Eastlands

Eastlands is a residential care home providing accommodation and nursing and personal care for up to a maximum of 20 people. The service provides support to people who have a physical disability and mental health conditions such as dementia. At the time of our inspection there were 19 people using the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there was one person using the service who have a learning disability and/or who are autistic.

Right Support: Model of Care and setting that maximises people’s choice, control and independence

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

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

People were protected from the risk abuse. They felt safe with staff. Risks to people's health and safety were assessed, monitored and changes acted on. There were enough skilled, trained and experienced staff to provide safe care. Medicines were well managed. The home was clean and tidy and procedures to reduce the risk of the spread of COVID-19 were in place. Learning from accidents and incidents took place, appropriate notifications were forwarded to the relevant authorities.

People's needs were assessed prior to them coming to Eastlands, this enabled the provider to be assured they could meet people's needs. People's care was provided in accordance with the Equality Act 2010. Almost all training had a 100% completion rate. Action was being taken to address any shortfalls. Staff felt supported and enjoyed their role. People were supported to maintain a healthy, balanced diet. Good oral health care was encouraged. People were supported to lead healthy lives and staff liaised with and acted on guidance from external health and social care professionals. The environment was suitable and adapted for people living with mental health conditions, physical disabilities and dementia.

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 felt staff were kind, caring and respectful. They enjoyed the company of staff.

Staff provided care in a dignified way that respected people's privacy. People were supported to make decisions about their care where able. Easy read documentation was used to support decision making. People's independence was encouraged and supported wherever possible

Support plans were detailed, person-centred and relevant to people's individual needs. A skills coordinator supported people with their activities and life goals. Efforts had been made to provide information for people in accordance with the Accessible Information Standard. The complaints process was clear and understood by people. Complaints had been responded to in accordance with the provider's policy. End of life care not currently provided; however, staff received the training needed to support people if required.

There have been clear, sustained improvement since the registered manager was in post. All breaches from the previous inspection had been addressed and there was a clear structure in place for monitoring risk, assessing staff performance and driving improvement and development. The registered manager was supported by senior management to carry out their role. The registered manager understood and adhered to the regulatory requirements of their role.

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 5 July 2019) and there were 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.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 Eastlands 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.

We found the following examples of good practice.

People and their visitors were protected from catching and spreading COVID-19. People had named visitors who could attend regularly. Pre-arranged visits for others were also available. All visitors were informed of the requirement to provide a negative Lateral Flow Test (LFT) result and to show their COVID-19 Passport. All visitors were required to wear Protective Personal Equipment (PPE) in accordance with the provider’s COVID-19 policies and procedures.

Where an outbreak of COVID-19 was identified, the provider ensured government guidelines regarding safe visitation to the home continued. This protected people from the risk of social isolation and enhanced their mental wellbeing.

People were supported to use and access their environment in a safe way. Social distancing was encouraged wherever possible. We observed communal areas were well ventilated and seating areas were separated wherever possible. One person had COVID-19 at the time of this inspection. Safe isolation procedures were in place to protect others from the risk of infection. Staff had also taken the time to explain to the person why they needed to isolate and what would happen over the coming days.

People were admitted to the premises safely. Proof of a negative LFT were required two days prior to admission and another on the day of arrival. People were encouraged to isolate upon arrival, although it was acknowledged this could prove problematic for people living with dementia. For those people, specific staff were assigned to support them ready to identify any potential risks. Staff also refrained from mixing on other floors of the service.

There were ample supplies of PPE at the home. Staff had received training on how to ‘Don and Doff’ (put on and take off) their PPE to reduce the risk of cross-contamination. Staff explained to people why PPE was needed, especially when they left the home for any reason.

A robust testing regime was in place. All staff and people living at the home were tested regularly and in accordance with government guidance. Staff test results were stored centrally enabling the provider to continually review whether staff had been tested and if not, to find out and to act. All staff were fully vaccinated. Most people living at the home had been fully vaccinated and received a booster. All had received at least two vaccinations.

The layout of the premises ensured the risk of the spread of COVID-19 was reduced. Regular cleaning of all touch points and other key areas was carried out throughout the day. PPE was readily available, and we observed staff wearing PPE as required.

There were enough staff to support people safely and to cover any staff holidays, sickness and COVID-19 isolation. Where needed, regular agency staff provided cover for shifts. A negative LFT result and vaccine passport was required prior to agency staff commencing their role.

The provider had assessed the impact of potential ‘winter pressures’ and acted accordingly. Regular COVID-19, outbreak and other related audits were carried out to help identify any areas of concern. We saw action plans were in place and reviewed. Staff wellbeing was paramount, and the provider had implemented a number of initiatives to support staff.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s experience of using this service:

The provider had not met the characteristics of ‘Good’ in all areas. This has meant the overall rating for this service has changed from ‘Good’ to ‘Requires Improvement’. We have identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. More information about this is in the full report and can also be found at www.cqc.org.uk

There have been a high number of incidents that have required investigating both internally and externally by the local authority safeguarding team. Some people’s health and safety may have been affected. Most people received their medicines safely; however, we did find some minor areas where improvements were needed. There were enough staff to support people. People who presented behaviours that may challenge others were supported to reduce the risk to them and others. Specialist training was being completed to ensure that people were cared for by appropriately trained and competent nurses. The risks to people’s health and safety were assessed to support the provision of safe care and treatment. The risk of the spread of infection was safely managed. The provider had systems in place to help staff to learn from mistakes.

People received care and treatment in line with the characteristics of the Equality Act 2010. There were gaps in some staff training, although this was being addressed. 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 support this practice. However, conditions on the restrictions for one person had not been appropriately adhered to. People received the support they needed to maintain a healthy diet. People had access to other health and social care agencies where needed. The environment had been adapted to support people living with a physical disability.

People and relatives found the staff to be caring and respectful. However, some felt staff could do more to spend more meaningful time with them. There were periods of the day when people were left alone in communal areas with little staff engagement. People were treated with dignity when personal care was provided. Independence was encouraged. People felt involved with decisions and that staff respected their wishes. People’s records were stored securely to protect their privacy.

People were not always supported to lead their lives in their chosen way. Staff did not engage with people sufficiently to enable them to follow their chosen hobbies and interests. People’s care records contained detailed examples of their personal preferences and choices. Staff did not do enough to support people with this. People’s needs were assessed prior to them coming to live at the home. However, we found some examples of inconsistent information, or changes to care that had not been documented in people’s care plans. Complaints were responded to in line with the provider’s complaints policy. People were not currently receiving end of life care. End of life care plans were basic and required more detailed reference to people’s personal preferences.

Quality assurance processes were in place; however, these were not always effective in in highlighting and addressing the concerns we have raised during this inspection. A high turnover of managers has led to low staff morale which has contributed to the issues found during this inspection. The new manager was highly thought of and staff now felt more valued and respected. Feedback from quality surveys highlighted some good areas of care, such as people feeling safe. However, there were concerns in other areas; such as, people’s views on the activities provided. The manager had a good understanding of the regulatory requirements of their role.

Rating at last inspection: At the last inspection the service was rated as Good (27 June 2017).

Why we inspected:

We carried out this inspection in response to an increase in risk at the service. This included the number of safeguarding referrals made to the local authority safeguarding team as well as concerns raised by commissioners of this service.

Follow up:

We will continue to review information we receive about the service until the next scheduled inspection. If we receive any information of concern, we may inspect sooner than scheduled.

On the day of our inspection there was not a registered manager in place and there had not been for a period of six weeks. An application had not yet been submitted for a new registered manager, although we were assured by a representative of the provider that recruitment was on-going. 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. We will continue to monitor the recruitment and application process and will address any further delays with the provider.

During our previous inspection on 8 September 2016 we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the safe management of people’s medicines. During this inspection we checked to see whether improvements had been made and we found they had. We did find one omission in a person’s medicine administration records; however stock levels suggested the person had received their medicines. Other areas of safe medicine management such as; storage, administration and timely ordering were now managed effectively.

Staff could identify the potential signs of abuse and knew who to report any concerns to. Risks to people’s safety were continually assessed and reviewed. There were enough staff to keep people safe and to meet their needs.

The principles of the Mental Capacity Act (2005), including Deprivation of Liberty Safeguards, had, on the whole been followed when decisions were made about people’s care.

People were supported by staff who completed an induction prior to commencing their role. Staff training had taken place, with refresher courses booked for the staff that needed them. Staff felt supported by the manager.

People were supported to maintain good health in relation to their food and drink. People’s day to day health needs were met by staff and referrals to relevant health services were made where needed.

Staff were kind and caring and provided people with dignified, respectful and compassionate care and support. Staff were knowledgeable about people’s needs and listened to and acted upon their views. People’s privacy and dignity were maintained. People were involved with decisions made about their care and were encouraged to lead as independent a life as possible. People were provided with information about how they could access independent advocates, although this information needed to be placed in a more accessible part of home. People’s friends and relatives were able to visit whenever they wanted to.

People were encouraged to take part in activities, as well as following their own hobbies and interests. Two activities coordinators were in place to support people with this. People living at the home had detailed person centred care plans in place which contained their preferences and likes and dislikes. Staff were knowledgeable about people’s preferences. Some care plan documentation required archiving to ensure all records available for staff were reflective of people’s current health needs. People were provided with the information they needed if they wished to make a complaint and relatives felt their complaint would be acted on.

A registered manager was not in place at the time of the inspection. This had led to some complaints received by relatives not being responded to in a timely manner. The current manager was respected and well-liked by all. People were invited to regular reviews with their key workers to discuss their needs and were encouraged to provide feedback about the quality of the service. Quality assurance processes were in place to ensure people and others were safe in the home.

On the day of our inspection there was not a registered manager in place. 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 our inspection an application to be registered as the manager had been made by the person managing the home. We will monitor the progress of this application.

People were supported by staff who could identify the potential signs of abuse and knew who to report any concerns to. Risks to people’s safety were assessed and reviewed, although the frequency of these reviews was inconsistent. There were enough staff to keep people safe.

People’s medicines were not always managed safely. Processes for the timely ordering of people’s medicines were not effective. There were also discrepancies in the stock levels of some medicines and people’s medicine administration records were not always appropriately completed. Guidance for the administration of ‘as needed’ medicines was in place, although a review of the administration of these medicines was needed to ensure they were administered appropriately.

People were supported by staff who completed an induction prior to commencing their role and had the skills and training in place to carry out their role effectively. Not all staff received regular supervision of their work and an effective appraisal system was not yet in place.

The principles of the Mental Capacity Act (2005) had not always been followed when decisions were made about people’s care. Some assessments were comprehensively completed, whereas others were too generic and increased the risk of decisions being made for people that were not in their best interest. Applications to the authorising body to legally deprive people of their liberty had been made for the people who had been assessed as most at risk; however, further applications for others within the home were required.

Staff communicated effectively with people. People received a varied diet that took into account their food and drink preferences. People’s day to day health needs were met by staff and external professionals where required.

Staff treated people with respect and dignity and listened to and acted upon their views. Staff respected people’s privacy and people were involved with decisions made about their care. People were encouraged to lead as independent a life as possible. People were provided with information about how they could access independent advocates, although this information was not easily accessible. People’s friends and relatives were able to visit whenever they wanted to.

Whilst some people received support in following the hobbies and activities that were important to them, others did not. People’s support records were person centred and focused on providing them with care and support in the way in which they wanted. People were provided with the information they needed if they wished to make a complaint, however the format in which the complaints process was written, could make it difficult for people with communication needs to understand.

The manager acknowledged that improvements were required to ensure that people received a high quality of care and support at the home. Although relatively new to their role, the manager had plans in place to address these issues. The manager held regular discussions with representatives of the provider to discuss and agree how to make these improvements.

The manager was visible throughout the inspection. Staff and the people who lived at the home spoke highly of them. The manager, although not yet registered with the CQC understood what was required of them once they became registered. Quality assurance processes were already in place to address the areas of concern identified within this report. People were encouraged to provide feedback about the quality of the service and this information was used to make improvements.

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

Mental capacity assessments were put in place for each person identified, to meet their needs and protect their rights.

We spoke with a relative of a person that used the service who told us that staff at the service were very caring towards their relative and that they were able to meet their needs. We spoke with three staff members who told us that they received the training that they needed to meet people's needs. One staff member told us 'We adapt the care here to meet people's routines and needs.' However, we did identify some concerns about the way in which people's mental capacity was being assessed and recorded despite evidence that training had been provided to staff.

We found that people's needs were assessed and people's preferences were recorded. We saw that there were care plans and risk assessments put in place to ensure people's safety and welfare. We found that staff had a good understanding of people's needs. We found that staff received appropriate training and supervision and that people that there were effective safeguarding procedures in place.

We observed the care and support that people were receiving, looked at their care records and spoke with one person using the service, one relative, three staff, the manager and regional manager.

A visitor who was an advocate of a person using the service told us, 'The staff are very friendly, they always keep me informed of everything. I have also been able to see my relatives GP regularly and discuss things. My relative could not be in a better place.'

A person using the service told us that they were cared for in their preferred way.

We found that people who used the service had their care and treatment planned in consultation with them and their advocates. There were accurate records that detailed how staff were supporting them safely. All risks to their health and welfare were assessed to encourage the early detection of ill health. The systems in place demonstrated that people were protected from abuse and the provider monitored the quality of the service provided.