Eastlake

Eastlake is a residential home providing accommodation and personal care for up to 53 people aged 65 and over. Some people living at the service are living with dementia, others are elderly and frail or have medical conditions that require them to live in this type of service. At the time of our inspection, there were 53 people living at Eastlake.

The service is divided into four units. Each unit has its own lounge and dining area. There is a level communal garden for everyone to use.

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

Whilst people spoke positively of the level of care and support, we found shortfalls in governance arrangements. Systems and processes were not fully aligned towards clearly formulated goals. For example, smooth and seamless transition of care was a goal for when people left hospital, but there were no clearly defined systems and processes to facilitate this. This also applied to other fundamental goals including person-centred care, risk management, and partnership work. Robust, reliable, and sustainable systems must be established to deliver these goals.

There was a framework for risk management and control. However, this was inconsistently applied. Audits did not consistently identify shortfalls. There was an accident/incident reporting system, but this was not fully utilised. Underlying causes of incidents and accidents were not fully considered.

We identified some strengths in partnership working, particularly with visiting professionals, including GPs. On the other hand, there were weaknesses in communication so that care was more joined up. The provider had begun some work to make improvements.

People were supported to engage in home life and maintain contacts with family and friends. Local schools, and other members of the community were invited to chat and sing with people. People remarked on this, clearly appreciating the connection with different generations and their local community.

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.

People told us they felt safe living at the home. Relatives of people living at the home told us they felt their loved ones were safe.

Staff were recruited safely, and the relevant checks had been carried out on staff before they started work.

Staff we spoke with understood what constituted abuse and knew what actions to take if they felt someone at the home was being abused. There was a safeguarding policy in place for the staff to refer to.

We observed the home as clean and well kept. We were assured that the provider was supporting people living at the service to minimise the spread of infection.

Rating at last inspection and update

The last rating for this service was good (published 04 February 2020).

Why we inspected

We received concerns in relation to the provider’s risk management framework, including management of medicines, incidents, falls, leadership, and the general governance. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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 Eastlake on our website at www.cqc.org.uk.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect

We found the following examples of good practice.

At the start of the pandemic, the provider employed ‘Welfare Assistants’ to ensure that people had access to meaningful engagement and activities, such as one-to-one and gardening activities, as people were unable to access the local community due to COVID-19 restrictions.

Eastlake is a residential home providing accommodation and personal care for up to 53 people aged 65 and over. Some people living at the service are living with dementia, others are elderly and frail or have medical conditions that require them to live in this type of service. At the time of our inspection, there were 48 people living at Eastlake.

The service is divided into four units. Each unit has its own lounge and dining area. There is a level communal garden for everyone to use.

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

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. Staff had not always followed the principals of the Mental Capacity Act 2005. Although the registered manager acted on the shortfalls immediately, we have issued a recommendation to the registered provider in relation to this.

People said staff were kind and caring and it was evident from our observations that good relationships had developed within the service. People enjoyed the food they were provided with and told us staff looked after their medicines for them. People said they felt safe and there was evidence that risks to people had been identified. Where people required the input of a healthcare professional this was sought.

People had access to a range of activities both within and outside of Eastlake and they told us they could make decisions around how they spent their time, their care and that staff encouraged independence.

People lived in a clean environment that was suitable for their needs and everyone said they had not had a reason to complain.

Management carried out a range of audits and looked for ways to improve the service. People were included in this in that they could offer up suggestions and staff were also consulted. Staff worked with external agencies and the outside community to increase opportunities for people.

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

Rating at last inspection

The service was rated Good at our last inspection (report published 22 August 2017). We found at this inspection, the service had retained their Good rating.

Why we inspected

This was a planned inspection based on the previous rating.

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.

There was 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.

People and their relatives gave positive feedback about the home, and its staff. A relative said, “I can't say enough about the staff here, they've been brilliant”.

People were safe at Eastlake. Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

There were sufficient numbers of staff who were appropriately trained to meet the needs of the people who live here. Staff recruitment procedures were safe to ensure staff were suitable to support people in the home. The provider had carried out appropriate recruitment checks before staff commenced employment. They had also checked to ensure staff were eligible to work in the UK.

People would be protected in the event of an emergency. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency. Appropriate safety checks were carried out on equipment and fire safety systems.

Staff induction and ongoing training was tailored to the needs of the people they supported. Staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support.

People received their medicines when they needed them. Staff managed medicines in a safe way and were trained in the safe administration of medicines.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and received support from staff where a need had been identified. People’s individual dietary requirements where met. Drinks were readily available to people via the use of ‘hydration stations’ in addition to regular drinks supplied by staff. Overall people were happy with the quality of the food. Recent work had been done to make improvements to the meals in response to people’s feedback.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. People’s health was seen to improve due to the care and support staff gave.

The staff were kind and caring and treated people with dignity and respect. Staff took time to sit and talk with people, and encouraged them to take part in activities. Caring interactions were seen throughout the inspection, such as staff holding people’s hands and making people feel good about themselves. The staff knew the people they cared for as individuals.

People received the care and support as detailed in their care plans. People and relatives were involved in reviews of care to ensure it was of a good standard and meeting the person’s needs. .

People had access to a wide range of activities. People and relatives were positive about the choice of activities, and how there was always something interesting to do. Many clubs, such as book clubs and knitting clubs took place to enable people to follow their interests and hobbies.

People knew how to make a complaint. When complaints had been received these had been dealt with quickly and to the satisfaction of the person who made the complaint. Staff knew how to respond to a complaint should one be received.

The provider had effective systems in place to monitor the quality of care and support that people received. Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. We had noted that the homes quality assurance processes had identified an issue with staff completing records inconsistently. This was under constant review by the registered manager and we saw that improvements had been made. The registered manager had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained.

People lived in a happy home with good leadership and a staff team that worked well together. A number of staff had chosen to place their own relatives in the home because they were happy with the care provided. A person said, “'It's a very good place this, you wouldn't get better around here or anywhere.” A relative said, “My family member would love to live at home (but cannot), this is the best substitute by far.”

The inspection took place on the 15 February 2016 and was unannounced.

A registered manager was 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.

The registered manager did not undertake quality assurance process, including regular audits on health and safety, infection control and medication. The registered manager met CQC registration requirements by sending in notifications when appropriate. We found both care and staff records were stored securely and confidentially.

People were kept safe. We spoke with the registered manager upon arrival regarding access to the service. The registered manager advised key pads were in place on the first floor for people with dementia, to reduce risks of falling. During the inspection we saw a key code on one of the three exits form the first floor. This demonstrated the risk of people falling down the stairs had not been correctly assessed or managed. However the manager immediately took action and later confirmed that access that the door had been secured for safety.

Incidents and accident were fully investigated by the registered manager, and actions put in place to reduce the risk to people of accidents happening again such as people falling.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When people lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We did not consistently see the code of practice being applied in the service. We have made a recommendation to the provider regarding this.

People received their medicines as they were prescribed and when they needed them. Processes were in place in relation to the correct storage, disposal and auditing of people’s medicines. One person told us “Yes, I have never missed any of my medicines.”

People told us care staff treated them properly and they felt safe. One person said; “ I feel safe here. I would talk to the team leader if I had not felt safe with staff.” Staff had written information about risks to people and how to manage these in order to keep people safe. One person had been assessed as being at risk of falls, we saw an action plan detailing actions for staff to undertake to minimise the risk to the person which detailed the appropriate call system and mobility assessments in care plans.

Staff had received training in safeguarding adults and were able to tell us about the different types of abuse and signs a person may show if they were being harmed. Staff knew the procedures to follow to raise an alert should they have any concerns or suspect abuse may have occurred. One staff member said “ If I noticed or suspected any abuse I would report it to one of the team leaders. If they were not available I would report to one of the care managers.” and “They have to escalate all abuse to the Surrey safeguarding team, CQC and police. I would recognise abuse through different ways; if people become nervous, have bruising or are timid when you approach them.”

Care was provided to people by a sufficient number of staff who were appropriately trained and deployed. People did not have to wait to be assisted. One person said; “Staff come straight away as soon as I press the button. There are always staff around.”

Staff recruitment processes were robust and helped ensure the provider only employed suitable staff to care for people. Staff had the specialist training they needed in order to keep up to date with care for people. Staff demonstrated best practice in their approach to the care, treatment and support people received. Some staff had NVQ in health and social care and other staff were working towards them. Staff received appropriate induction. The registered manager had put in place the care certificate for staff to undertake as well as the providers set induction process.

People and their relatives gave positive feedback about the service they or their family member received. People were very happy. One person said “It’s such a friendly place to live.”

People and their families had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. Staff ensured people had access to healthcare professionals when needed.

People were provided with a choice of freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night. Specialist diets to meet medical or religious or cultural needs were provided where necessary. One person said “I have my food pureed. I have a choice and the meals are tasty.”

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. We observed some positive interactions and it was evident people enjoyed talking to staff. People were able to see their friends and families as they wanted and there were no restrictions on when relatives and friends could visit. The activities on offer to people were varied. One person said “I choose when I want to be on my own in my bedroom. I can do my puzzles when I want to. I have privacy in my bedroom and staff always knock on my door.”

People’s views were obtained by holding residents’ meetings and sending out an annual satisfaction survey. People knew how to make a complaint. One person said “I have no complaints; there is nothing to complain about. I would talk to the manager if I needed to make a complaint.” Complaint procedures were up to date and people and relatives told us they would know how to make a complaint if they needed to. The policy was in an easy to read format to help people and relatives know how to make a complaint if they wished.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During the inspection we observed staff speaking respectfully and kindly to residents. There were lots of conversations and laughter during breakfast and lunch time. People using the service were offered choice and if they did not want to do something, staff offered them alternatives and asked them what they would like to do.

Throughout the inspection people were seen spending time in their rooms listening to music, spending time on the computer, having their hair done and taking part in various activities. Other people were seen spending time with the cats that lived at the service.

People who used the service were allowed to decorate their rooms to their taste and had pictures and photos on the walls. All the rooms that we saw had ornaments and personal belongings on show.

A family member told us "the staff are really nice - it is nice to see the same faces when we visit. I feel very happy that she is safe here. I have a lot of confidence in this place". Another family member said "the staff are well trained and supported. They have the skills and qualities to do their jobs. The staff get to know their residents and know what they like and when to prompt them to do something".

We found the service had completed comprehensive assessments of people's needs in order to be able to provide the most appropriate care. We found people's care plans had contained detailed risk assessments which had been regularly reviewed.

We saw the service had systems in place to deal with poor nutrition and people were provided with adequate food and hydration.

We found all staff had been trained in safeguarding and the service had up to date safeguarding and whistle blowing policies. We found the service had systems in place to monitor the ordering, storage and disposal of medicines. We found there to be one gap in the Medication Administration Recording (MAR) sheets.

The service had a recruitment policy in place which had been followed when they had employed staff.