Eastcotts Care Home with Nursing

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Incidents and accidents were collated and reviewed but not in depth which meant that opportunities for learning could be missed. The records did not always demonstrate effective analysis, and the same learning was identified month on month, despite different types of incidents taking place. Some clinical analysis was undertaken, and infections and skin tears were reviewed on a monthly basis.

The registered manager understood their responsibilities under duty of candour and shared information with the relevant stakeholders.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Relatives were positive about how the service worked with other professionals and told us that referrals were made promptly and advice followed. One relative told us, “It is the way they look after [my relative], they were choking, and they referred them straight away to the [speech and language therapy] team”

Staff worked closely with healthcare partners, such as the specialist dementia team and occupational therapists to promote people’s wellbeing. Weekly meetings were held with the local GP practice to review people’s health.

Visiting health professionals told us that staff were alert to changes in peoples wellbeing and escalated concerns appropriately. One Health professional told us, “Nursing staff are well organised here and very good with people at the end of their life.” Another told us, “Staff are available, professional and helpful.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The provider shared concerns quickly and appropriately.

Staff told us that they had undertaken training on safeguarding and were clear about their responsibility to report matters of concern. Body maps were used to record changes in people’s skin. We saw examples where the registered manager had taken action when concerns had been identified.

Prior to our inspection we had received feedback that where people lacked capacity, the provider did not always have the correct records in place to ensure decisions and restrictions to people’s care had been made in line with the Mental Capacity Act 2005 (MCA). We saw that training had been undertaken, and a member of staff had taken responsibility for undertaking assessments and making applications. We were assured by the registered manager that this work was well underway.

The provider had systems in place to identify risk and to reduce the likelihood of harm however actions were not always implemented consistently.

Risk assessments were undertaken, and care plans were in place. However, some of the care plans were not detailed and did not clearly document how risks should be managed and the actions that staff should take to keep the person and others safe. One person’s care plan stated that they should be provided with pain relief before staff delivered personal care, to reduce any distress but we could not see that this was being undertaken consistently.

Another person had been identified as being in need of close monitoring and while there was evidence of some monitoring this was not being undertaken as outlined in their care plan.

Other risks were better managed, and we saw that people had specialist mattresses to reduce the likelihood of skin breakdown, and these were checked regularly. People at risk of choking were provided with the correct consistency of food. A relative told us how they had supported their family member, and they had gained weight, “My relative stopped eating and lost weight. They weigh them weekly, provide milkshakes and they always bring a banana snack with the drinks.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Portable heaters were in use throughout the building but there were no risk assessments in place.

Not all wardrobes were secured to the wall and therefore there was a possibility that they could fall on people causing injury. There were radiator covers in place but some of these were not fixed into place and could move if people fell against them. A fire risk assessment had been completed 6 months previously but there was no evidence that actions had been taken to address the areas identified. We observed a fire extinguisher in the lounge had come away from the wall and when we looked at the checks on extinguishers, we saw that these were out of date. The provider told us that following our inspection they took immediate action to address this and planned to appoint a health and safety lead to review health and safety across the home.

A food hygiene inspection had been carried out prior to our inspection and found that systems were not working effectively. The food hygiene rating had been reduced to a score of 1. The registered manager told us that they were taking action to address the shortfalls.

Whilst there were clearly gaps in the oversight there was evidence of some servicing and checks on equipment such as slings, hoists and electrics.

Some areas of the home looked tired and furniture and other items had been discarded outside. Following the inspection the provider told us that they had plans to refurbish some areas and remove unwanted items.

Staff were not always deployed effectively to provide safe care that met people’s individual needs.

People told us that staff were kind, but they had to sometimes wait for support. Comments included, “Sometimes there are not enough carers in this lounge, only visitors in here”,and another said that when the buzzer goes, “They are slow, always say they are busy, so I have to do it (buzz) a few times.”

We observed that staff were not always available in the communal areas, although there were people in these areas, at risk of falls. People were observed trying to stand but were very unsteady and were asked to sit down as staff passed through the room. In one of the lounges cutlery was laid out but oversight was not effective, and one person tried to cut their clothing. The meal was served but staff were not available to support people to eat until they had finished supporting people elsewhere.

The management team carried out recruitment checks on staff prior to their appointment which included right to work, and disclosure and barring checks. References were sought but not always from previous employers and we asked the provider to follow this up. Agency staff were used to cover shortfalls and staff sickness, but a profile and induction checklist was not always in place, to ensure agency staff had the information about the home they needed before starting work.

Staff told us that they were provided with training and induction when they commenced their role. Competency checks were completed to evidence understanding in key areas.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading.

The service was clean and tidy and all but one of the toilets we visited had hand soap and paper towels. Foot operated bins were in place and posters were displayed reminding staff about handwashing. Staff had good access to personal protective equipment, and we saw it being used appropriately. People and their relatives spoke highly about the cleanliness, one told us, “Cleanlinessis good, they go above and beyond.” Another said, “They are always mopping the floor, yes it’s clean.”

Some areas were tired and in need of upgrading. Paint work for example was chipped which presented challenges for housekeeping staff.

An audit had recently been undertaken by the home’s infection control lead, and an action plan was in place.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Guidance was provided on how people liked to take their medicines. Records were up to date and showed people received their medicines as prescribed. Running totals were maintained and records tallied with the available medicines. Controlled drugs were appropriately stored.

Where people were prescribed their medicine via a patch, there were records to show that the site was being rotated to prevent skin irritation.

Prescribers reviewed people’s medicines at regular intervals. Staff followed safe procedures when giving people their medicines and there were regular assessments of staff competence around medicine management.

Medicine audits were completed.