Eastbrook House

Updated 17 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 21 and 22 August 2018 and was unannounced.

The inspection team consisted of one inspector, two pharmacist inspectors and two experts by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.’

Before the inspection, we checked for any notifications made to us by the provider and the information we held on our database about the service and provider. Statutory notifications are pieces of information about important events which took place at the service, such as safeguarding incidents, which the provider is required to send to us by law. We also looked at action plans that the provider had sent to us following the last inspection in September 2016.

During the inspection we observed how staff interacted and supported people who used the service. We spoke with seven people using the service, ten relatives and friends and nine staff members which included the health, safety and training manager, deputy manager, two heads of care, one senior carer and four care staff.

We looked at the care records of seven people who used the service and medicines administration record (MAR) charts and medicines supplies for nine people. We also looked at the personnel and training files of six staff members. Other documents that we looked at relating to people's care included risk assessments, medicines management, staff meeting minutes, handover notes, quality audits and a number of policies and procedures.

Updated 17 October 2018

This inspection took place on 21 and 22 August 2018 and was unannounced.

Eastbrook House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Eastbrook House accommodates up to a maximum of 43 people in one adapted building. At the time of this inspection there was 39 people living at the service.

There was a registered manager in post at the time of this inspection. However, the registered manager was away on annual leave. 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.

At the last inspection on 27 and 28 September 2016 the service, although rated ’Good’ overall, was found to be in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The management and administration of medicines was not safe. There was incomplete recording and monitoring of people’s food and fluid intake and re-positioning charts for people at risk of malnutrition and pressure sores.

Following the last inspection in September 2016, we asked the provider to complete an action plan to show what they would do and by when to improve each of the key questions to at least good. At this inspection we found that the provider had made significant improvements to ensure the safe administration of medicines. Re-positioning charts were comprehensively completed as required. However, we identified concerns relating to the lack of meal choices people were offered especially at lunch time and we found very little improvement in the way in which food and fluid charts were completed and monitored to ensure people who were at risk of malnutrition and dehydration were supported appropriately.

At the last inspection we found that people were not given a choice of what they would like to eat especially for those people living with dementia who may not have known what was on the menu and may not have been able to request an alternative. During this inspection we found little improvement had taken place especially after the last inspection the registered manager had assured us that improvements in this area would be implemented. Following the inspection the registered manager sent us information in relation to the improvements they had implemented following this inspection.

Fluid charts were put in place to monitor people’s fluid intake where this was an identified need. However, we found that these were not completed comprehensively to fully monitor people’s intake and take appropriate action where poor fluid intake was noted. However, we saw that people were appropriately hydrated and always had access to a variety of hot and cold drinks.

Care staff continued to demonstrate a clear and in-depth understanding of abuse, how to recognise signs of abuse and the steps they would take to ensure people were protected and kept safe and free from abuse.

Risk assessments continued to identify and assess risks associated with people’s health, care and support needs. Guidance and information was available to all staff on how to reduce or mitigate all assessed risks so that people were kept safe and free from harm.

We observed sufficient numbers of staff available to appropriately support people with their health, care and social needs. However, staff that we spoke to felt that due to additional tasks allocated to them in the absence of laundry and kitchen staff, this impacted on their workload and ability to appropriately care and support people.

We observed people to have access to a variety of drinks and snacks to support their hydration and nutrition needs. On the first day of the inspection, people were observed enjoying their food and were seen to eat well. However, on the second day of the inspection, we observed people not to eat so well and a large amount of waste returned to the kitchen. We saw that food had not been presented well and people did not seem to like the taste of the meal that they had been given.

The provider continued to follow robust recruitment practises to ensure that only staff assessed as safe to work with vulnerable adults were recruited.

All staff demonstrated a good level of understanding of the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLS). Records confirmed that people, where possible, had consented to the care and support that they received and where people were not able to make such decisions, relatives had been involved in the decision-making process.

Care staff continued to be supported through on-going training, regular supervision and annual appraisals to enable them to carry out their role effectively.

Care plans were detailed and person centred which gave specific information and guidance to care staff on how to meet people’s identified needs and wishes. We saw that care staff knew the people they supported very well.

We observed people and relatives had established positive and caring relationships with care staff who knew them and their relatives very well and supported not only the person but their relative as well.

The provider had displayed their complaints policy which detailed guidance on how people and relatives could lodge a complaint. People and their relatives knew who to speak with if they had any concerns or issues to raise.

The provider had a number of processes in place to monitor and oversee the quality of care that was provided to people. However, the provider did not robustly follow their own governance systems as the inspection process highlighted issues that the service should have identified and addressed themselves. We have made a recommendation about ensuring robust and complete governance systems are adhered.