Archived: Eastbourne Villa

We looked at a range of records, spoke with the manager, five members of staff and five people who used the service. We also observed the interactions between staff and people living at Eastbourne Villa.

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

Is the service safe?

People were treated with respect and dignity by the staff. People told us they were listened to and that they felt safe. Staff understood their role in safeguarding the people they supported.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. At the time of our inspection they had no DoLs in place. The home had policies and procedures in relation to the Deprivation of Liberty Safeguards but not for the Mental Capacity Act and only five out of 16 staff had received Mental Capacity Act training, three of which were in 2012.

There was no system in place to make sure that manager and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This increased the risk of harm to people and failed to ensure that lessons were learned from mistakes. The home did not have a complaints policy.

Safe recruitment procedures ensured that people were protected from unsuitable staff.

Is the service effective?

People's health and care needs were assessed and however it was not recorded that these were reviewed. Some monthly reviews were dated December 2013. Body maps were in place but these were not fully dated, for example one person's said 20/7 but no year was added.

Daily records such as fluid charts, turning charts and daily events charts were completed but the column that said date and time, only the date was added.

People's care plans provided information on the care they needed but they were not person centred. There was very little information about a person's life history, their likes or dislikes.

Records of activity and social recordings were not completed, therefore it looked like the last time someone had quality time spent with them was August 2013.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff engaged with people in a positive way and showed respect, kindness and gave people gentle encouragement.

Staff we spoke with demonstrated a good understand of the people they cared for and were able to tell us how they tried to recognise and meet people's individual needs. Staff told us they were looking forward to starting the distance learning dementia training.

Is the service responsive?

People who used the service said they knew how to make a complaint if needed. We asked to see the complaints file, there was one complaint registered. The manager told us that any verbal complaints or little complaints such as clothes going missing were not recorded. There was information on the walls to say how someone could make a complaint, although this needed updating. This meant people were at risk of not having their concerns and needs properly taken into account.

Staff we spoke to had a good understanding of how to raise concerns and felt able to raise these with the manager.

Two people who used the service had seen the dietician and been diagnosed as clinically malnourished. One person was in May 2014 and had not been weighed since and one person was diagnosed on the 11th June 2014 but was not weighed again until the 8th July 2014. We spoke with the manager regarding this and the first person was not weighed due to mobility reasons and needing special scales, the manager had been in contact with the dietician about this, although this was not recorded. The second person was due to the decision to weigh them monthly rather than weekly. We have asked the manager to put something in place immediately regarding this.

In one person's care file it stated they liked to see the chiropodist regularly, there were no records of any visits to see the chiropodist. Whilst we looked at the finance records we saw evidence of payment to a chiropodist. We asked a member of staff to find this record in the professional visits log, this was not recorded.

One person had not received a diabetic eye screening test since January 2013. We spoke to the manager about this and there was a legitimate reason, this had not been recorded.

Is the service well-led?

We looked at the finance records for seven people and found that there were discrepancies with one of them, there was '1.10 less money than recorded. We spoke with the manager about this and she was going to investigate.

The service did not have any records of quality assurance systems in place. Therefore the registered manager was not protecting the people who used the service and others against the risks of inappropriate or unsafe care and treatment.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance and record keeping.

People who used the service had the opportunity to attend meetings. Topics discussed were mainly food and the choice, likes and dislikes.

Staff also attended regular meetings where they discussed holidays, a recent local authority inspection, and completion of records along with handwriting. At the latest meeting they discussed staff cut backs, fees and rotas. The manager also said she puts a monthly newsletter in with their pay, this covered any updates, changes, relevant news and inspections that had taken place.

The manager said she was planning on setting up relative's meetings.

Survey/questionnaires had been sent out to all relatives with a few responses. Staff had also completed one and the majority of the comments were they enjoyed working at Eastbourne Villa but the d'cor needed updating, they would like more activities and there were not enough staff. We discussed with the manager about how they were going to address these concerns.

One member of staff explained that they were key worker for a person that used the service. This person loves gardening and had totally transformed the back garden. They said they often took this person to garden centres, at least once a week. We questioned how this left the staff in the home, as there was only two staff on duty at any one time. The person said she could only do this on her day off.

Eastbourne Villa was badly in need of redecorating, paper was coming off the walls, walls were half painted and then left, paint was coming off window seals leaving bare wood and carpets needed cleaning. Many areas looked like they could do with a thorough clean; the manager said it was difficult as they had one cleaner who worked for two hours a day. It was then left for the two members of staff to clean, do laundry, provide all meals after the cook went home at 1pm and care for the people who used the service. There were also a clear lack of any activities taking place; we have asked the manager to look into this.

What people told us.

People who used the service said, 'Staff are nice, all helpful and pleasant,' and 'Staff are brilliant and will do anything for me,' and 'I feel safe, I have no worries.'

Staff we spoke with said, 'Staff interacts well on a personal level, they know the residents really well,' and 'I feel supported and my manager is very supportive,' and 'There is never a single day I do not want to come to work.' One member of staff said 'I love the residents; the manager is great I just wish the owners would support more.'

At the last inspection in June 2013 we had concerns about the systems in place to control the risk of infection, staffing levels and quality monitoring. At this inspection we found that improvements had been made.

The manager had produced a file of information that included policies and procedures on the control of infection and good practice guidance. All staff were undertaking a distance learning course on the prevention and control of infection. The laundry arrangements were seen to be satisfactory and good hygiene practices were promoted by the provision of protective clothing for staff and the use of hand wash gel and paper towels.

Staffing levels had been increased and there were plans in place to increase them further. This ensured that care staff were spending their time with people who lived at the home rather than on domestic and laundry tasks.

The manager had produced a file of information to evidence that quality monitoring systems had been introduced and were being used. This included evidence of care plan reviews, resident and staff meetings, satisfaction surveys, a newsletter and quality audits. This gave people the opportunity to comment on the care they received.

We saw that improvements had been made to medications systems at the home and that staff had completed appropriate training. Staff had also completed other training that assisted them in carrying out their role effectively.

Some improvements needed to be made to infection control policies and practices to ensure that the home met current guidelines, although we found the home to be clean on the day of our visit. People who lived at the home said, "Yes, the home is always clean and there are no unpleasant smells". The design of the home was suitable for purpose and had been appropriately maintained.

We saw that there were times of the day when staff had to take on dual roles, for example, assisting people to get up as well as preparing their breakfast and administering medication. We felt that people's dependency levels may not have been taken into consideration when staffing levels had been determined.

Quality monitoring systems had lapsed and therefore people did not have the opportunity to comment on their care or express their views. This had resulted in a lack of opportunity for learning to take place from analysis of audits and consultations.

We spoke with staff and observed the administration of medication on the day of this inspection. We found that staff administered medication in a safe way.

Improvements had been made to the home's medication policy, to the storage of medication and in returning medication to the pharmacy.