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Inspection carried out on 4 September 2019

During a routine inspection

About the service

Eastbury Nursing Home is a care home with nursing for up to 20 people. The home supports people who are over the age of 40 and who have both physical and mental health needs. The home can also care for people who have disabilities or nursing needs as the home provides 24-hour nursing care. At the time of this inspection 18 people were using the service.

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

People were supported by kind and caring staff and people told us they liked living at the home.

The home was clean, and it had a welcoming environment and nice space for people to socialise with each other.

Staff were recruited in line with the providers policies. Staff received training throughout their employment to ensure they had the skills to provide good care and support.

Systems were in place to safeguard people. When risks were identified the home had clear systems to manage the potential risk. People told us they liked the food and they helped to choose the menu. The menu was varied and helped people to have a balanced diet.

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 were supported to access their healthcare appointments. Staff worked in partnership with health care professionals to ensure people had appropriate support. Referrals were appropriately made to health care professionals if people’s needs changed.

People’s care plans reflected their needs but also their likes and dislikes. Positive behaviour support plans were used by staff to help staff support people and pre-empt incidents. People’s privacy, dignity and independence was respected and maintained by staff.

People were supported to engage in a variety of activities which were individualised to their interests and hobbies. Systems were in place to deal with concerns and complaints. This enabled people to raise concerns about their care if needed.

The home was well managed, the registered manager had implemented a variety of audits which were completed on a weekly or a monthly basis. If an issue was identified an action plan was developed which was clear and highlighted the work which was required to improve the service.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used no restrictive practices and supported people in line with positive behaviour support principles.

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

Rating at last inspection

The rating at the last inspection was good (published 8 April 2017)

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.

Inspection carried out on 28 February 2017

During a routine inspection

This inspection took place on 28 February 2017 and was unannounced. The last inspection of the service was in January 2016 when we found two breaches of the regulations. The provider sent us an action plan in February 2016 and said they had already taken action to address the issues we identified. We found at this inspection that the provider had made improvements in the areas we identified at our last inspection. They had reviewed care planning systems in the service and provided dignity training for care staff.

Eastbury Nursing Home is a care home with nursing for up to 20 people who have mental health needs. Some people also had additional physical needs or learning disabilities. At the time of this inspection, 18 people were using the service, although one person was in hospital on the day we visited.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 provider appointed a new manager in January 2017 and they told us they would begin the process to apply for registration with CQC.

People were safe because the provider and staff operated systems to protect them from abuse. The provider also assessed risks to people using the service and gave staff clear guidance on how to manage risks they identified. We have made a recommendation that the provider should review their safeguarding policy and procedures to include the latest guidance.

There were enough staff to meet people’s care needs and the provider carried out checks on new staff before they started to work in the service. Staff had the training they needed to care for and support people using the service.

We saw no examples of people being deprived of their liberty unlawfully.

Staff ensured people had access to the health care services they needed and people received the medicines they needed safely.

People told us they enjoyed the food provided in the service.

Some parts of the service were in need of refurbishment and redecoration.

People using the service told us staff were caring and treated them with respect and people were able to choose where they spent their time.

People’s health and personal care needs were recorded in their care plans with guidance for staff on the support they needed. People’s care records also included their social care needs and the provider arranged appropriate activities.

The provider recorded and responded to complaints from people using the service and others.

The atmosphere in the service was open, welcoming and inclusive.

The provider had appointed a qualified and experienced manager to oversee the day to day operation of the service.

The provider had systems in place to monitor quality in the service and make improvements.

Inspection carried out on 12 January 2016

During a routine inspection

The inspection took place on 12 January 2016 and was unannounced.

The last inspection of the service took place on 7 September 2013 when we found that there were no breaches of Regulation.

Eastbury Nursing Home is a care home with nursing for up to 20 people who have mental health needs. Some people also had additional physical needs or learning disabilities. At the time of our inspection 18 people were living at the home. Their needs included support with brain injury, physical and learning disabilities, dementia and other mental health needs as well as nursing care needs. The home was managed and run by MD Homes, a private organisation who ran five nursing homes in North West London.

The last registered manager left the service in 2015. A new manager was appointed in August 2015 and has been managing Eastbury Nursing Home and another of the provider’s care homes since this time. The manager had applied to be registered with the Care Quality Commission and this application was being processed at the time of the inspection. 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 and associated Regulations about how the service is run.

Most people were happy with the service and some of the things they said were, ‘’The service is very comfortable and very friendly’’ and ‘’It is very good here.’’

People told us the staff were kind and caring and they had good relationships with them. However, we saw that some of the staff supported people by focussing on the task they were performing rather than people’s individual needs and preferences.

People’s social and emotional needs were not always met and they did not always feel involved in planning their own care.

There were procedures designed to safeguard people from abuse and the provider followed these. Information about the procedures was available for people who lived at the home and staff.

The risks to people’s safety and well-being had been assessed.

The environment was safe and clean.

People received their medicines in a safe way.

The provider’s recruitment procedures made sure the staff were suitable to work at the service.

The staff had the skills, training and support they needed to care for people.

People had consented to their care and treatment where they were able. Where people lacked the capacity to consent, the provider had taken appropriate action to provide care in their best interests in accordance with the legal requirements of the Mental Capacity Act 2005.

People’s nutritional needs were met and they had a choice of freshly prepared and nutritious meals.

People were given the support they needed to stay healthy.

There were clear and detailed care plans which described the action the staff needed to take to support people.

There was an appropriate complaints procedure and people knew how to make a complaint.

People felt that the service was well managed and they were able to contribute their views.

There were systems to audit and monitor the quality of the service and these included evidence that changes had been made to help develop and improve the service for people living there and the staff.

We found two breaches 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.

Inspection carried out on 7 September 2013

During a routine inspection

At the time of our inspection there were 17 people using the service. We spoke with three of these people, the deputy manager and two other members of staff. We were unable to speak with some people who were using the service as they had complex needs which meant they were unable to share their views with us. However, we observed care in the home, spoke with staff and viewed records to gather information about people's experiences.

People were asked for their consent before care and treatment were provided and staff were able to demonstrate how they involved people in decision making about their care wherever possible. We found that people’s needs were assessed and a care plan developed to ensure that these were met effectively.

We saw staff responding promptly to requests for support and engaging people in conversation. People told us that they were well looked after by staff. One person told us, "it is very good here, the staff are very hard working" and another person said, "they (staff) treat us very well."

People were supported to eat a balanced diet taking account of their individual dietary needs which were monitored. People told us they enjoyed the food provided by the home and one person said, "the food is very nice here" and another told us "the food is really nice, I like fish and chips and lasagne."

The home was clean and free of offensive odours and there were systems in place to prevent the spread of infection.

Effective systems were in place to ensure that the required records were maintained and kept up to date.

Inspection carried out on 5 January 2013

During a routine inspection

We spoke with the deputy manager, two other members of staff and three people who use the service. We used a number of different methods to help us understand the experiences of people using the service, because some of them had complex needs which meant they were not able to tell us their experiences.

People told us that they felt listened to by staff and the care records showed that people were involved in planning their care. We observed staff interacting positively with people, talking to them in a respectful way and one person when talking about the staff said, "they are very polite and kind". People's cultural and spiritual needs were being considered and supported.

People's needs were appropriately assessed and a care plan developed so that staff knew what action to take to meet them. We observed staff caring for people in a sensitive manner. For example, staff chatted to people whilst supporting them with their lunch and supported them at an appropriate pace and did not rush them.

The home was clean, warm and well maintained. There were adequate numbers of staff on duty to meet the needs of the people living at the home and staff told us there were always enough staff on duty including a qualified nurse. The home has an effective system in place for managing complaints about the service. Complaints are responded to promptly and appropriately.

Inspection carried out on 17 January 2012

During a routine inspection

People said they liked living in the home and one person told us they had a key to their bedroom and could lock their room for privacy. Comments people made about the staff included, “they let me spend time in my bedroom if I want to or I can sit with other people”.

People said they were offered choices, for example with meal options and we saw the cook during the mealtime asking people if they were happy with the food.

People said staff were available to assist and support them. We observed staff took time to talk with people and asked them about their choices. One person said “the staff listen to me”. People confirmed they were able to see the GP when they needed to and other healthcare professionals, for example the chiropodist.

One person told us “I know the medication I am taking and staff explain why I need to take it”. People said they trusted the staff to give them the medication they needed.

People told us they could attend meetings held in the home. They said this was where their views were sought on various subjects, such as menu choices and hearing news about the home.

Reports under our old system of regulation (including those from before CQC was created)