Eastwood House

Eastwood House is a residential care home providing personal care to 15 people aged 65 and over at the time of the inspection. The service can support up to 19 people.

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

There was not enough staff to keep people safe. Rotas identified shortfalls; however, agency staff were arranged as and when required. There had been several occasions where staffing levels had been low, but staff worked the best they could to address the shortfalls in the absence of a manager. There was no evidence people were at risk of harm from this concern. The new manager had been at the home for one week and had already been working on a plan to identify shortfalls, issues and concerns.

The premises were clean and staff followed infection control principles and government guidelines.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating was Requires Improvement (published 06 December 2021).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels within the service. A decision was made for us to inspect and examine those risks. Targeted inspections do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe sections of this full report.

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 Eastwood House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Eastwood House is a residential care home providing personal care to 16 people aged 65 and over at the time of the inspection. The service can support up to 19 people.

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

We last inspected the service in June 2021 and at that time we had concerns regarding infection control, managing risks to people, governance of the home and Eastwood House was rated Inadequate overall. At this inspection we found improvements had been made and the home was no longer in breach of regulations, however further improvements were still needed.

Quality checks and audits had been completed but had not always been effective in identifying the shortfalls found. The culture within the home was positive in promoting person-centred care and positive outcomes for people. The provider was willing to make further improvements to the home.

Systems were in place to protect people from the risk of abuse. Risk assessments had been carried out to identify risks. There were enough staff working at the home to meet people's needs. The provider had robust staff recruitment practices in place. Medicines were managed safely. Accidents and incidents were reviewed to see if any lessons could be learnt from them.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 Inadequate (9 July 2021) with three 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 we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 9 July 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Eastwood House is a residential care home providing personal care to 16 people aged 65 and over at the time of the inspection. The service can support up to 19 people.

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

There were widespread and significant shortfalls in the way the service was led. There were three breaches of the Health and Social Care Act 2008 (Regulations) 2014.

People's care records did not always reflect their current care needs and increased the risk to people’s health and safety. People were at risk from infections because the infection prevention and control processes were not always effective. The environment in which people lived and staff worked was not appropriately maintained in places. The provider had not acted to address this. People were not always supported by sufficient numbers of suitable and experienced staff because there were not enough permanent workers employed by the home.

Governance and management systems were not always reliable and effective. The home lacked the drive for improvement to address many of the significant concerns we raised during our last and this inspection. Support for staff from management was inconsistent. The provider did not have up to date policies and procedures in place for staff to follow.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 29 October 2019) and there was one breach of regulation. The provider was asked to complete an action plan after the last inspection to show what they would do and by when to improve. The provider had failed to complete an action plan.

At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 16 and 17 September 2019. A breach of legal requirements was found. The provider had not completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had now met legal requirements. This report only covers our findings in relation to the Key Questions Safe 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 changed from requires improvement to inadequate. 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.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Eastwood 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 have identified breaches in relation to assessing and managing risks to people, infection prevention and control processes and the management and governance of the home at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Eastwood House is a residential care home providing personal care for up to 19 people. At the time of our inspection there were 12 people living at the home.

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

The home was clean and free from unpleasant odours. Some parts of the building would benefit from being redecorated and some of the lounge chairs need to be replaced as they are stained and ripped. The moving mechanism on some dining chairs was broken.The service has a refurbishment plan in place. All servicing of equipment had been completed, apart from the fire extinguishers. This was out of date.

Medicines were managed and administered safely, although there was not always someone trained in medicines administration on duty at night. This meant a senior person on-call had to attend the home if someone needed medicines, such as pain relief, during the night. The temperature of the medicines room was occasionally higher than recommended for the safe storage of medicines.

Risks to people’s health and safety had been assessed. People had detailed and person-centred care plans in place. However, two people who were at risk of choking did not have information in their care plans about how staff should thicken their drinks and staff did not record that they had added thickener. Staff we spoke with were aware of how much thickener to add.

There were enough staff to provide people with the appropriate level of support. The correct recruitment checks had been carried out when new staff joined the service. Staff had completed training in a range of different topics. The registered manager told us dementia and end of life care would be added to the training programme. Staff had received regular supervision meetings.

There was a relaxed and happy atmosphere in the home. People were cared for by staff who showed kindness, compassion and respect. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. There were many opportunities for people to take part in activities to occupy their time and provide enjoyment and stimulation. Staff helped people to access healthcare services and receive ongoing healthcare support.

The home had a registered manager, although they had only been in post for six months. Staff were complimentary about the way the home was managed and about the recent changes that had been implemented. Some audits were in place to monitor the quality of the service and the environment. However, these needed to be more robust as they had not identified all the concerns we found during our inspection. The registered manager was aware that further improvements were needed and took immediate steps during our inspection to make some of the required changes.

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

Rating at last inspection

The last rating for this service was good (report published February 2017).

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements.

Enforcement

We have identified one breach of the regulations. This is in the management of risks to people's health and safety.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Eastwood House is a care home with 23 places for older people and people living with dementia. On the day of our inspection there were 17 people living at the service.

Eastwood House is required to have a registered manager 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. At the time of the inspection the registered manager had left the service and a new manager was in post. They were in the process of submitting their registered manager application with CQC, we will monitor this.

At our last inspection of the service on 14 December 2015 2016 we identified the provider was in breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured the Mental Capacity Act and Deprivation of Liberty Safeguards were being applied appropriately. At this inspection we found action had been taken to make the required improvements.

People’s rights were protected under the Mental Capacity Act 2005. Staff were aware of the principles of this legislation. Correct action had been taken when people lacked mental capacity to consent to their care or if concerns were identified with their freedom and liberty.

Staff had received training in adult safeguarding and therefore were aware of how to protect people from harm. Risks associated to people’s needs had been assessed and planned for. However, this information was either limited or missing for some people. Accidents and incidents were recorded, monitored and analysed for themes and patterns and action was taken to reduce further reoccurrence.

Following a fire service audit completed by the local fire authority in September 2016, the provider had an action plan in place to make the required improvements to fire safety.

People’s dependency needs were monitored to ensure sufficient staff were available at all times. Some concerns were identified with staffing levels at a particular time of the day. The provider took action and staffing levels increased with immediate effect to meet this shortfall. Staff were recruited through safe recruitment processes.

People received their medicines as prescribed and these were managed correctly.

Staff received an induction, training and appropriate support. There were sufficient experienced, skilled and trained staff available to meet people’s needs.

People received a choice of what to eat and drink and these met people’s needs and preferences. People were supported appropriately with their healthcare needs and the service worked well with external healthcare professionals.

Staff were caring, kind and compassionate and had a good approach with supporting people. People were involved in opportunities to discuss and review the care and support they received. Information about independent advocacy services was available should people have required this support.

Care plans to support staff to know how to meet people’s needs in the main were informative and were reviewed regularly. However, an electronic care record system used was difficult for staff to access and manage, and impacted on the detail and reliability of information recorded about people’s needs.

People who used the service, relatives and staff received opportunities to be involved in the development of the service. The manager was clear about the action required to continually improve the service and staff were aware of their role and responsibilities.

The provider had met their regulatory requirements because they had notified us of events and incidents which they are required to do. There were systems in place to monitor the safety and quality of the service provided.

We spoke with the manager and the provider's representative. We also looked at some records held in the service which included the care files for three people. We observed the support people who used the service received from staff and carried out a tour of the home.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who were using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe.

We found care plans and risk assessments had been improved and work was on-going to ensure they were kept up to date and protected people who used the service from avoidable harm.

We found the provider had taken steps to protect the rights of people who did not have the capacity to consent, and there were systems in place to ensure they acted in accordance with the legal requirements of the Mental Capacity Act (2005).

We found the home to be clean and well maintained. However, the manager had not yet determined whether the infection control systems such as, policies, procedures and guidance were in line with relevant national guidance. This meant the manager did not know if people were fully protected from the risk of infection.

Is the service effective?

Systems were in place to ensure that people's individual support needs could be identified and met.

We observed people's support was delivered in such a way as to meet their individual needs and preferences. We saw people's care files had been reorganised since our last inspection. Staff told us the care files provided them with up to date information on how to support people safely.

Is the service caring?

People who used the service told us they were treated with kindness. Throughout the day of our inspection we found staff were friendly and caring in their approach.

Staff we spoke with told us, 'We want to provide the best care for people.'

A person who used the service told us, 'I am only here for a short stay but I come regularly. The staff are so kind to me and nothing is too much trouble really.'

Is the service responsive?

We found systems were in place to identify changes in people's health quickly to enable an effective response.

We found that people were supported in accordance with their individual needs and wishes.

Is the service well-led?

We found that some of the planned improvements to ensure the manager assessed the quality of the services provided had not been completed. The manager had made significant improvements since the appointment of two senior care staff to assist with managerial responsibilities. However more work was needed to ensure the systems of quality audits were fully implemented to drive continuous improvement and ensure best practice is sustained.

We found the manager to be caring and knowledgeable about people who used the service. The manager had made significant improvements to the care planning and record keeping since our last inspection.

We found the manager was being supported by two senior care staff to implement systems of audit around the quality of the services provided.

During the inspection we gathered information to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe. Relatives also told us they felt their family members were safe. A relative said, 'When I get in my car I know that [family member is] safe and well looked after.'

We found care plans and risk assessments on many subjects. However, it was not always clear from the information recorded whether all of the care plans and risk assessments had been reviewed monthly, who had been involved and what changes had taken place.

We saw there were appropriate arrangements in place for the safe handling, storage and administration of medicines. People told us they received their medication on time.

People told us they felt there were enough staff to meet their needs. Staff also told us they felt there were enough staff to meet people's needs.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw that a DoLS application had been made following our inspection on 27 September 2013. However, a DoLS policy was not in place within the care home. Staff we spoke with did not have a clear understanding of DoLS.

Is the service effective?

People who used the service told us they received good care. One person said, 'They're [staff] there if I need them.'

We saw people had care plans which set out their care needs. However, we saw staff had not always acted in accordance with a person's identified needs regarding pressure area care.

The provider and staff did not understand their responsibilities under the Mental Capacity Act 2005. We found gaps regarding Mental Capacity Act 2005 assessments.

We also found gaps in staff training.

Is the service caring?

People were supported by kind and attentive staff. A person said staff were, 'Very caring.' Relatives also told us staff were caring. One relative said, 'They're kind and they are very thoughtful.'

We saw staff interact with people. We saw they treated people with respect and were kind and caring. We saw they were patient and communicated warmly with people.

Is the service responsive?

A person who used the service told us, 'If something's wrong there's somebody there in no time at all.'

Staff had a good understanding of people's care and support needs. We also saw they arranged for people to access other services such as opticians and chiropody services.

We found people's needs were assessed and care plans and risk assessments were in place. However, information was sometimes unclear when new information had been added to care plans.

Is the service well-led?

People told us they felt they would be listened to if they raised any concerns. One person said, 'The manager is really brilliant.'

Staff told us they felt supported and listened to by the manager. A staff member said, 'She's a good manager.' They told us they felt they could contribute their views and staff meetings took place.

A visiting health professional told us they felt the service was well-led.

However, the provider did not have effective processes in place to regularly monitor the quality of the service provided. We found gaps regarding audits.

One person said, 'All the staff know me and what I like. It's very good; it's lovely here."

One relative said, 'Things have been changing slightly for the better during the last few months. I'm very happy with the service."

We saw that people's individual needs and risks had been assessed and reviews had been completed on a monthly basis since our last inspection.

We found that care plans had been updated since our last inspection and risk assessments had been completed regularly. We found that staff recorded daily the food and fluid intake for people identified at higher risk of poor nutritional intake and the manager had assessed people's fluid intakes on a regular basis.

One staff member said, 'We're more aware of people's individual needs now, like the need to record people's food and fluid intakes. We've got more staff now and we're running more smoothly.'

We saw that the service had made improvements in the planning and delivery of care for people who used the service following our last inspection in September 2013.

We found that Mental Capacity Assessments had not always been done when it would have been appropriate to do so. We also found that a deprivation of liberties safeguarding application had not been done for one person when it would have been appropriate to do so. This meant that the home did not have appropriate arrangements in place to obtain people's consent.

Most people told us that they were happy with the care they received at Eastwood House. Relatives of one person told us, 'The staff bend over backwards to help.'

However, we found that people were not protected against the risks of receiving care that was inappropriate or unsafe. This was because care plans and risk assessments were not regularly updated to reflect their changing needs.

Medication was not administered safely. This was because medications were not given in line with people's medication care plans. Records were not accurate or sufficient enough to protect people from the risks associated with taking medication.

There were insufficient numbers of staff to meet the needs of people.

A complaints policy was in place and was displayed throughout the home. People and their relatives told us that they felt confident that they would be listened to if they made a complaint.

Relatives of people who used the service said, 'Care staff are friendly and our relative seems very happy. We can ask staff for anything at any time.'

We saw that care plans and risk assessments had been reviewed on a regular basis. Staff were able to describe people's individual care needs and referred to information which we saw in people's care plans.

A relative told us, 'The home has followed the safeguarding process for my relative and I've been happy with their response. The home took action quickly and appropriately; I'm happy with the outcome.'

During our inspection we observed that the environment in communal and individual bedrooms looked clean and maintained.

A staff member told us, 'The home is maintained; there's new guttering in progress. Faults and repairs are dealt with quickly.' We checked the service's maintenance files and found appropriate maintenance checks took place.

We spoke with a person who used the service, they told us, 'Staffing has increased recently. Staff attend to my call buzzer during the night.' A member staff said, 'Staffing numbers are ok; sometimes we need more staff.' Staff shortages on the rota had been covered by members of the staff team.

One person who used the service told us, 'Staff are competent and they know their jobs.' We looked at three staff files and saw that supervision meetings were held between the staff and the manager.

Two relatives told us, 'Our views are sought and respected. We've had no complaints yet but we know how to raise any concerns with the manager.' We looked at surveys completed by people who used the service and their relatives. The responses were mostly positive.