The inspection took place on the 27 and 28 February 2017 and was unannounced. At the last inspection on 22, 26 and 28 October 2015 we found the provider (who is also the registered manager) had breached seven of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA 2014). These breaches related to Regulation 9 (Person centred care), Regulation 10 (Dignity and respect), Regulation 11 (Need for consent), Regulation 12 (Safe care and treatment), Regulation 17 (Good governance), Regulation 18 (Staffing) and Regulation 19 (Fit and proper persons employed). At our last inspection the registered manager had not always ensured people’s preferences in relation to their food choices were met, that people were treated with compassion at all times and that appropriate action had been taken to ensure consent had been sought for all aspects of people’s care. The registered manager had also not always ensured that people were protected from risks associated with falls, the registered manager did not have effective quality assurance processes in place and records did not reflect the care and treatment people received. The registered manager had also not always ensured that staff received the appropriate supervision and support in their role and that people were protected from the employment of unsuitable staff.
We told the registered manager they needed to take action and we received two reports setting out the action they would take to meet the regulations. At this inspection we reviewed whether or not these actions had been taken and whether the registered manager was now meeting the requirements of the HSCA 2014. We found improvements had been made regarding the breaches identified; however, additional time was required to ensure these improvements were embedded and sustained in staff’s working practices.
Eastfield Nursing Home, to be referred to as the home throughout this report, is a home which provides residential and nursing care for up to 52 older people who have a range of needs, including those living with Parkinson’s disease and dementia, sensory impairments as well as epilepsy and diabetes. The home is situated in a residential area in the village of Liss and has approximately five and a half acres of land which includes a secure garden for people to enjoy at the rear of the home. Facilities include a small dining room, conservatory seating area and large lounge on the ground floor with two smaller lounges on the first floor. At the time of the inspection 46 people were using the service.
The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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 were kept safe as the registered manager ensured sufficient numbers of staff were deployed in order to meet people’s needs. In the event of unplanned staff shortages the registered manager sought to use familiar and known agency staff to support people with their care. However, people told us they often had a protracted wait to receive care after requesting staff assistance. Staff deployment was not always monitored to ensure that people were receiving care at the time they required. Plans were in place to address this immediately following the inspection; however, time is needed to ensure this system is effective and improves the response people experience when using their call bells.
Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people during their daily interactions. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. However, we could not always see that people had always been accurately assessed to identify whether they were clearly able to make decisions regarding all aspects of their care.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager showed an understanding of what constituted a deprivation of person’s liberty. People had been appropriately assessed as to whether they could consent to living at the home prior to the provider appropriately submitting the required applications where people were deprived of their liberty. Authorisations had been granted by the relevant supervisory body to ensure people were not being unlawfully restricted. Conditions applied to such authorisations had been recognised by the registered manager; however, we could not see that appropriate action had always been taken to ensure these conditions were met. Where conditions relating to a person’s DoLs authorisation are not met it could mean the DoLS would cease to be in the person’s best interest. This would place the person at risk of being deprived of their liberty without lawful authority.
The home provided care for those living with dementia however we could not always see that the environment supported these people to move around the home independently. We have made a recommendation that the registered manager seeks guidance on how to develop the home to become more accessible to those living with dementia.
The registered manager had not always fulfilled their legal requirements by informing the Care Quality Commission (CQC) of notifiable incidents which occurred at the service. Notifiable incidents are those where significant events had happened. This allows the CQC to monitor that appropriate action was taken to keep people safe. However, positive action had been taken to address this and we could see at the time of the inspection notifications were submitted in a timely fashion.
People using the service told us they felt safe, relatives agreed they felt their family members were kept safe whilst living at the home. Staff understood and followed the registered manager’s guidance to enable them to recognise and address any safeguarding concerns about people.
People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. Appropriate risk assessments were in place to keep people safe.
People were protected from the unsafe administration of medicines. Nurses were responsible for administering medicines and had received additional training to ensure people’s medicines were administered, stored and disposed of correctly. Nurse skills in medicines management were regularly reviewed by managerial staff to ensure they remained competent to administer people’s medicines safely.
Recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff. New staff induction training was followed by a period of time working with experienced colleagues. This ensured staff had the skills and confidence required to support people safely.
People were supported by staff who had up the most relevant up to date training available which was regularly reviewed to ensure staff had the skills to proactively meet people’s individual needs.
People were supported to eat and drink enough to maintain a balanced diet. We saw meals were prepared to meet people’s individually assessed nutritional requirements. Staff followed guidance in people’s care plans to ensure they received a meal which met their needs. Alternatives were offered and prepared when people did not wish to choose from the two meal choices offered and people were encouraged to eat and drink sufficient to maintain their health and wellbeing.
People’s health needs were met as the staff and the registered manager had detailed knowledge of the people they were supporting. Staff engaged with healthcare agencies and professionals when required. This was to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.
Staff had taken time to develop companionable relationships with the people they were assisting. Staff understood people’s communication needs and used non-verbal communication methods where required to interact with people. These were practically demonstrated by staff during their interactions with people.
People received respectful care from staff who understood their care needs. People had care and support which was delivered by staff using the guidance provided in individualised care plans. Care plans contained information to assist staff to provide care in a manner that respected each person’s individual requirements. Although this information was not always completed fully we could see that staff knew how to support people in the way they required.
People were supported to participate in activities to enable them to live interesting lives and prevent them experiencing social isolation. A range of activities were available to people to enrich their daily lives which were promoted by staff to ensure people were able to participate in, if they wished to do so.
Relatives knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People and relatives were asked to complete a biannual quality assurance questionnaire to provide their views on the quality of the care and support provided. An action plan was then created to ensure people’s views were documented and positive action taken to address and areas raised.
The registered manager had a philosophy of care which detailed the way in which care would be delivered to people. Staff we spoke with were able to recognise what this philosophy of care meant we saw these standards were evidenced in the way care was delivered to people.
Relatives told us and we saw that the home had an acti