Archived: Eastgate Manor

The service was last inspected on 06, 09, 12, 25, 26 November 2015 where we found seven breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, good governance, and staffing. There was also one breach of Care Quality Commission (Registration) Regulations 2009 related to notification of incidents. The service was rated inadequate in all five domains and placed in special measures.

The provider sent us an action plan to show us how they would address our concerns. The action plan stated that all actions would be completed by 4 December 2015

At the last inspection in November 2015, we asked the provider to take action to make improvements to dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, governance, staffing and notification of incidents, and this action has been completed.

There was no registered manager in post. A manager had been appointed who was in the process of registering with the Care Quality Commission (CQC). 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.

Health and safety checks on the premises and equipment had been carried out. Risk assessments related to the building and individual risks to people were in place. Regular spot checks and audits had been carried out by managers. However, the provider was unable to locate the most recent legionella risk assessment and an electrical test being carried out on the day of the inspection was overdue.

A safeguarding policy and procedure was in place and staff had received safeguarding training. Staff were knowledgeable about the procedures to follow in the event of concerns. A number of issues were being looked into by the local authority safeguarding team who were working closely with the service.

The premises were clean and well maintained and recently refurbished. Infection control procedures were followed and person protective equipment (gloves and aprons) used to help to prevent the spread of infection were available, but was not always distributed effectively to enable staff to locate them in a timely manner.

Suitable numbers of staff were on duty during the inspection. The service continued to use high numbers of agency staff but arrangements were in place to employ the same staff to provide consistency. A recruitment drive was ongoing, and staff had been deployed to the home from other services to improve the skills mix and leadership while recruitment took place. We have recommended that the skills mix continues to be monitored until more permanent staff are in post.

Safe recruitment procedures were followed. There were a small number of gaps in recruitment records but the overall process was robust. A record of accidents and incidents was maintained and analysed monthly to identify trends or concerns.

Training was provided in key areas and updated regularly. Systems of staff supervision and appraisal were in place and staff told us they felt well supported.

People had access to health care in a timely manner. This had been a concern at the last inspection. Some professionals felt however, that there was now a tendency to over report health concerns for fear of failure to act. This was impacting upon the workload of all involved. Advice from visiting professionals was acted upon however, we found one occasion when a piece of equipment had been recommended and had not been sourced in a timely manner. We found that where a professional had not visited a person as planned, that prompt action had been taken by staff to ensure that the appointment was rearranged for the following day.

People were supported with eating and drinking, and we were told that meals had improved. Food and fluid intake was recorded and weights of people were monitored. A new chef was in post. Appropriate support was given to people during their meal although people living with dementia would benefit from further support to make meal choices.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. it also ensures unlawful restrictions are not placed on people in care homes and hospitals.

The service was operating within the principles of the Mental Capacity Act (2005) and capacity assessments had been carried out. Applications had been made to deprive people of their liberty and best interest’s decisions were recorded. These did not always detail who had had been involved in the decision making process.

People, relatives and visiting professionals told us that people appeared well cared for. Kind, caring, and meaningful interactions with people were observed. People experiencing distress were attended to promptly, with the exception of one person who had to wait some time. Some staff appeared to lack initiative to sit and chat with people and spent periods of time sitting in the lounge with the television on while people slept. Some people had hairstyles which appeared unkempt, but people were generally clean and tidy in appearance.

Care plans were in place and had improved since the last inspection. They were up to date and had been regularly reviewed. They were, however, lacking in person-centred information although steps had been taken to address this with the introduction of personal profiles. This information had not been incorporated into care plans as yet.

An activities coordinator was in post, and we saw records of a number of activities that had taken place. We found little evidence that activities were planned around the specific interests or needs of people, and there was a focus on group activities. Records related to how well people had participated in activities, were brief and made evaluation of activities difficult. We have made a recommendation about this.

An interim manager was in post and was in the process of being registered with CQC. There were plans to replace them with another manager who had been appointed following completion of their probationary period. Relatives and staff said they found the turnover of managers unsettling and were hoping for a period of managerial stability.

Quality assurance systems had been improved and there were regular checks audits and spot checks carried out by senior managers.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe care and treatment and person centred care. You can see what action we told the provider to take at the back of the full version of this report.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found.

Is the service caring?

We saw that people were supported by attentive staff who displayed patience and gave encouragement when helping people, for example by assisting them with mobility or eating. Our observations confirmed that staff promoted independence whilst ensuring that they offered assistance to people when required. People told us that they were happy with the care and support they received from the service, and that staff treated them with dignity and respected their wishes and their privacy. One person said, "The staff are wonderful sometimes. I think they treat me with respect."

People’s diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. Staff were fully aware of people's care and support needs.

Staff told us and people confirmed that activities were offered within the home. This showed the provider promoted people's well-being.

Is the service responsive?

People's care needs and any potential risks that they may be exposed to were assessed before they received care and support from the provider. The provider had arrangements in place to review people's care records regularly. We saw that amendments were made to people's documentation as their needs changed, to ensure this remained accurate and any issues were promptly addressed.

Staff told us, and records showed that where people required input into their care from external healthcare professionals, such as occupational therapists or doctors, or where, for example, their weight or behaviours needed to be monitored, they received this care.

There was an effective complaints system in place and we found that people, their relatives and staff felt confident in raising concerns with the manager.

Is the service safe?

People told us they felt safe and the care that we observed was delivered safely. For example, we saw that appropriate and safe moving and handling techniques were used when staff assisted people with mobility. Risks that people may be exposed to in their daily lives and in relation to their care needs had been considered. We saw that instructions had been drafted for staff to follow to ensure people remained as safe as possible in light of these identified risks.

People's nutritional needs were met appropriately and where there was a need for monitoring their weight, or fluid and food intake, this was done. We saw that where necessary people had been referred to dieticians and speech and language therapists for specialised input into their care.

We reviewed the arrangements in place for the management of medicines including how medicines were obtained, stored, administered and disposed of when no longer required. We found that these arrangements were both appropriate and safe. Staff with responsibility for medication administration had been appropriately trained.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We discussed the recent Supreme Court judgement handed down on 19 March 2014 in the case of 'P v Cheshire West and Chester Council and another' and 'P and Q v Surrey County Council', about what constitutes a deprivation of liberty. The manager confirmed they had been in contact with their local safeguarding team in light of this judgement, for further advice on their responsibilities and the arrangements they now need to put in place, for people in their care.

Is the service effective?

People told us they were happy with the staff who cared for them and they met their needs. One person said, "I am well cared for." Another person told us, "The staff are all right. In fact most of them are very good." It was evident from speaking with staff and through our own observations that staff had a good knowledge of the people they cared for and their needs.

Most people told us they felt involved in their care and all of the relatives we spoke with told us they felt fully informed about their relation's care needs. One relative told us, "It took some time for my mother’s care plan to be sorted out, but I am kept fully informed of any problems or changes in her situation now."

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

An effective quality assurance system was in place which helped to ensure that people received a good quality service at all times, by monitoring care and addressing shortfalls promptly. The provider monitored the care that staff delivered.

Staff told us they were clear about their roles and responsibilities and they had a good understanding of the ethos of the home. The provider had a range of policies and procedures in place which gave direction and instruction to staff. A number of audits were carried out regularly, in addition to health and safety checks, which assisted the provider in measuring the effectiveness of their service and protecting people's welfare.

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. We observed that relationships between staff and people appeared to be good and people looked well-presented and well cared for.

We found that there were infection control systems in place and these were adhered to.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One staff member said, 'I only have to ask and the manager responds to any training I feel I need.'

People were asked their views about the service provided and these were taken account of. People were aware of the complaints procedure. The provider had systems in place to monitor care delivery and ensure the health, welfare and safety of people who used the service was maintained.

Records contained accurate and appropriate information.

Although some improvements had been made in relation to staff training needs we found shortfalls in the provision of training in safe working practices and the appraisals and supervisions for staff were still outstanding.

We found the planning and delivery of care did not always meet people's individual needs or ensure their welfare and safety.

We found that care records did not always contain accurate or appropriate information and documentation.

Another person said 'Sometimes they do not put the cream on my neck when I need it.' However, other evidence did not support this.

Overall, we found that improvements had been made and people were given their medicines safely.

We spoke with two people about their medicines. One person said 'I get my tablets on time and they (the nurse) are kind.' The other was concerned that in the past they had ran out of her 'dressings' but this had not happened recently.

Overall we found medicines were not always safely handled and improvements are needed.

During the inspection we spoke with people about their experiences of the care and support they received from this service. One person said, 'The staff are all friendly, if you ring your buzzer then they'll come, it's not always straight away but they'll come and help.' We found the planning and delivery of care did not always meet people's individual needs or ensure their welfare or safety.

We observed that people in the 'memory care' dementia unit were not being cared for in a clean, hygienic environment and that systems were not in place to reduce the risk and spread of infection.

We noted that the management had made improvements in the staffing levels since the last inspection and additional permanent employees were now in post.

Although a system for staff supervisions were now in place, some staff had yet to receive a supervision and and an appraisal process was not due to be implemented until May 2013. Staff training needs were not being met.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

We found that care records did not always contain accurate or appropriate information and documentation.

We spoke with seven people about their experiences of the care and support they received from this service. They said some of the staff knew what support they needed. They said staff were kind and helpful. One of the relatives told us they felt things were better. Another person said, "Staff are good here, but like everywhere else they are short of staff."

We saw relationships between staff and people were good and there was a relaxed atmosphere. People told us staff spoke to them respectfully and they were consulted about their care preferences. We saw good interactions between staff and people during our visit.

Records were not always maintained to an appropriate standard,which meant we were not able to confirm support was provided as necessary or that care was actually delivered. Where people were unable to make decisions for themselves it was not clear whether their relatives or representatives had been involved.

Staff training was not recorded properly and staff were unable to confirm what training had been delivered.