current practice.

There were systems in place for managing medicines in the home. A medicine procedure was available for staff and staff had completed training in relation to safe medicine administration. Medicines were stored safely and records showed they were administered as prescribed. Healthcare professionals such as chiropodists, opticians, GPs and dentists were involved in people's care when necessary.

People's needs were met by caring, patient and considerate staff. People’s privacy and dignity was respected by staff. People, their families and staff were all complimentary about the home. Staff were enthusiastic about working with the people who lived at the home and developed positive relationships with them.

People’s care plans were personalised, detailed and contained important information about people's needs as well as their routines and what was important to them. An assessment was carried out before people came to live at the home. Staff supported people to prepare appropriate plans where people were receiving care at the end of their lives.

There was an open and transparent culture within the service. People and staff told us that the registered manager was approachable. The management team was visible throughout the home. The registered manager knew people and their relatives well. There was a quality assurance system in place which monitored the quality of the care provided.

The service has 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.

We last inspected the service in January 2016 and rated the service as requires improvement. At this inspection we found that some improvements had been made. However we continued to have concerns about staff deployment and management of clinical risks. The rating therefore remains as requires improvement.

People spoke positively about the service and the care that was provided. They told us that the staff were kind and caring. There were sufficient staff, however they were not always deployed effectively and this placed people at risk of poor care. Risks were identified but not always managed effectively. For example, people at risk of pressure ulcers were identified and provided with specialist mattresses but we found that some of these were set at the wrong setting for people, which meant that they did not work effectively to prevent people from acquiring a pressure ulcer. Peoples health needs were not always well managed and staff were not always following best practice, for example in how they managed and documented the support provided to people with wounds and catheters. This could lead to confusion as to what care had or had not been provided and failed to mitigate the risks to people’s welfare and poor care.

People were given their medicines as prescribed but they were not always stored securely. The checks on clinical equipment were not sufficient and as a result may not work effectively.

The systems in place to recruit staff were thorough and references and other checks were undertaken before staff started work at the service. Staff had a good understanding of abuse and the steps that they should take to protect people. A training programme was in place to ensure staff had the skills and knowledge to undertaken their role. There were however still some gaps and we found that staff had a limited understanding of the Mental Capacity Act 2005 (MCA).

Staff told us that they were well supported when they started work at the service and told us that they received regular supervision.

People enjoyed the meals provided and supported to eat well.

Care plans were in place and staff had a good understanding of people’s needs. Activities were provided which promoted peoples wellbeing and we were told that these were being extended to weekends

The manager was approachable and promoted an open culture. Complaints were taken seriously and investigated. People’s views were sought in a variety of ways including resident meetings and questionnaires. The provider had invested in the fabric of the building and there was a new lounge in use for people to use. There were systems in place to drive improvement but these would benefit from being more robust to ensure consistency of practice.

During this inspection we identified a breach of the health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with relatives who told us that they were confident in the service and that staff were kind. We spoke with seven staff who were compassionate and observed them supporting people with dignity and kindness.

We found non compliance with medication. The provider confirmed that staff had received training and we saw evidence that a medication policy was in place, but staff were not following their training or adhering to the policy when administering medication. This, along with some errors on the records, was placing people at risk.

There have been some positive developments with the environment and the number of single rooms had increased. We found that the fire safety risk assessment had not been reviewed and some equipment was not serviced or in place. We have referred this matter to the local fire service as well as making a compliance action because people were at risk.

There were ineffective systems in place to reduce the risk and spread of infection because staff were sluicing shared commodes in a toilet and did not have any guidance on best practice cleaning methods.