Archived: East Hill House Residential Care Home

East Hill House is a residential care home that was providing personal care and accommodation for up to 34 people aged 65 and over.

At the time of the inspection there were 31 people living at East Hill House. The majority of people were living with a form of dementia. The home had a dementia care unit called The Willows in the main house which provided care for up to eight people with more significant needs associated with their dementia. There was a small unit opposite the main house called The Court which provided accommodation for up to 10 people who received food services and some personal care but liked to maintain some independence with staff support.

People’s experience of using this service:

Community working was exceptional and led to improved quality of life of people through involvement with community projects and events. We received excellent feedback from people, relatives and external professionals about the activities and engagement with the community. The registered manager prioritised activities that would provide stimulating experiences for people and enable them to feel valued and part of their community. Care plans were detailed and contained good information for staff to help them meet people’s needs.

The home was well led by a management team that were motivated to provide an inclusive environment for people. The registered manager had good oversight of the service where any concerns were identified and acted upon without delay.

We have made a recommendation that the provider and registered manager evaluate the impact of the service initiatives to ensure they achieve exceptional outcomes for people.

People were supported with kindness and compassion. People and their families were involved in the planning of their care and developed positive relationships with staff.

People told us they felt safe and well cared for. People received medicines safely by staff who were competent to give them. People received safe and effective care from staff who understood how to recognise and report issues of concern and potential abuse. When things went wrong the registered manager investigated and staff learned from this and changed practices. People were protected from infection by staff who had completed training in infection control procedures.

People were supported to eat and drink and monitored to ensure they were nourished and hydrated. The provider had effective systems in place to maintain staff skills and knowledge through training and development.

Rating at last inspection:

The service was rated good at the last inspection published on 20th October 2016.

Why we inspected:

This was a planned comprehensive inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to inspect in line with our inspection programme.

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

The home has a dementia care unit 'The Willow's' on the third floor of the main house which provides care for up to eight people with dementia. There is a smaller unit opposite the main house 'The Court' which provides accommodation for up to 10 people.

The service had a registered manager. 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.

People and their relatives told us the service was safe. Staff had undergone safeguarding training and had access to policies and guidance to enable them to safeguard people.

People and professionals told us risks to people were well managed. Risks to people had been assessed in relation to falls, choking, skin care and moving and handling. There were care plans in place to say how identified risks would be managed and staff understood how to manage risks to people. Risks to people from their environment were managed safely. Incidents were reviewed and measures taken to reduce the risk of repetition for people.

People and their relatives said there were enough staff on duty. The registered manager used a staffing dependency tool to determine the safe level of staffing for the service. There were enough staff rostered to meet people’s needs. People were safe as they were cared for by staff whose suitability for their role had been assessed by the provider.

People and professionals told us medicines were well managed for people. People’s medicines were ordered, stored and disposed of safely. Where people lacked the capacity to consent to their medicines, legal requirements had been met. Staff had completed medicines training and updated their internal medicines training, but had not all updated their on-line medicines training within the past year, as required by the provider. There was no impact of this on people who received their medicines safely. The registered manager took immediate action once the issue was identified to ensure staff updated their training and implemented a process to ensure that in the future they would be made aware of upcoming expiry dates for staffs’ on-line medicines refresher training.

People told us the staff were well trained. People were cared for by staff who had received suitable training, on-going support and professional development to ensure they were competent to deliver peoples’ care effectively.

People reported that their consent was asked for when care was being given. Staff told us they had undertaken Mental Capacity Act (MCA) 2005 training, which records confirmed. They were able to demonstrate how it applied to their day to day work with people. The forthcoming introduction of new MCA paperwork by the provider will enable staff to more clearly document the outcome of best interest decisions for people in relation to Deprivation of Liberty Safeguards applications.

People were happy with the quality of the meals provided. People were appropriately supported by staff wherever they were eating within the service. People’s weights were monitored and appropriate action was taken if people were at risk from weight loss.

People and relatives reported there was good healthcare provision. Staff arranged for people to see a range of health care professionals as required.

People and relatives said the care delivered was very good. They thought staff were friendly, kind, caring, helpful and respectful. People experienced positive relationships with the staff who cared for them.

People’s communication needs were documented to enable staff to understand how to interact with them. People were supported to express their views and to make decisions. People were provided with relevant information about the service.

People reported that staff upheld their privacy and dignity when providing their care. Consideration had been given in regards to how people’s dignity could be positively promoted by staff.

People and their relatives told us they received the care they needed. People’s care plans had been regularly reviewed to ensure they remained relevant and up to date. People were cared for by staff who had information about how to respond to their individual needs.

People told us and our observations showed that a variety of activities took place. People including those on the dementia unit were supported and encouraged to be involved in activities both within the service and in their local community.

People’s complaints were investigated, responded to and any required actions taken. Various forums and processes were in place to seek feedback on the service from people and their relatives.

Throughout the inspection staff were observed to apply the provider’s values in the course of their work. People were encouraged to be involved in the service for example, with staff recruitment and staff recognition. Staff told us there was an ‘open’ culture within the service and they were provided with opportunities to speak out if required.

People and relatives were complimentary about the manager and staff and the management of the service. The service was well-led by a visible and supportive management team.

A range of aspects of the service were audited in order to identify areas for improvement for people. In addition to audits completed at the service level, the provider’s regional manager and quality team audited the service. Feedback from people, their relatives and stakeholders was sought and acted upon to improve the service for people.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who use the service, their relatives, staff supporting them and from looking at records. We spoke with four people, one person's relative, three staff, the registered manager and the regional manager during the course of the inspection. Not all people who lived on The Willows were able to communicate with us about their experiences of the care provided. Therefore we used our Short Observational Framework for Inspection (SOFI) to observe the care provided to people on this unit.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Risks to people had been identified and there were plans in place to manage these risks. We saw evidence that the guidance for staff in relation to the management of risks to people had been followed.

Staff received training in safeguarding and they had updated this annually. Staff understood their roles and responsibilities in relation to safeguarding people. Relevant guidance was available for both staff and people.

Relevant checks had been made in relation to staff during their recruitment to ensure that they were suitable to work with vulnerable people.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. No-one was subject to DoLs however, we saw evidence that the service was aware of how to make referrals.

Is the service effective?

People's needs had been assessed to ensure that the service was able to meet their needs. People had been involved in their care planning and asked about their preferences. One person told us 'Yes, I was involved in planning my care.' The care delivered to people reflected what was recorded in their care plans.

There was evidence that staff had used evidence based practice to inform the care that people received. They used risk assessment tools to assess and monitor risks to people. Staff had received relevant training in caring for people with dementia.

People had been provided with relevant information in a range of formats in order to enable them to make decisions about their care.

There were a range of activities for people to engage with. Staff had ensured that people from the community came into the home and that people were supported to go out when they wished.

Is the service caring?

Staff were observed to treat people with dignity and respect when they communicated with people and provided their care. People told us that they were treated with dignity and respect. One person's relative told us 'Staff always treat X with dignity and respect.'

Staff were seen to be caring towards people, their communication was respectful and kind. They used appropriate communication methods if the person had dementia, for example, touch. People told us 'The staff are very good' and another person said 'Staff care about you.'

Is the service responsive?

People told us that the service had been responsive when their needs had changed. One person's relative told us 'They respond to issues.' Changes to people's care were communicated to staff via the staff handover. People's records were updated when there were changes to their care.

Is the service well-led?

People were encouraged to be actively involved in the running of the home. People contributed to staff training and interviewed staff. There was a regular resident's meeting. People told us 'The manager is responsive to suggestions.' Staff had been encouraged to contribute their ideas.

People and staff provided positive feedback on the management of the home. People told us 'The manager is very good' and 'X leads them well.' There was a clear management structure in place. There were a number of processes to ensure that the provider could monitor the quality of the service provided.