You are here

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.

Reports


Inspection carried out on 14 June 2018

During a routine inspection

Easthill Home for Deaf People 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.

At our last inspection in November 2015, we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. The service was meeting all relevant fundamental standards of care. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

This inspection took place on 14, 15 and 29 June 2018 and was unannounced.

The home accommodates up to 15 people and specialises in supported older deaf people whose primary means of communication is British Sign Language (BSL). At the time of our inspection 10 deaf people, were living at the home. The home was based on three levels connected by stairwells, a passenger lift and a stair lift. All bedrooms had sink facilities and bath or shower rooms were available on each floor, together with communal areas where people could socialise.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

People felt safe living at the home. Staff knew how to identify, prevent and report abuse. They assessed and managed risks to people and risks posed by the environment effectively.

Arrangements were in place for the safe management of medicines. People received their medicines as prescribed. The home was clean and hygienic and staff followed best practice guidance to control the risk and spread of infection.

There were enough staff to meet people’s needs in a timely way. Appropriate recruitment procedures were in place and pre-employment checks were completed before staff started working with people.

People’s needs were met by staff who were competent, trained and supported in their role. Staff acted in the best interests of people and followed legislation designed to protect people’s rights and freedom.

People’s dietary needs were met and they received appropriate support to eat and drink enough. Adaptations and improvements had been made to the home to make it supportive of the people living there.

People were supported to access healthcare services when needed. Staff made information available to other healthcare providers to help ensure continuity of care and supported communication between people and health professionals.

People were cared for with kindness and compassion. Staff knew people well and built positive relationships with them. They were skilled at communicating and engaging with people and adapted BSL to effectively meet people’s communication needs.

Staff protected people’s privacy and dignity. They encouraged people to remain as independent as possible and involved them in planning the care and support they received.

People’s needs were met in a personalised way. Each person had a care plan that was centred on their needs and reviewed regularly. Staff empowered people to make choices and responded promptly when people’s needs changed.

People had access to a range of activities based on their individual interests, including regular access to the community. They knew how to make a complaint and an accessible complaints procedure was in place.

Staff took account of people’s end of life wishes and preferences. They supported people to remain comfortable and pain free.

People and professionals who had regular contact with the home felt it w

Inspection carried out on 5 & 6 November 2015

During a routine inspection

The inspection took place on 5 and 6 November 2015 and was unannounced. The home is registered to provide accommodation for up to 15 older people and specialises in caring for deaf people. There were nine people living at the home when we visited, some of whom were living with dementia or had a learning disability.

At the time of our inspection the manager had applied to be registered with CQC and their application was being processed. 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 our previous inspection on 5 and 7 May 2015, we identified breaches of five regulations. We issued two warning notices in relation to the safety of the care provided and the lack of quality assurance processes. We also issued requirement notices in relation to the need for consent; safeguarding people from abuse; and the suitability of the premises. The provider sent us an action plan on 12 August 2015 stating they had taken action and were meeting the requirements of all regulations.

At this inspection we found all areas of concern had been addressed. This was confirmed by comments made by people, relatives and staff, who reported significant improvements had been made in the quality and safety of the service.

People said the most important aspect of living at the home was the opportunity to mix with other deaf people and to be able to communicate with staff effectively. A mix of deaf and hearing staff were employed, who were skilled in communicating with people using British Sign Language (BSL). They understood how to adapt BSL to people’s individual needs and used this effectively.

Staff acted as advocates for people when they became ill and supported them to access healthcare services. BSL interpreters were arranged for all medical appointments to help people communicate effectively with doctors and specialists.

People were treated with kindness and compassion. Staff spoke fondly about the people they supported and knew them well. People were encouraged to remain as independent as possible, their privacy was protected and they were treated with respect.

People told us they felt safe. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. Individual risks to people, such as developing pressure injuries or falling, were assessed and managed effectively. Arrangements were in place to deal with emergencies, including suitable fire safety measures.

Care and support were provided in a personalised way by staff who understood and met people’s needs well. Care plans were comprehensive and were regularly reviewed. A range of activities was provided and the home had set up a deaf club to encourage deaf people living in the community to visit.

The home was clean and staff followed guidance to reduce the risk of infection. Medicines were managed safely and people received their medicines when they needed them.

There were enough staff to support people at all times and recruitment processes helped make sure only suitable staff were employed. Staff received appropriate training, support and supervision in their work and felt valued.

Staff followed legislation designed to protect the rights and freedom of people living at the home and sought consent from people before providing care or support.

The dining room and some people’s bedrooms had been decorated and people had been involved in choosing the colour schemes. Plans were in place to improve the building further.

People were satisfied with the quality of the food and received a choice of suitably nutritious meals. If people started to lose weight, they were referred to specialists and given appropriate support.

People were involved in discussing and planning the care and support they received and were consulted about all aspects of the service. The provider acted on feedback from people, for example by changing the menu and introducing new foods. The provider’s complaints policy had been translated into BSL and people knew how to complain.

There was a clear management and staffing structure in place and people and their relatives said they considered the service was well run. Staff and management had a shared vision to provide high quality care. Staff were happy in their work and well-motivated.

There was an open and transparent culture. Community links were being developed, visitors were welcomed and staff enjoyed good working relationships with external professionals. Audits of key aspects of the service were conducted. The results showed the service was making continual improvement.

Inspection carried out on 5 and 7 May 2015

During a routine inspection

The inspection took place on 5 and 7 May 2015 and was unannounced. The home is registered to provide accommodation for up to 15 older people and specialises in caring for deaf people. There were 10 people living at the home when we visited, some of whom were living with dementia or had a learning disability.

At our previous inspection on 9 and 17 September 2014, we identified breaches of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We issued two warning notices in respect of the lack of quality assurance processes and the lack of support for staff. We also set compliance actions in relation to: care and welfare; consent to care and treatment; infection control; and staffing. The provider sent us an action plan stating they would be meeting the requirements of all regulations by 1 February 2015.

At this inspection we found improvements had been made, but the provider had not addressed all areas of concern adequately. As a result, they were continuing to breach regulations relating to fundamental standards of care.

The home is required to have a registered manager as a condition of their registration but there was not one in place at the time of our inspection. 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. A new manager had been recruited and was due to start work shortly after our inspection. In the interim, the Chief Executive Officer (CEO) of the provider was acting as manager.

Infection control procedures had improved and the home was visibly clean. However, infection control risks had not been assessed and staff were not protected from the risks posed by a person with a serious viral infection when delivering personal care to them.

Suitable arrangements were in place for the obtaining, handling, safe keeping and disposal of medicines, but there was no system in place to properly account for all medicines in stock. There was insufficient information about when to administer “as required” medicines to people. There was no system in place to make sure creams and ointments that were being applied to people had not exceeded their ‘use by’ date and were still effective.

Staff had received fire safety training and knew what action to take in the event of a fire. However, three people did not have vibrating pillows to wake them if the fire alarm was activated. This would put them at risk in the event of a fire. Measures had not been put in place to protect a person who was at risk of developing pressure injuries.

Health and safety risks posed by the environment had not been assessed or measures put in place to manage them. The temperature of hot water in some rooms exceeded safe levels and put people at risk of scalding.

Staff sought consent from people before providing care, but legislation designed to protect people’s rights was not followed. Relevant people had not been consulted to make sure decisions were made in the best interests of people. The liberty of some people may have been restricted without the relevant legal authority.

People expressed concerns about the design and layout of the building as it did not meet their needs. Some areas of the home were in need of redecoration and the lighting and decoration of one person’s bedroom did not support their visual needs. The provider had not developed a written schedule of works, with timescales and costings to improve the environment.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Audits of key aspects of the service were not conducted and, where they were conducted, these were not always effective. As a result, the requirements in one of the warning notices we issued had not been met fully.

People felt safe at the home and staff knew how to identify, prevent and report abuse. There were enough staff to meet people’s needs at all times, including a mix of deaf staff and hearing staff. The process used to recruit staff was safe and helped ensure staff were suitable for their role. Staff received appropriate supervision, appraisal and professional development.

Staff were suitably trained, including in the use of British Sign Language (BSL). Deaf staff were highly skilled in using BSL and hearing staff received regular training to continually improve their ability to communicate. In addition, communication was enhanced through the use of pictures where appropriate.

People were treated with kindness and compassion. Staff knew people well and used this knowledge to help build positive relationships.

People were offered a choice of suitably nutritious meals and received appropriate support to eat and drink. They saw doctors and healthcare specialists when needed and were supported to attend appointments.

Staff described practical ways in which they respected people’s privacy and dignity. Bedroom doors had locks and confidential information about people was kept securely.

People (and their families where appropriate) were involved in discussing and planning the care and support they received and family members were kept up to date with any changes to their relative’s needs. Care and support were provided in a personalised way that met people’s individual needs. Care plans were comprehensive, reviewed regularly, and most were up to date.

People were encouraged to make choices and be as independent as possible. A new activities coordinator had been appointed who had started to identify people’s individual interests.

The provider’s complaints procedure had been translated into BSL on a DVD and staff had spent time discussing this with people. Feedback from people and their relatives was sought and listened to. Issues raised about transport for trips out, the menu and activities had been addressed.

People told us they were happy living at the home and felt improvements had been made since our last inspection. Staff understood their roles and took a team approach to providing care. Concerns they had raised with the provider had been addressed. They told us there had been “massive improvement” to the way the home was run.

There was an open and transparent culture within the home. Visitors were welcomed and there were good working relationships with external professionals.

At this inspection we found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, some of which were continued concerns from our previous inspection. You can see what action we have told the provider to take at the back of this report.

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.

Inspection carried out on 7 January 2014

During a routine inspection

We spoke with three out of 13 people using the service at the time of our visit and observed the care and support provided in the shared areas of the home. People told us they were satisfied that the care they received met their needs. They were given choices. They said care staff were gentle and supportive when they helped them with their personal care. People said they felt safe in the home and would not wish to move elsewhere. One said, �It�s lovely�. People told us they occasionally had problems communicating with staff who were still learning British Sign Language (BSL).

We found people�s care and support were provided in an environment where the specific needs of deaf people and deaf culture were understood. Suitable adaptations had been made to the building so people were living in a safe environment. Staff were aware of people�s care needs and supported them in a caring manner. Care and support were delivered with people�s consent. However where people did not have the capacity to consent, there was incomplete awareness of the legal requirements. Staff were not supported by an effective system of appraisal and supervision, and training in compulsory topics was not refreshed regularly. The provider�s systems for monitoring the quality of the service were not effective or comprehensive.

We carried out this inspection with an expert- by-experience who was a counsellor and advocate for deaf people, and a BSL interpreter. They found it to be �a nice home" where people received appropriate care according to their needs and where they were safe from harm.

In this report the name of a registered manager appears who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. An interim manager was managing the regulated activity and is referred to as �the manager� in this report.

Inspection carried out on 17 January 2013

During a routine inspection

At the time of our visit Easthill was registered for the regulated activities "Personal Care" and "Accommodation for persons who require nursing or personal care". The manager confirmed they were not currently providing personal care in people's own homes, so our inspection did not include that activity.

We spoke with three out of 14 people using the service and a social worker who was visiting one of their clients. They told us Easthill was a friendly place with �good relationships between staff and residents�. They said that care and support were delivered according to people's needs, and that they were given choices. People's care was adapted to the individual and their independence and privacy were respected.

We found that people were involved in their care and support, which was delivered according to person centred care plans. People using the service were protected against the risk of abuse. The provider had effective recruitment and induction processes and made the necessary checks before new staff started work. There were systems in place to monitor and improve the quality of the service.

We carried out this inspection with an expert-by-experience who was an advocate for deaf people. They found it to be a �nice home where residents received appropriate care and [attention to their] needs to make sure they were safe from harm.� There were members of staff who understood deaf culture because they were themselves deaf or had deaf family members.

Reports under our old system of regulation (including those from before CQC was created)