Archived: Eastgate House Residential Home

Eastgate House Residential Home can provide accommodation and personal care for 20 older people. There were 11 people living in the service at the time of our inspection.

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. The registered manager was not present in the service during our inspection visit.

At our inspection on 25 July 2014 there were two breaches of legal requirements. We found that people were not always receiving all the assistance they needed to keep their skin healthy. In addition, we found that accurate records were not always being kept to suitably describe the care that was being provided and to list the number of staff who were on duty. After the inspection the registered persons wrote to us to say what actions they intended to take to address the problems in question. They said that all of the necessary improvements would be completed by 30 September 2014. At the present inspection we found that the necessary improvements had been made and that the two legal requirements had been met.

People were helped to avoid the risk of accidents and staff knew how to respond to any concerns that might arise so that people were kept safe from abuse.There were reliable arrangements for ordering, dispensing and recording the use of medicines. There were enough staff on duty to care for people and background checks had been completed before new staff were appointed. People were protected from the risk of acquiring avoidable infections.

Parts of the accommodation were not adapted and decorated to meet people’s individual needs. Although staff knew how to care for people in the right way the registered persons had not made robust arrangements to provide all of the training they considered to be necessary. People were assisted to eat and drink enough and the catering arrangements helped people to enjoy their meals. Staff had made sure that people were offered all of the healthcare assistance they needed.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the Mental Capacity Act 2005 (MCA) and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. Five people living in the service were being deprived of their liberty or were subject to a high level of supervision and the registered manager had taken the necessary steps to ensure that their legal rights were protected.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, promoted their dignity and there was provision for confidential information to be kept private.

People had been consulted about the care they wanted to receive and they had been given all of the practical assistance they needed. People who lived with dementia and who could become distressed received the individual support and reassurance they needed. People were given opportunities to pursue their hobbies and interests and there was a system for resolving complaints.

Quality checks had not consistently identified and resolved problems. However, when people and their relatives had suggested improvements to the service their ideas had been implemented.

Good team work was promoted and staff were supported to speak out if they had any concerns because the service was run in an open and inclusive way. People had benefited from staff acting upon good practice guidance.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

We used a number of different methods to help us understand the experiences of people using the service. Some of the people using the service had complex needs which meant they were not all able to tell us about their experiences. However, we observed care being provided, spoke with six people who lived at the home, two people's relatives and six staff members. At the time of our inspection there were 11 people living at the home.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you would like to see the evidence that supports the summary, please read the full report.

Is the service safe?

There were enough qualified, skilled and experienced staff to meet people's needs. People were cared for in a clean, hygienic environment and systems were in place to maintain this. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

However, people were not protected against the risks of unsafe or inappropriate care because some care records were inaccurate or were not up to date. This included a person's risk assessment and another person's repositioning record.

Is the service effective?

We found there were sufficient staff on duty to meet the needs of the people living at Eastgate House. People told us they felt their needs were met. However, we found that people did not always experience care and support that met their needs and protected their rights. For example, we found that one person was not repositioned at the frequency stated in their care plan, increasing the risk of pressure ulcers developing.

Relatives raised concerns about recent changes to the staffing arrangement whereby this and a neighbouring home, also owned by the provider, shared the staff group. This meant that there had been an increase in the number of different staff providing care to people. Most staff told us that they preferred working in one home and said this meant they got to know the needs of the people they were providing care for better.

Is the service caring?

During our inspection we saw very positive interactions between staff members and the people living at the home. Staff treated people in a caring, respectful and friendly manner. The people and the relatives we spoke with made positive comments about the staff who provided their care. However, one person told us they felt staff were often in a hurry to leave while they were talking with them.

Is the service responsive?

We saw that referrals had been made to health care professionals including dentists, dieticians and chiropodists.

We found that the manager was aware of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were of appropriate procedures in relation to ensure that people who could not make decisions for themselves were protected. However, we were concerned about the ability of staff to assist people who were confused to make informed choices about their personal care.

Is the service well led?

The home's current manager had been in post since early June 2014 and had not yet applied to register with us. However, they have expressed their intention to do so shortly.

Since the manager took up post they had implemented effective systems to help them monitor and assess the quality of the service provided. They had developed action plans which were being worked through, to improve the service provision. Staff spoke positively about the improvements that had recently been made to the service. This included the purchase of various items, the provision of additional supervision and training, and the instigation of systems that helped them provide care in a more organised way.

We found that the provider was not compliant with the regulations in two of the six areas we assessed. We have asked the provider to tell us how they will make improvements and meet the requirements of the law. If you wish to see the evidence supporting our summary please read the full report.

At our inspection of 21 August 2013 people who used the service said that they were receiving all of the care they needed. They told us staff were caring and attentive. Also, they said that staff were trustworthy people who were committed to promoting their wellbeing. A person said, "The staff make the place, they're lovely to us. They're kind and they'll do pretty much anything to help us.'

At our inspection of 21 August 2013 we found that the provider had strengthened its arrangements to protect people from abuse or the risk of abuse and to ensure their human rights were respected and upheld. This meant that people who used the service could be reassured that any restriction of their liberty would only be used if it was in their best interests and if it was supported by the proper legal authorisation.

We saw that staff had consulted with people who used the service and their representatives about what assistance was to be provided.

People said that they received all of the health and personal care they needed. Records confirmed that assistance had been provided in a safe, reliable and responsive way.

Records showed that staff had received training in a number of key subjects and they had most of the knowledge and skills they needed.

We saw that quality checks had been completed to help ensure that people were reliably provided with the facilities and services they needed.

We found that the provider had measures in place to help safeguard people from abuse. However, more robust arrangements needed to be made to support people who might need to have their liberty restricted in order to keep them safe.

People's needs were assessed, but care records we examined demonstrated to us that care and treatment was not always planned and delivered in line with their individual care plans.

During our inspection we saw that appropriate arrangements were in place in relation to the recording of people's medicine. We also saw that medicines were kept safely, and prescribed and given to people appropriately.

We found that appropriate checks were undertaken before staff began working at Eastgate House. Records examined demonstrated to us that people were cared or supported by suitable qualified staff.

We saw that people were made aware of how to make a complaint if they wanted to. People we spoke with told us they would be able to make a complaint if they were not happy, but that they had not needed to so this.