Archived: Eastview Residential Home

At our last inspection on 29 December 2017, we found five breaches of Regulation of the Health and Social Care Act 20018 (Regulated Activities) Regulations 2014. Improvements were needed with consent to care and treatment, how risks to people were monitored and managed, how people’s nutrition was managed and how the quality of the service was monitored by the provider. Improvements were also required to ensure safe recruitment procedures were followed and people’s care records were detailed and reflected how to meet their needs. We rated the service overall requires improvement. The key questions safe, effective, responsive and well-led were rated requires improvement. The key question caring was rated good.

At this inspection we found that improvements had been made and were ongoing. The provider was no longer in breach of any regulations. We were encouraged by the progress made by the management team to turn the service around and the overall rating has changed from requires improvement to good.

A registered manager was 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.

Eastview Residential Home 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.

Eastview Residential Home provided a safe service to people. This included systems in place intended to minimise the risks to people, including from abuse, falls and with their medicines. Staff understood their roles and responsibilities in keeping people safe. They were trained and supported to meet people’s needs. Staff were available when people needed assistance and had been recruited safely. Where people required assistance to take their medicines there were arrangements in place to provide this support safely, following best practice guidelines.

People were cared for in a compassionate way by staff who understood their care needs. People were complimentary about the care they received and the approach of the management team and staff. Staff had developed good relationships with people. Staff consistently protected people’s privacy and dignity and promoted their independence.

People and their relatives where appropriate were involved in the planning of their care and people’s care records reflected their personal preferences. The care records were reviewed regularly and updated when people’s care needs changed.

People enjoyed a positive meal time experience and were supported to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access healthcare services. Input from other professionals was sought where concerns were identified about a person’s health or wellbeing needs. Information about people’s healthcare needs was shared appropriately with other professionals to ensure continuity of care.

The registered manager and the staff understood their obligations under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported to pursue their hobbies and participate in activities that they chose. People knew how to complain and share their experiences. Their feedback was valued, acted on and used to improve the quality of the service.

There was visible leadership in the service. Improvements had been made and were ongoing to the systems for monitoring the quality and safety of the service provided. The registered manager had worked closely with social care professionals to implement person-centred care plans and an audit system. Recording, auditing and documentation in these areas had improved.

At the last inspection on 30 June 2015 we rated the service ‘Good’ overall. At this inspection of 17 October 2017 we found that the service needed to make improvements in a number of areas. This included how risks to people were monitored and managed, how people’s nutrition was managed and how the quality of the service was monitored by the provider. Improvements were also required to ensure that care records reflected people’s needs in sufficient detail and that recruitment procedures were safe.

The service had a registered manager in place. 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.

Risks to people were not consistently monitored and managed effectively. Where risks were identified the measures in place to reduce the risk were not always clear.

Care records did not contain enough information for staff to provide safe and effective care that met people’s individual needs. Staff we spoke with were not always aware of, or clear about the care people required and how this should be delivered. New staff had recently started at the service or were due to start after our inspection, and it was unclear how these staff would know how to care for people safely.

Where people had a low weight or were at risk of malnutrition, there were no clear plans stating how staff should support them to ensure they did not continue to lose weight. Staff practice we observed meant that we were not reassured that people were always actively encouraged to eat sufficient amounts.

The service did not practice safe recruitment procedures. This is because they did not always obtain appropriate identification, references and Disclosure and Barring Checks (DBS) before new staff were allowed on the premises.

The provider of the service did not assess and monitor the quality of the service and have systems in place to monitor the performance of the registered manager. This meant that areas for improvement we identified were not independently identified by the provider.

People told us there was enough competent staff to help them when they required it. However, improvements were required to ensure that the number of staff needed was calculated based on people’s social needs as well as their physical needs.

Staff told us they felt supported in their role. However, they did not consistently demonstrate a good knowledge of subjects they had received training in and this had not been identified by the service.

The service was not meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and complying with the principles of the Mental Capacity Act (MCA) 2005. Improvements were required to ensure that people’s capacity to make decisions was assessed and that plans were in place around people’s capacity to consent. Improvements were also required to ensure that a formal best interest’s process was followed where appropriate.

Improvements were required to the knowledge of staff and the registered manager around MCA and DoLS and how it applied to people in their care.

People told us and we observed that the staff were kind, caring and respectful towards them. People and their relatives were given the opportunity to feed back on the service and their views were acted on. Some improvements were required to ensure that people’s views about their care were reflected in care planning and care reviews.

Staff we spoke with knew people on an individual basis. Some care records contained information about people’s life history and some limited information about their likes and dislikes. However, improvements were required to ensure that all care plans were fully personalised to include people’s preferences.

Improvements were required to ensure that people using the service received the support they required to remain engaged and stimulated.

Medicines were managed, stored and administered safely.

People told us they had appropriate access to support from other health professionals such as GP’s, chiropodists and dentists. However, improvements were required to ensure that the service recorded the reason for and the outcome of these visits.

People told us they felt safe and secure living in the service. They were cared for by staff who understood the principles of safeguarding and how to recognise and report abuse.

People told us that the food they were provided with at the service was good quality and there were sufficient amounts of it. They said they felt able to request more food or drinks if they wished.

People told us they knew how to complain and felt they would be listened to if they wished to make a complaint. The service had not received any complaints at the time of our visit.

The registered manager and provider created an open, transparent and honest atmosphere within the service. People, relatives and staff were invited to feed back their views on the service. Staff told us they felt able to raise concerns and share work or personal issues with the registered manager.

Further information is in the detailed findings below.

People told us that the staff treated them with respect and kindness. One person said, "All the staff are very good." Another person said, 'They (staff) are marvellous." Another said, "They (staff) are all very kind." This was confirmed in our observations during our inspection. We saw that staff interacted with people in a caring, respectful and professional manner.

We looked at the care records of four people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights.

Staff personnel records that were seen showed that staff were trained and supported to meet the needs of the people who used the service.

We found that the service was clean and well maintained. Safety checks were regularly undertaken to ensure that people were provided with a safe environment to live in.