Archived: East Dean Grange Care Home

We found the following examples of good practice.

People were supported to maintain contact with their family and friends. People were able to go out with their family and friends when they wished to, and visitors were welcomed to the home. There was a visiting rota to ensure visits could be managed safely. Visitors were able to meet with loved ones in their bedrooms which allowed them time together in private. In addition to bedroom visits, there was also a visiting ‘pod’. This meant visits could take place without entry to the home. The manager told us this was not currently being used but it would become useful in maintaining visits in the event of an outbreak.

People and staff followed the testing program in line with government guidance. All visitors to the home, both family and professionals were required to provide a negative test and have their temperature checked before entering the home.

All non-exempt staff and visiting professionals were required to provide evidence that they had been vaccinated against COVID-19 before they came into the home. The manager told us that before any contractors visited the home they were made aware of this requirement.

PPE was available throughout the home and staff were seen to be using this appropriately. There was adequate stock available. The home was clean and tidy. There was a cleaning program in place. Care staff were responsible for cleaning high-touch points, such as door handles and light switches twice a day.

We found the following examples of good practice.

The home was clean and well maintained. There was a regular cleaning programme throughout the day with some cleaning duties completed during the night. There was a well-resourced cleaning team who followed and completed cleaning schedules. They were knowledgeable regarding current Covid-19 cleaning guidelines and had completed training on this subject. Care staff were also completing additional cleaning. For example, they cleaned mobile hoists following use and attached a paper band to indicate that suitable cleaning had been completed.

The home was currently closed to all visitors due to a recent Coid-19 outbreak. However, visiting had continued for those people at the end of their life, with individual risk assessments to safeguard people and visitors. Staff supported people to remain in contact with their families through phone and video calls. There was a visiting policy to provide relevant guidelines to follow once the home re-opens to visitors. Along with a visiting pod to support safe visiting in the future, which provided a separate entrance directly to the outside.

There were systems in place to ensure people who had tested positive for Covid-19 were isolated in their own rooms all of which had en-suite facilities. People who chose to visit the dining areas or communal areas were supported by staff to maintain social distancing. For example, chairs and tables had been re-arranged to allow more space between people.

An adequate supply of personal protective equipment (PPE) was available and staff had received specific Covid-19 training, this included guidance for staff about how to put on and take off PPE safely. Staff were seen to be following correct IPC practices. Hand sanitisers were readily available throughout the home. Regular testing for staff and people was being undertaken to support the safe management of IPC.

People’s experience of using this service:

People were supported by staff who treated them with kindness, respect and compassion. Staff understood people’s needs, choices and histories and knew what was important to each person. People were enabled to make their own decisions and choices about what they did each day.

People were supported to take part in a variety of activities that they enjoyed and were meaningful. There was an activities program that was continually being updated to reflect what people liked to do. People received support that was person centred, and staff knew them well. Complaints had been recorded, investigated and responded to appropriately.

People’s safety was maintained at East Dean Grange. They were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. The home was clean and tidy throughout.

There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the service.

Staff understood the risks associated with the people they supported. Risk assessments provided further guidance for staff about individual and environmental risks. People were supported to receive their medicines when they needed them.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this. People were asked for their consent before they received any care or support.

Staff received training and support that enabled them to deliver the care and support that people needed. People's health and well-being needs were met. They were supported to access healthcare services when they needed them. People's dietary needs were assessed. They were supported to eat a wide range of healthy, freshly cooked meals, drinks and snacks each day.

The registered manager knew people and staff well. They understood their responsibilities and had a quality assurance framework to support their oversight of the service provided

Rating at last inspection: Good (report published 14 October 2016.)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

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

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

At the time of this inspection 22 people were living in the service. This inspection took place on

18 and 19 August 2016 and was unannounced.

The service had a registered manager. 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 quality monitoring systems needed further development to ensure they were used to promote best practice and to identify shortfalls and demonstrate effective responses. For example in order to ensure adequate staffing to maintain quality care at all times.

People were looked after by staff who knew and understood their individual needs well. Staff treated people with kindness and compassion and supported them to maintain their independence. People’s dignity was protected and staff were respectful. All feedback received from people and their relatives was positive about the care, the atmosphere in the service and the approach of the staff and registered manager. One person told us East Dean Grange was “A very nice place to be.”

Feedback from visiting professionals was positive. They told us staff worked with them to improve the health of people and to provide ‘excellent’ care.

People were protected from the risk of abuse because staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a deprivation of liberty and followed correct procedures to protect people’s rights.

Staff were provided with a full induction and training programme which supported them to meet the needs of people.

People were given information on how to make a complaint and said they were comfortable to raise a concern or give feedback. A complaints procedure and comment cards were readily available for people to use.

Staff monitored people’s nutritional needs and responded to them. Preferences and specific diets were provided. People were supported to maintain their own friendships and relationships. Staff related to people as individuals and took an interest in what was important to them.

Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views on a daily basis and satisfaction surveys had been completed. The management style fostered an open culture that listened to people.

There were 24 people living at East Dean Grange at the time of this inspection visit. We spoke with the manager, a senior carer on duty and one of the cleaning staff.

We looked at the environment and reviewed the systems that the home had in place to maintain a clean and hygienic environment. We reviewed staff practice and training and the procedures the home followed in relation to infection control. We found that risks associated with cross infection had been assessed and the home was clean in all areas seen.

We looked at care records that the home maintained. These were found to be accurate and ensured the safety and wellbeing of people who used the service.

People told us that they were always asked for consent, and that they had given consent to the care that was provided.

People told us that they were treated with kindness and respect and that they received the care and support they needed. One person said, 'Everything is very good, we are looked after very well.'

We reviewed the facilities and practice in relation to infection control. We found that risks associated with cross infection had been assessed and responded to.

We looked at the systems and processes the home had in place to support and supervise staff working in the home. These were found to provide suitable systems for supporting staff.

We looked records that the home maintained these were not always accurate and did not ensure the safety and wellbeing of people who used the service.

We looked at the systems and processes in place for the safe management of medicines. We found that arrangements that had been established ensured the safe management of medicines.

We looked at the staffing arrangements in place. Staff told us that they were well supported and trained to do the jobs that they were employed to do. People using the service told us that the regular staff working in the home were 'good at their job.' Staffing arrangements were flexible and responded to the changing occupancy and dependency of people living in the home. This ensured sufficient staff were working in the home.

We looked at the systems and processes in place for the safe management of medicines. People who used the service told us that they received their prescribed medicines safely. However, we found that record keeping and practice within the home had not always ensured the safe administration of medicines.

Staff told us that they were well supported and trained to do the jobs that they were employed to do.

People using the service and staff told us that staffing availability was impacting on care. We found that the management of the home had recognised this issue and responded to this identified need by increasing the staffing numbers.

We looked at the systems and processes the agency had in place to respond to complaints. These processes ensured complaints could be raised and resolved to people's satisfaction.