Eaton Court

At the last inspection of this service in January 2017 we rated this service as requires improvement in safe and well-led, which meant the quality rating of the service was requires improvement overall. We found two breaches of legal requirements because staff were not completing monitoring charts which showed the amount of fluids and support people were receiving and there was a failure to ensure documents were up to date and showed a full and contemporaneous account of people's needs and how their welfare was being monitored. There was a lack of an effective auditing system to ensure people's need were met. These issues were breaches of Regulation 9, Person-Centred Care and Regulation 17, Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection we found improvements had been made to meet the relevant requirements.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well-led to at least good. We found at this inspection people were receiving appropriate care and support and this was documented. We found the service was monitored appropriately and effective auditing and monitoring was in place to help staff assess if people’s need were met.

Eaton Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Accommodation was provided for up to 45 people over two floors. Eaton Court is close to a bus route, and local facilities are within walking distance. During our inspection there were 35 people using the service.

The service has a registered manager in place. 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.

Staff protected people from harm and abuse and understood how to report concerns to the management team, local authority and to the Care Quality Commission. This helped to protect people.

Staffing levels were monitored daily to make sure there was enough skilled and experienced staff to meet people’s needs. Staff undertook training in a variety of subjects to maintain and develop their skills. Supervisions and appraisals were provided to support staff and to identify any further training needs. Staff recruitment procedures were robust.

There were adequate infection prevention and control measures in place at the service. General maintenance was undertaken. Accidents and incidents were monitored and emergency plans were in place to help to protect people’s health and safety.

Medicines were effectively managed. People received their prescribed medicine in a timely way from staff who undertook this safely.

People’s preferences for their care and support were recorded. People were treated with dignity and respect. Care records were personalised and people’s communication needs were known by staff. Risks to people’s wellbeing were monitored and staff encouraged people to maintain their independence, where possible. Staff contacted health care professionals for help and advice to maintain people’s wellbeing.

People’s mental capacity was assessed. We found care and support was provided in line with the Mental Capacity Act 2005. Staff encouraged people to make choices about how they wished to live their life, where possible.

People were treated with kindness and their diversity was respected. There was a confidentiality policy in place for staff to follow. Care records were stored securely in line with current data protection legislation.

A complaints policy was provided to people and issues raised were dealt with. Information was provided about advocacy services so people could gain help to raise their views, if they wished.

Visiting was permitted at the service. People were encouraged to maintain contact with family and with friends. There was a programme of activities provided for people, which now occurred at the weekend.

The registered manager was open and transparent. Quality assurance checks and audits were taking place to maintain or improve the service. A new electronic care record system was being introduced to free up staff and to ensure care records were always kept up to date. The environment was being further enhanced for people living with dementia. Work was being undertaken to ensure people who preferred to spend their time in their bedroom from becoming socially isolated. The registered manager was looking at how the location of staff at the service could be indicated to people living there and to visitors.

This inspection took place on 11 and 12 January and was unannounced. This was the services first inspection under the new provider.

At the time of the inspection 34 people were living at the service.

There was no registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Where there is no registered manager the service can only be rated as requires improvement in the domain of well-led.

The documentation used to monitor people’s wellbeing was not always completed and did not give a full picture of the care the person had received. There were gaps in the recording and no indication of what the person should be receiving so no meaningful evaluation could be made so further treatment could be sought if required. Although there were audits in place these had not picked up the shortfalls and the inconstancies of the recordings in the monitoring charts, the effect of the staffing changes and the use of aids to meet people’s needs. You can see what action we told the registered provider to take at the end of the report.

Before the inspection we received some concerns about the amount of staff on duty, during the inspection we checked the staffing number and found no evidence of neglect or poor practise, which meant people’s needs were not met. Care staff were supported by adequate amounts of ancillary staff so they could concentrate on meeting people’s need. We have made a recommendation that the registered provider looks at the deployment of staff to ensure numbers are used efficiently around the building. Staff understood the importance of protecting people from harm and could describe to us the types of abuse they may witness and how to report this to the proper authorities. They had received training in how to identify and report abuse, and this had been updated regularly. Staff handled people’s medicines safely and had received training which was updated. The service was clean and tidy and free from offensive odours. However, there was a lack of signage and stimulation to help those people who were living with dementia to navigate their way around the service. We have made a recommendation about this and it will be checked at the next inspection.

During the inspection we received a concern about the amount of food available for the people who used the service. We checked the food store and found there were adequate amounts of fresh, dried and frozen food available. We spoke with the cook who confirmed they had a plentiful supply of food. Staff had received training which equipped them to meet the needs of the people who used the service; this training had been updated regularly to ensure staff skills were up to date. People who needed support with making informed decisions were protected by the use of current legislation. We saw that all decisions made on their behalf were done in a least restrictive way and in their best interests. People were supported to access their GP and other health care professionals when needed.

People were cared for by staff who were kind and caring. Staff understood their needs and could meet these. Relationships between the staff and the people who used the service were good and they both seemed to enjoy each other’s company. There was lots of laughter and good natured banter around the service. People had been involved in the formulation of their care plans and these reflected their needs and how they wished to be supported. Staff treated people with dignity and respected their privacy.

The opportunity for the people who used the service to participate in activities had been affected by the staff changes. We have made a recommendation about this as a lot of the people who used the service spent a great deal of time in their rooms and this potentially could make them isolated if there was a lack of activities for them to participate in. The registered provider had a complaints procedure which was displayed around the service. All complaints were investigated to the satisfaction of the complainant; however, if the complainant was not happy with the way the investigation had been conducted they were signposted to other agencies for advice, support and guidance.

The people who used the service had the opportunity to have a say about how the service was run; this was in the form of surveys and meetings. Equipment was serviced and repaired as needed and new equipment was purchased when required. Despite the manager not being registered with the CQC they knew they had a responsibility to notify us of any incidents which affected the wellbeing of the people or affected the smooth running of the service.