Eastside House

Eastside House is a residential care home providing accommodation and personal care for up to 16 people aged 65 and over, some of whom may have dementia. At the time of the inspection there were 14 people living in the home.

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

At this inspection we found there were improvements made to the management of the service and progress had been made in a number of key areas, including medicines management and care planning.

We found there was still need for improvement in setting out and advising staff on how to manage risks, and how to support people with behaviours that can challenge. Reviewing of accidents and incidents needed to take place, to ensure lessons were learnt by the service, and all that all health professionals were involved in a timely way.

We also found there had been insufficient progress in completing mental capacity assessments for people. Due to this, we could not be fully confident people were always supported to have maximum choice and control of their lives, however, relatives gave us examples where people’s rights had been upheld.

Management of the service had improved, but we found some staff were working excessively long hours, and audits were not robust enough to identify the issues we found at this inspection.

However, people and their relatives praised the service and people told us the service had improved since the last inspection. Staff were kind and caring, and they understood the needs and preferences of people. The staff team provided continuity of care for people.

Medicines management was safe, as was recruitment. People and their relatives told us the management team was responsive.

People had access to a balanced and healthy diet, although the menu was limited. Some people told us they would like more flexibility for getting snacks and drinks.

People and their relatives told us that they were happy with the management of the service and that they were kept up to date about their relative’s care.

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 21 September 2021 and there were breaches of regulation. We also issued a Warning Notice related to governance of the service.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We carried out an unannounced comprehensive inspection of this service to check whether the service had made improvements and addressed the issues set out in the Warning Notice.

At this inspection we found some improvements had been made but the provider remained in breach of two regulations, related to risk and governance of the service. We have also made a recommendation in relation to menu choices and activities.

The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

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.

Follow up

In response to the breach identified regarding good governance, regulation 17, we will be writing to the provider asking them to provide an action plan in response to the issues identified and to provide time specific updates on the progress of actions taken. We will work with the service and discuss with them how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Eastside House is a residential care home providing accommodation and personal care for up to 16 people aged 65 and over, some of whom may have dementia. At the time of the inspection there were 10 people living in the home.

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

People and relatives told us they felt safe with the care and support they or their relative received. People’s basic care and support needs were met, and relatives spoke positively of the service. However, we found significant concerns with care plans, risk assessments, management of medicines, and accident and incident reporting procedures which placed people at increased risk of harm.

People’s care plans were not person centred and people told us that there was a significant lack of organised activities available. Staff knew people well and most people reported that they were supportive and helpful. People’s preferences and choices and information from assessments was not always reflected in their care plans and care was not always delivered in line with national guidance.

Management oversight of the service was ineffective and did not identify the issues we found on the inspection. Managers were not completing audits in the areas where we found concerns and the service did not always promote good outcomes for people through person centred care. We found that several notifications had not been submitted to CQC.

People had access to a balanced and healthy diet, but some people and relatives told us there wasn’t enough choice. We recommended that the provider reviews their procedure for offering food choices to people and the overall mealtime experience.

People told us they would raise issues only reluctantly and not directly with the provider, instead relying on family or friends to speak on their behalf. We recommended that the provider reviews its procedure for receiving feedback from people.

People received care and support from staff that were appropriately skilled and trained to carry out their role. Staff told us they received regular training, supervisions and appraisals and that the management team were approachable and supportive.

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

Relatives told us that they were satisfied with the management of the service and that they were kept up to date about their relative’s care.

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 01 May 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 25 March 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, need for consent, person centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

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.

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

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We found several breaches of regulation and issued the registered manager and provider with a warning notice in relation to good governance.

Follow up

We will request an action plan from the provider and meet with them following this report being published, to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

People’s experience of using this service: Where risk assessments were in place, these gave information and guidance to care staff on how to ensure people were kept safe from harm and to minimise risks. However, we found that where people had specific risks associated with their health and medical needs these had not been identified or risk assessed.

The service was not working in line with the principles of the Mental Capacity Act 2005 (MCA).

Mental capacity assessments and best interests decisions had not been completed for people who had been assessed as lacking capacity.

Where people had been noted as lacking mental capacity and subjected to restrictions that could have amounted to a deprivation of liberty, Deprivation of Liberty Safeguards authorisations had not been applied for to ensure that people were being deprived of their liberty lawfully.

Care plans and associated records were not always current and reflective of people’s needs and preferences. Although reviews of people’s care had taken place, the care plans had not always been updated to reflect any significant changes.

People could access all areas of the home as they pleased and engaged in activities of their choice and preference. However, this could be further improved on to ensure people engaged in a variety of activities and outings to further enhance their well-being.

Management oversight processes were in place to check aspects of the service provision but these were not always effective because they had not identified any of the issues we found as part of this inspection process.

People were very happy living at Eastside House and told us that care staff were kind and caring. People knew the care staff well and had established positive relationships with them.

We observed that care staff also knew people well and delivered care according to their needs and preferences.

Relatives were complimentary of the care and support that their loved one received and found care staff to be attentive to their needs.

People were observed to enjoy the meals provided at the home. People were offered choice and we saw people had access to drinks and snacks throughout the day.

Medicines management and administration was safe. People received their medicines on time and as prescribed.

Recruitment processes followed by the service ensured that only those staff assessed as safe to work with vulnerable adults were recruited. Sufficient numbers of staff were available to support people safely.

People and their relatives knew who to speak with if they had any complaints or concerns and were generally confident that their concerns would be appropriately addressed.

Rating at last inspection: At the last inspection the service was rated good (report published October 2016). However, at this inspection we found areas of concern that required attention and improvement. The service has now been rated requires improvement.

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

Follow up: We found four regulatory breaches during this inspection. We will ask the provider to submit an action plan detailing the steps they intend to take to ensure the required improvements are implemented. We will also continue to monitor the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Eastside House is a care home for up to sixteen people that specialises in the care and support of older people and people living with dementia. There were three vacancies when we inspected.

There was a registered manager in post at the service. A registered manager is a person who has registered with the 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 and their representatives provided good overall feedback about the service. There was particular praise for how people’s health needs were addressed. The service supported people well with healthcare matters and acted on the advice of healthcare professionals. There was evidence of effectively addressing some aspects of concern around some people’s health.

People were treated in a respectful and individualised manner that recognised their needs and preferences. For example, people’s support needs around nutrition and hydration were recognised and addressed. Attention was paid to people’s safety, and the service took action when safety issues were identified.

There was a calm and friendly atmosphere at the service. There were enough staff working at the service to keep people safe and uphold good standards of cleanliness. The registered manager and the owner worked closely with staff and people using the service to help ensure appropriate standards of care and support were provided. The service encouraged concerns to be raised informally and responded to them.

The service encouraged people to keep in contact with friends and family, and to have visitors. People’s cultural backgrounds were considered as part of the care provided.

There was sufficient ongoing training and support of staff to equip them with the skills needed for their roles, particularly due to the owner’s investment in ongoing training for all staff in a national care qualification.

We made two recommendations in this report based on minor concerns identified during the inspection. We recommended that the registered people look into specialist training on safer recruitment of staff, as written references were not consistently in place for new staff before they started working at the service. We also recommended that specialist activity guidance be sought, particularly with a dementia focus, to broaden staff awareness and skills on how different people using the service may engage.

At this inspection we found that improvements had been made. There were now records to account for all medicines coming into the service and those being returned to the pharmacist. Medicines management systems ensured that there was enough of each person's medicine without excess stock accumulating. Checks of records against remaining stock found no overall discrepancies. We found that people were protected against the risks associated with medicines because the provider now had appropriate arrangements in place to manage medicines.

We also found that people's care plans were now being kept up-to-date and included relevant information such as about their mobility and dementia care needs. Where someone needed their fluid intake monitored, this was up-to-date and without significant gaps. People were protected from the risks of unsafe or inappropriate care because accurate records were maintained.

We did not speak with people who use the service on this occasion. We spoke with a visiting healthcare professional who told us, 'you're not going to get better than this home.'

Feedback and observations indicated that staff and the management team knew people as individuals, and responded to people's care needs. We found that the service liaised well with health professionals. Care was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found that people were protected from the risks of inadequate nutrition and dehydration. They were cared for in a clean, hygienic environment, and were protected from the risk of infection.

However, we found that people were not always protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements for the recording, safe administration and disposal of medicines were not in place.

We also found that people were not always protected against the risks of unsafe or inappropriate care arising from a lack of proper information about them. Accurate records in respect of each person, including up-to-date care plans and fluid monitoring charts, were not always maintained.

'The staff are wonderful,' one person told us. We observed that staff interacted warmly and inclusively with people who use the service. They worked as a team and attended to people in an unhurried and pleasant manner. They were appropriately trained and supported. We noted also that the environment was safely maintained.

There were systems in place aimed at ensuring people experienced care and support that met their needs. However, we found there was a failure to review and update falls risk assessments after people had had falls. This may have failed to protect people against inappropriate or unsafe care.

There has been no registered manager working at the service since March 2012. This is a breach of the provider's registration conditions. We are writing separately to the provider about this.