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Easthill Home for Deaf People Good

Our most recent reports on this service are available as British sign language videos. You can watch the video of our December 2015 report here. British sign language videos of our July 2015 report and our November 2014 report are also available.
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Inspection report

Date of Inspection: 9, 17 September 2014
Date of Publication: 1 November 2014
Inspection Report published 01 November 2014 PDF

Overview

Inspection carried out on 9, 17 September 2014

During an inspection looking at part of the service

At our previous inspection, in January 2014 we identified that suitable arrangements were not in place for obtaining, and acting in accordance with, the consent of people; staff did not receive appropriate training, supervision and appraisal; the provider did not have an effective quality assurance system in place; and the views of staff and people using the service were not regularly sought. We set three compliance actions and the provider wrote to us telling us they would take action to meet the regulations by 30 April 2014. They then wrote to us again, telling us there had been delays and the regulations would be met by 4 June 2014.

At this inspection, on 9 and 17 September 2014, we looked at outcomes relating to the compliance actions. We also looked at outcomes relating to: care and welfare; infection control; and staffing to assess whether the provider was meeting the requirements of the regulations.

The inspection was carried out by an adult social care inspector and an expert by experience in dementia. This is a person who has personal experience of using or caring for someone who uses this type of care service.

At the time of our inspection there were 13 people living at the home. We spoke with six people, using British Sign Language (BSL) interpreters, spoke with a visiting community nurse, three members of staff and the registered manager. We also spoke with staff from: the community dental clinic, the risk office of the local hospital and the fire and rescue service. Following the inspection we discussed our concerns with the local safeguarding authority.

We considered all the evidence we had gathered under the outcomes we inspected and used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found:

Is the service safe?

We found the service was not safe. There were not enough skilled and experienced staff to meet people�s needs at all times. The manager told us they needed three members of care staff during the day, but this was not achieved regularly. A member of staff described staffing levels as �very poor� and said this put people at increased risk. One person told us they sometimes had to wait for assistance. They said, �They help [another person], but sometimes I get forgotten�.

People were not protected from the risk of infection because appropriate guidance had not been followed. Infection control risk assessments and audits had not been completed and not all staff had been trained in the prevention and control of infection.

There were arrangements in place to deal with foreseeable emergencies, but these were not robust. The effectiveness of these arrangements when there were no hearing members of staff on duty had not been tested and staff had not been trained in fire safety.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service had policies and procedures in place in relation to MCA and DoLS, although these were not understood well by staff. During the inspection the manager made an application for a DoLS authorisation for one person and staff were due to receive training in MCA in the week of our inspection.

We saw an example of a decision that had been taken in the best interests of a person who lacked mental capacity. However, other decisions taken on behalf of people were not documented and it was not clear why or how these decisions had been made. These included decisions relating to medicines and access to the keypad code to allow people to leave the building.

Is the service effective?

Not all aspects of the service were effective. Staff did not receive appropriate and timely training. Approximately half the courses where staff were due to receive initial training or refresher training in core subjects, such as infection control, health and safety, and food safety were overdue. A system of supervisions and appraisals for staff had not been implemented, so staff did not receive appropriate support.

There was a lack of information in care plans about when staff needed to administer medicines that were prescribed on an �as required� basis. For people who had their blood sugar levels monitored, there was no information about the range of levels that was normal and safe and what action staff should take if their levels were outside of this range.

The arrangements for ensuring people were supported to access healthcare were not always effective. A dental appointment for one person had been cancelled and another person had not been supported to attend an appointment following surgery and an appointment to have a blood test.

Is the service caring?

People told us staff were caring. One person described staff as �good people�. We observed staff interacting positively with people, for example by kneeling down so they communicated on the same level as people in chairs; they also used touch, where appropriate, to calm, relax and show empathy with people.

However, parts of the environment were not conducive to people�s welfare. For example, some areas needed decorating; some carpets were worn; the curtains in one person�s bedroom were hanging off the rail, so they were unable to close them fully. For those people who were living with dementia, the d�cor did not support them to navigate around the home, as there was a lack of colour contrast and few signs.

Is the service responsive?

The service was responsive. More deaf staff had been recruited to help people communicate their needs and wishes better using BSL. People told us this was a positive step. One person said staff used BSL �to talk to me about help and care�.

People�s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were personalised and had been developed either with the person concerned or their family members. They included plans to meet the person�s physical and emotional needs and information about how to communicate with the person.

People told us they were happy with the quality of care and support they received. A visiting community nurse told us they had �no concerns� about the home.

Is the service well-led?

The service was not well-led. The action plan developed to achieve compliance following our last inspection had not been completed. People were not asked for their views about their care and treatment and the provider did not have a system in place for obtaining the views of staff.

We found audits of medicines were conducted and the findings used to ensure medicines were managed safely. However, the manager told us there had been no audits to assess and monitor the quality of any other aspects of the service and they had not identified all the concerns we found during our inspection. Therefore, people could not be sure that shortcomings in the service would be identified and corrected in a timely manner.

We saw most actions detailed in a fire safety action plan had been completed; however, some actions were still outstanding, including the training of staff and the completion of work to bring a fire door up to the required standard.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to consent; care and welfare; infection control; staffing; supporting workers; and assessing and monitoring the quality of service provision.