Eastfield Nursing Home

Eastfield Nursing Home is a residential care home providing personal and nursing care to up to 52 older people who may be living with dementia or a physical disability. At the time of our inspection there were 48 people living in the home.

People’s experience of using this service and what we found

People were safe and protected from avoidable harm and abuse. The provider supported people to keep themselves and their belongings safe and secure. The provider had processes to manage people’s medicines safely, and had adapted their infection control measures in response to the COVID-19 pandemic.

The service was managed and led well. The leadership and culture promoted high-quality, person-centred care. The provider could show clear improvements in how the service was managed.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection:

The last rating for this service was good (published 10 August 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

This information included concerns received in relation to how the service supported people safely. As a result, we undertook a focused inspection to review the key questions of safe and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating of good.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Safe visiting arrangements were in place. Staff and visiting professionals were asked to provide evidence of their vaccination status against COVID-19 prior to entering the home. People were supported by staff to keep in touch with those important to them. Visitors were required to complete a COVID-19 test, had their temperature checked and wore personal protective equipment (PPE).

There were ample supplies of PPE at the home. Staff had received training on how to 'Don and Doff' (put on and take off) their PPE to reduce the risk of cross-contamination. Staff explained to people why PPE was needed, and people accepted this.

Staff supported people's social and emotional wellbeing. Alternative forms of maintaining social contact were in place including video calls. The home had made adaptations to create a visitors' 'pod' to allow partitioned visiting without having to enter the care home.

Staff followed government guidance in relation to personal protective equipment (PPE). We saw all staff were wearing face masks. Hand sanitiser and PPE was readily available throughout the home. The home had sufficient supplies of PPE.

The provider had an up to date infection control policy in place and carried out appropriate environmental audits. The provider ensured staff were kept up to date with government guidance.

Audits were carried out to ensure staff were following government guidance about the management of infection control during the COVID 19 pandemic.

At our last inspection on 27 and 28 February 2017, we found a breach of regulation relating to how the provider carried out assessments for people who lacked capacity or were at risk of being deprived of their liberty. We found improvements were needed in a total of three key areas. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question effective to at least good.

At this inspection we found improvements had been made in all key areas, and the provider was meeting the fundamental standards required by regulation.

Eastfield Nursing Home 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.

Eastfield Nursing Home is registered to provide residential and nursing care for up to 52 older people who have a range of needs, including older people, people living with dementia, and people living with a physical disability. The home is situated in the village of Liss and includes a secure garden for people to enjoy at the rear of the home. Facilities include a dining room, a conservatory seating area and three shared lounges. At the time of the inspection 42 people were living at the home.

There was a registered manager in post. A registered manager is a person who has registered with 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.

The provider had arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely. Recruitment processes were in place to make sure the provider only employed workers who were suitable to work in a care setting. There were arrangements in place to protect people from risks associated with the management of medicines and the spread of infection.

Care and support were based on thorough assessments and care plans, which reflected professional standards and were kept up to date. Staff received appropriate training and supervision to maintain and develop their skills and knowledge to support people according to their needs. People were supported to eat and drink enough to maintain their health and welfare. People were supported to access healthcare services, such as GPs and specialist nurses. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care workers had developed caring relationships with people they supported. People were supported to take part in decisions about their care and treatment, and their views were listened to. Staff respected people’s independence, privacy, and dignity.

People’s care and support took into account people’s abilities, needs and preferences, and reflected their physical, emotional and social needs. People were able to take part in a range of leisure activities and entertainment. People were kept aware of the provider’s complaints procedure, and complaints were managed in a professional manner.

The provider had a clear vision and strategy, which was shared with staff. Systems were in place to make sure the service was managed efficiently and to monitor, assess, sustain and improve the quality of service provided.

At our last inspection the registered manager had not always ensured people’s preferences in relation to their food choices were met, that people were treated with compassion at all times and that appropriate action had been taken to ensure consent had been sought for all aspects of people’s care. The registered manager had also not always ensured that people were protected from risks associated with falls, the registered manager did not have effective quality assurance processes in place and records did not reflect the care and treatment people received. The registered manager had also not always ensured that staff received the appropriate supervision and support in their role and that people were protected from the employment of unsuitable staff.

We told the registered manager they needed to take action and we received two reports setting out the action they would take to meet the regulations. At this inspection we reviewed whether or not these actions had been taken and whether the registered manager was now meeting the requirements of the HSCA 2014. We found improvements had been made regarding the breaches identified; however, additional time was required to ensure these improvements were embedded and sustained in staff’s working practices.

Eastfield Nursing Home, to be referred to as the home throughout this report, is a home which provides residential and nursing care for up to 52 older people who have a range of needs, including those living with Parkinson’s disease and dementia, sensory impairments as well as epilepsy and diabetes. The home is situated in a residential area in the village of Liss and has approximately five and a half acres of land which includes a secure garden for people to enjoy at the rear of the home. Facilities include a small dining room, conservatory seating area and large lounge on the ground floor with two smaller lounges on the first floor. At the time of the inspection 46 people were using the service.

The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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 were kept safe as the registered manager ensured sufficient numbers of staff were deployed in order to meet people’s needs. In the event of unplanned staff shortages the registered manager sought to use familiar and known agency staff to support people with their care. However, people told us they often had a protracted wait to receive care after requesting staff assistance. Staff deployment was not always monitored to ensure that people were receiving care at the time they required. Plans were in place to address this immediately following the inspection; however, time is needed to ensure this system is effective and improves the response people experience when using their call bells.

Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people during their daily interactions. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. However, we could not always see that people had always been accurately assessed to identify whether they were clearly able to make decisions regarding all aspects of their care.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager showed an understanding of what constituted a deprivation of person’s liberty. People had been appropriately assessed as to whether they could consent to living at the home prior to the provider appropriately submitting the required applications where people were deprived of their liberty. Authorisations had been granted by the relevant supervisory body to ensure people were not being unlawfully restricted. Conditions applied to such authorisations had been recognised by the registered manager; however, we could not see that appropriate action had always been taken to ensure these conditions were met. Where conditions relating to a person’s DoLs authorisation are not met it could mean the DoLS would cease to be in the person’s best interest. This would place the person at risk of being deprived of their liberty without lawful authority.

The home provided care for those living with dementia however we could not always see that the environment supported these people to move around the home independently. We have made a recommendation that the registered manager seeks guidance on how to develop the home to become more accessible to those living with dementia.

The registered manager had not always fulfilled their legal requirements by informing the Care Quality Commission (CQC) of notifiable incidents which occurred at the service. Notifiable incidents are those where significant events had happened. This allows the CQC to monitor that appropriate action was taken to keep people safe. However, positive action had been taken to address this and we could see at the time of the inspection notifications were submitted in a timely fashion.

People using the service told us they felt safe, relatives agreed they felt their family members were kept safe whilst living at the home. Staff understood and followed the registered manager’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. Appropriate risk assessments were in place to keep people safe.

People were protected from the unsafe administration of medicines. Nurses were responsible for administering medicines and had received additional training to ensure people’s medicines were administered, stored and disposed of correctly. Nurse skills in medicines management were regularly reviewed by managerial staff to ensure they remained competent to administer people’s medicines safely.

Recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff. New staff induction training was followed by a period of time working with experienced colleagues. This ensured staff had the skills and confidence required to support people safely.

People were supported by staff who had up the most relevant up to date training available which was regularly reviewed to ensure staff had the skills to proactively meet people’s individual needs.

People were supported to eat and drink enough to maintain a balanced diet. We saw meals were prepared to meet people’s individually assessed nutritional requirements. Staff followed guidance in people’s care plans to ensure they received a meal which met their needs. Alternatives were offered and prepared when people did not wish to choose from the two meal choices offered and people were encouraged to eat and drink sufficient to maintain their health and wellbeing.

People’s health needs were met as the staff and the registered manager had detailed knowledge of the people they were supporting. Staff engaged with healthcare agencies and professionals when required. This was to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.

Staff had taken time to develop companionable relationships with the people they were assisting. Staff understood people’s communication needs and used non-verbal communication methods where required to interact with people. These were practically demonstrated by staff during their interactions with people.

People received respectful care from staff who understood their care needs. People had care and support which was delivered by staff using the guidance provided in individualised care plans. Care plans contained information to assist staff to provide care in a manner that respected each person’s individual requirements. Although this information was not always completed fully we could see that staff knew how to support people in the way they required.

People were supported to participate in activities to enable them to live interesting lives and prevent them experiencing social isolation. A range of activities were available to people to enrich their daily lives which were promoted by staff to ensure people were able to participate in, if they wished to do so.

Relatives knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People and relatives were asked to complete a biannual quality assurance questionnaire to provide their views on the quality of the care and support provided. An action plan was then created to ensure people’s views were documented and positive action taken to address and areas raised.

The registered manager had a philosophy of care which detailed the way in which care would be delivered to people. Staff we spoke with were able to recognise what this philosophy of care meant we saw these standards were evidenced in the way care was delivered to people.

Relatives told us and we saw that the home had an acti

We spoke with four people who used the service and five relatives who were visiting people that day. One person who used the service said 'It's very good here. I can't fault it'. Another said 'The staff are very good.' One visiting relative said 'I couldn't praise the home enough.' Another said '(my relative) is really well looked after.'

The owner/manager was away at the time of the inspection. We spoke with the two nurses on duty, three care staff, the cook and one of the management team from the sister home nearby. Staff told us 'It's really lovely here ' it's down to the owner.'

We reviewed care records for three people living at the home. We found that people experienced safe and effective care because their needs were assessed and reviewed, and care plans kept current.

People could choose from a varied menu and had the support they needed to help them eat and drink.

People were protected from the unsafe management of their medication because there were effective systems in place to minimise the risk.

Staffing levels were flexible and there were sufficient staff to meet the needs of the people using the service.

We asked about how people and their relatives were involved in the care planning and delivery process. We were told by staff that there was a great deal of involvement and to some extent this was confirmed by the relatives we spoke to.

We asked about the level and quality of care in the home. Most of the people who used the service and their relatives seemed very happy with the service and the staff. The provider had introduced a computerised system for recording and monitoring care plan information which provided useful guidance to assist staff in carrying out their care duties.

Measures were in place to ensure the safeguarding of people living at the home. Staff had undertaken training related to safeguarding vulnerable people and were able to assure us of their knowledge and understanding in this regard.

We looked at support for staff, and were told by staff members that they had undertaken a wide range of training and were being encouraged to work towards further qualifications. Supervision processes were in place to support staff.

We looked at the way service quality was assessed and monitored and identified concerns regarding the auditing of the service.