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Inspection Summary


Overall summary & rating

Good

Updated 17 October 2018

This inspection took place on 21 and 22 August 2018 and was unannounced.

Eastbrook House 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. Eastbrook House accommodates up to a maximum of 43 people in one adapted building. At the time of this inspection there was 39 people living at the service.

There was a registered manager in post at the time of this inspection. However, the registered manager was away on annual leave. 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 the last inspection on 27 and 28 September 2016 the service, although rated ’Good’ overall, was found to be in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The management and administration of medicines was not safe. There was incomplete recording and monitoring of people’s food and fluid intake and re-positioning charts for people at risk of malnutrition and pressure sores.

Following the last inspection in September 2016, we asked the provider to complete an action plan to show what they would do and by when to improve each of the key questions to at least good. At this inspection we found that the provider had made significant improvements to ensure the safe administration of medicines. Re-positioning charts were comprehensively completed as required. However, we identified concerns relating to the lack of meal choices people were offered especially at lunch time and we found very little improvement in the way in which food and fluid charts were completed and monitored to ensure people who were at risk of malnutrition and dehydration were supported appropriately.

At the last inspection we found that people were not given a choice of what they would like to eat especially for those people living with dementia who may not have known what was on the menu and may not have been able to request an alternative. During this inspection we found little improvement had taken place especially after the last inspection the registered manager had assured us that improvements in this area would be implemented. Following the inspection the registered manager sent us information in relation to the improvements they had implemented following this inspection.

Fluid charts were put in place to monitor people’s fluid intake where this was an identified need. However, we found that these were not completed comprehensively to fully monitor people’s intake and take appropriate action where poor fluid intake was noted. However, we saw that people were appropriately hydrated and always had access to a variety of hot and cold drinks.

Care staff continued to demonstrate a clear and in-depth understanding of abuse, how to recognise signs of abuse and the steps they would take to ensure people were protected and kept safe and free from abuse.

Risk assessments continued to identify and assess risks associated with people’s health, care and support needs. Guidance and information was available to all staff on how to reduce or mitigate all assessed risks so that people were kept safe and free from harm.

We observed sufficient numbers of staff available to appropriately support people with their health, care and social needs. However, staff that we spoke to felt that due to additional tasks allocated to them in the absence of laundry and kitchen staff, this impacted on their workload and ability to appropriately care and support people.

We observed people to have access to a variety of drinks and snacks to support their hydration and nutrition needs. On the first day of the inspection, people were observed enjoying their food and were seen to eat well. However, on the second day of the inspection, we observed people not to eat so well and a large amount of waste returned to the kitchen. We saw that food had not been presented well and people did not seem to like the taste of the meal that they had been given.

The provider continued to follow robust recruitment practises to ensure that only staff assessed as safe to work with vulnerable adults were recruited.

All staff demonstrated a good level of understanding of the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLS). Records confirmed that people, where possible, had consented to the care and support that they received and where people were not able to make such decisions, relatives had been involved in the decision-making process.

Care staff continued to be supported through on-going training, regular supervision and annual appraisals to enable them to carry out their role effectively.

Care plans were detailed and person centred which gave specific information and guidance to care staff on how to meet people’s identified needs and wishes. We saw that care staff knew the people they supported very well.

We observed people and relatives had established positive and caring relationships with care staff who knew them and their relatives very well and supported not only the person but their relative as well.

The provider had displayed their complaints policy which detailed guidance on how people and relatives could lodge a complaint. People and their relatives knew who to speak with if they had any concerns or issues to raise.

The provider had a number of processes in place to monitor and oversee the quality of care that was provided to people. However, the provider did not robustly follow their own governance systems as the inspection process highlighted issues that the service should have identified and addressed themselves. We have made a recommendation about ensuring robust and complete governance systems are adhered.

Inspection areas

Safe

Good

Updated 17 October 2018

The service was safe. People and relatives told us that they and their relative felt safe living at Eastbrook House. Care staff demonstrated clear practices to be followed to keep people safe and free from abuse.

Risk assessments identified people’s risks associated with their health and care needs and gave guidance to staff on how to reduce or mitigate known risks to keep people safe from harm.

Administration and management of medicines was found to be safe.

The provider followed robust recruitment processes to ensure only staff assessed as safe to work with vulnerable adults were employed.

Staffing levels were observed to be sufficient to meet people’s needs. However, some care staff did express concern when additional duties were expected of them which impacted on their caring role.

Learning and improvements were reflected on and implemented where accidents and incidents were recorded.

Effective

Requires improvement

Updated 17 October 2018

The service was not always effective. People were not always offered a choice of meal especially at lunchtimes.

Care staff were regularly supported through training, supervision and annual appraisal to effectively carry out their role.

Pre-admission assessments were completed by the provider to ensure that the service could effectively meet the needs of the person.

People had access to a variety of drinks and snacks to support their hydration and nutrition needs. Where people required specialist diets or support this was provided.

The service followed the key principles of the Mental Capacity Act (2005) when delivering care and support to people.

Caring

Good

Updated 17 October 2018

The service was caring. We observed people to be treated with care, dignity and respect. People had developed positive relationships with the care staff that supported them.

People told us that they were always involved in all day to day decisions about the care and support that they received. We observed this in practise throughout the inspection.

People’s preferences and wishes about their care and support needs were clearly documented within their care plan.

People’s independence was promoted where possible.

Responsive

Good

Updated 17 October 2018

The service was responsive. Care plans were detailed and person centred and gave care staff an insight into people’s history and significant life events.

People received personalised care that was responsive to their needs.

People and relatives knew who to speak with if they had a complaint and were confident that their concerns would be appropriately dealt with.

People’s end of life preferences and wishes had been noted in their care plan.

Well-led

Good

Updated 17 October 2018

The service was not consistently well-led. The provider completed a number of audits and checks to monitor the quality of the service. However, these were not always formally recorded.

The service was aware of issues in relation to meal choices, however, the identification of this issue had not been recorded and there were no action plans in place to address the issue. Recording issues in relation to the completion of fluid intake charts had not be identified by the service.

People and relatives knew the registered manager and other senior managers and were complementary on how the service was managed.

Staff felt supported by the management team who displayed good competency and appropriate values for their roles.

People and relatives were given the opportunity to engage and give feedback about the quality of care that they received.

The service worked in partnership with other agencies and health care professionals to support the provision of holistic care and support.