Eastcroft Nursing Home

Eastcroft Nursing Home is a residential care home providing personal and nursing care to up 20 people. The service provides support to older people and those who live with dementia. At the time of our inspection there were 16 people using the service.

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

Risks to people’s health and welfare had been assessed but some risk assessments lacked detail and did not always contain enough information for staff to follow to provide people with safe care and treatment. Staff did not always follow the guidance provided by health care professionals.

The provider did not check that staff who administered medicines were competent to do so. The provider had no system in place to maintain oversight of staff training and failed to detect the low levels of pass rates for some. The provider did not have robust procedures in place to ensure the safe recruitment of staff. We observed some poor hygiene practices on the inspection day.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We found the provider was not consistently working within the principles of the Mental Capacity Act. Capacity assessments and best interest decisions were not decision specific. We observed that the way in which people were supported at times restricted their choices.

People’s needs were not always adequately assessed by the provider to ensure they could be met by staff when admitted to Eastcroft Nursing Home. The design of the home did not take into account the needs of those who lived with dementia. We have made a recommendation about this.

People did not always receive care which was respectful or dignified. We were told that on occasion, people were wearing clothes that belonged to others in the home. There were no individually designated incontinence fixation pants and we found some of the language used in care plans to be disrespectful to the person. The provider did not routinely seek people’s feedback about the care they received. However, we observed that staff were patient and kind with people.

Care plans did not accurately reflect people’s needs and they lacked guidance for staff about how to deliver person-centred care. Staff provided a limited amount of activities to people and these did not include the needs of those cared for in their room.

The provider failed to develop effective governance and quality assurance systems to assess the quality and safety of the support people received. There was limited oversight of the day to day operation of the home and a lack of audit of incidents to determine trends and themes. This meant there was no opportunity for staff to learn from incidents or for the provider to take actions to improve the care people received. The provider had not always notified CQC of incidents or accidents which is a requirement of their registration.

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

Rating at last inspection

The last rating for this service was good (published 29 January 2019 ).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk. This inspection examined those risks.

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.

You can see what action we have asked the provider to take at the end of this full report.

Following inspection, the provider told us they adapted the eating and drinking guidance issued guidance by a speech and language therapist with immediate effect. They initiated a new staff training programme. They are cooperating with the local authority to address shortfalls found on this inspection.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to keeping people safe from risk of harm, staff recruitment and training, medicine management, capacity and consent, person centred care and governance of the home at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This inspection took place on 04 December 2018 and was unannounced. At our previous inspection in August 2016 we rated the service as Good.

Eastcroft Nursing Home 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. The service can accommodate up to 21 older people. At the time of our inspection there were 18 people using the service the majority of whom were living with dementia.

The house people lived in had a homely feel, however certain aspects of the environment were required to better meet the needs of people living with dementia. Carpets in a number of the communal areas had a complex pattern. This can cause confusing or disorientation to people, as they can perceive the floor to not be flat. The registered manager said they were in the process of reviewing the flooring across the home as part of ongoing home improvements.

People told us they felt safe living at Eastcroft Nursing Home. Hazards to people’s health and safety had been identified, and management plans produced to reduce the risk of harm. Staff understood their responsibilities around identifying and reporting suspected abuse. There was an ongoing safeguarding review taking place at the time of our inspection.

People’s support needs were regularly reviewed to identify the safe levels of staff needed to meet those needs. Robust recruitment processes ensured that before new staff worked at the home, they were safe and suitable to do so.

Staff ensured that people received their medicines as prescribed, or when they needed them. Only those staff that were trained and competent were able to manage and give people their medicines.

People lived in a clean home. Infection control processes meant that the environment and equipment were routinely cleaned to keep people safe from the spread of infections. Staff followed good infection control practices, such as using gloves and aprons when handling food, and were seen to regularly wash their hands.

The staff team kept people safe by reviewing accidents and incidents and taking action to prevent reoccurrences.

A comprehensive assessment of people’s needs was completed before they moved into the home. This ensured the staff had the skills suitable to meet those needs . Staff received training and supervision to keep them up to date with best practice. Nursing staff were supported to maintain their registration, and take part in additional training as necessary.

People had enough to eat and drink. We had positive feedback about the choice and quality of food that people ate.

There were good links with the local health care services, so people had access to GP’s and other health care professionals when needed. Peoples health was seen to improve due to the care and support they received

People’s rights under the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were met. If a person could not make a specific decision for themselves people who had legal authority to make decisions for them where involved.

People were supported by staff that were caring, and respected their privacy and dignity. They felt involved in decisions on their day to day care, and staff knew the people they supported as individuals. People’s faiths, culture and lifestyles were respected.

Care plans had a good level of detail to enable staff to give a responsive level of care. These were reviewed periodically or as people’s needs change to ensure they reflected current support needs. People had access to activities that interested them, and they said they never felt bored as something was always going on.

There was a complaints policy in place and the registered manager said complaints were welcomed as it gave them the opportunity to improve.

Systems were in place to support people who were at the end of their lives. Staff knew their preferences and choices so people could be assured of a dignified, and as far as possible, pain free death.

The owner and management of Eastcroft Nursing Home set out to provide a friendly and family feel to the home. This is what we observed during the inspection, from the interactions between staff, their families and the staff, and the way the management spoke about people.

Quality assurance processes ensured that peoples feedback was obtained and acted on, and that staff provided a good standard of care to people. Notifications of incidents had been submitted to the CQC in accordance with the regulations.

There was a registered manager in place who was present on the day of the inspection. They were also registered with CQC as the provider. 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.

There were enough staff employed in the service to meet people’s needs. People said staff were attentive and they did not have to wait for attention.

People’s medicines were administered and stored safely. Risks had been assessed and managed appropriately to keep people safe which included the environment. The risk assessments for people were detailed and informative and included measures that had been introduced to reduce the risk of harm.

In the event of an emergency, such as the building being flooded or a fire, there was a service contingency plan which detailed what staff needed to do to protect people and make them safe.

Accidents and incidents were recorded appropriately and evaluated to prevent or minimise reoccurrence.

Staff had knowledge of safeguarding adult’s procedures and what to do if they suspected any type of abuse. Staff had undergone recruitment checks before they started work.

People’s rights were protected under the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring that people were consenting to their care. This also ensured that those who were unable to consent and where restrictions to their freedom and liberty had been undertaken, these had been authorised by the local authority.

People received care from staff who had received appropriate training to meet people’s needs. The provider ensured all staff were kept up to date with the mandatory training including moving and handling and health and safety. Staff did provide good care to people on the day of the inspection.

Staff were supported in their work and said that they had regular supervision with their manager. There were opportunities for staff and their manager to discuss their performance.

Nutritional assessments were carried out when people moved into the home which identified if people had specialist dietary needs. People had access to a range of health care professionals, such as the GP, dietician and chiropodist.

Staff at the service were caring and supportive and treated people with dignity and respect. We saw that care plans were person centred and had involved people whenever possible. Staff knew and understood what was important to the person.

People were supported by staff that were given appropriate information to enable them to respond to people effectively. Where it had been identified that a person’s needs had changed staff were providing the most up to date care.

People were able to take part in activities which they enjoyed. People and relatives told us that they knew what to do if they were unhappy about something. There was a complaints procedure in place for people and relatives to access if they needed to. We saw that complaints were investigated appropriately.

Staff said that they felt supported, valued and listened to. Systems were in place to monitor the quality of the service that people received. This included audits and surveys.

Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. The registered manager had informed the CQC of significant events in a timely way.

Below is a summary of what we found. The summary is based on our observations during our visit, discussions with people who used the service, their relatives, the staff supporting them and looking at records.

Is the service safe?

A relative of a person who used the service told us they felt the home was a safe place and felt confident that their family member received good care safely. They said they could talk to the provider if they felt unhappy regarding anything about the service. Safeguarding procedures were in place and staff understood their role and responsibility in safeguarding the people they cared for. We saw safe manual handling procedures being undertaken and saw no negative practices during our visit. We saw staff were recruited according to the home's recruitment policy and had all the required security checks in place. This ensures the welfare of the people they were supporting.

The service was clean and safe and provided people with safe access to all areas of the home.

Is the service effective?

People's health care needs were assessed with them whenever possible and written in a care pan. Arrangements were in place for people to see their GP when necessary to monitor their individual health care needs. People also had effective support to manage their dementia needs. Other support for example the chiropodist, dentist, optician, dietician and a Community Psychiatric Nurse (CPN) or clinician was provided on a regular basis and records were maintained in people's care plan.

Is the service caring?

People who used the service told us the staff were very caring and always treated them well. We saw the staff on duty were kind and caring and spoke with people who used the service in a polite and respectful manner. We were told by a relative of a person who used the service that they were so pleased they chose the home for their family member as it was a kind and caring home. We saw people were supported to eat their meals by staff who provided sensitive support for people who required this. We also saw staff took the time to enable people to be as independent as possible.

Is the service responsive?

The service was responsive to the needs of people who used the service. For example when a risk had been identified the provider responded with an action plan to minimise the risk but allow the individual to be as independent as possible. This included the management of falls. We saw the a sensory mat was provided for a person whose mobility needs changed and this was provided to alert staff of any unpredictable movements during the night.

The service also provided a sensory garden for people who used the service to enjoy following a suggestion at a home meeting.

Is the service well led?

The home is well managed by the provider who is also the registered manager. They have the support if a deputy manager/administrator and well established staff team who have a good understanding of the needs of the people who used the service.

There was a good auditing system in place for the monitoring of service provision and to recognise improvement when required. There were regular health and safety audits undertaken to ensure the health and welfare of people who used the service and to promote a safe working environment.

Complaints and accidents were monitored and the provider discussed the management of these in order to reduce the reoccurrence of these.

You can see our judgements on the front page of this report.

More information about the provider

Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions.

There is a glossary at the back of this report which has definitions for words and phrases we use in the report.

We were told that people had the opportunity to visit the home before they chose to live there or a representative could do this on their behalf. We met relatives of prospective service users viewing the home and they commented that they had read our (CQC) most recent report on line.

Some people who used the home told us they liked living in the home. One person who used the service said that they liked to go into town for coffee with the staff.

The home was clean and hygienic and staff were aware of their responsibilities regarding infection control. People told us that they liked their bedrooms and that they were very comfortable.

Staff told us that they liked working in the home. They said they had received the training and supervision necessary to undertake their roles.

We looked at the providers quality assurance systems and found a range of monitoring processes in place to monitor the quality of the service provided.

The provider was compliant following our visit.