Eastry House

Eastry House is a 'care home' for up to 22 people with learning disabilities. People in care homes receive accommodation and 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. At the time of the inspection, there were 17 people living at the service.

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

People were very happy living at Eastry House and spoke highly of the registered manager and staff. Despite this, we found the registered provider had failed to ensure management oversight of the service since our last inspection. This meant some areas identified at our last visit had not been addressed. It also meant the service had failed to improve or learn from past feedback.

There was a lack of quality auditing of the service which included provider audits. The premises could not be cleaned properly due to the poor condition of some areas. Staff were not always following good infection control practices or government guidance in relation to COVID-19. Accidents and incidents were not always included in the registered manager’s analysis meaning they could not robustly review for themes or trends.

People told us there were sufficient staff on duty each day and they were kind to them which made them feel happy and safe. People received the medicines they required and any risks specific to them were identified and guidance in place for staff to help keep them safe.

People and staff felt involved in the service and felt listened to and we observed an obvious close relationship between staff and people.

The registered manager had started to improve Eastry House and the quality of the service people received. Staff told us they had already had a positive impact despite only being registered since December 2020. The registered provider had good links with external agencies to help ensure people received appropriate care in line with their needs.

We expect health and social care registered providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and setting maximises people's choice, control and Independence.

Right care:

• Care is person-centred and promotes people's dignity, privacy and human rights.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

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 Requires Improvement (published 10 September 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received in relation to incidents and allegations of abuse at other locations registered with the provider. A decision was made for us to undertake a focused inspection to inspect and examine those risks. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as Requires Improvement. This is based on the findings at this inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Eastry House on our website at www.cqc.org.uk.

Eastry House is a care home providing personal care to 15 older people living with learning disabilities and dementia at the time of the inspection. The service can support up to 22 people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 22 people. 15 people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. The service is based in a small village with good access to the community including the church, shops and hair dressers.

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

People did not consistently receive person centred care, for example one person told us they would like to visit their place of worship but had not been supported to. Some interactions we observed were not person centred, and the manager told us they were working to provide staff with more person-centred training.

People told us they felt safe and well supported at Eastry House. Risks to people had been identified but not consistently mitigated through detailed guidance for staff. For example, care plans lacked instructions for staff to follow if someone living with diabetes became unwell. Management had identified documentation needed updating, however work to improve this was slow and risks to people had not been prioritised. People were supported by sufficient numbers of staff, but in some cases, staff were new or agency staff, who would benefit from detailed care plans and risk assessments.

Medicine management did not follow best practice for creams and ointments, but other medicines were managed safely, and plans were in place to improve this practice. Although the service was clean, people told us of infection control risks, including chairs that needed deep cleaning, and commodes which needed replacing.

People told us they were treated with dignity, compassion and respect. Most of the interactions observed were positive and it was clear staff knew people well and understood how to meet their needs.

People’s needs were assessed and when their needs changed, staff organised for involvement from the relevant healthcare professional.

People were not always supported to have maximum choice and control of their lives and staff did not always 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.

The service did not consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service did not always reflect the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support did not always focus on them having as many opportunities as possible for them to gain new skills and become more independent.

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 31 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We have identified breaches in relation to the governance and quality assurance processes at this inspection. Please see the action we have told the provider to take at the end of this report.

The service is registered to provide accommodation and personal care for up to 22 older people living with learning disabilities and dementia. There is a communal lounge, dining room, conservatory and craft room on the ground floor. Bedrooms are situated on the ground and first floor, accessed by a lift. The service is situated in the village of Eastry near Sandwich, with easy access to local shops. At the time of the inspection there were 16 people living at the service.

A registered manager was in post, however they were not present at the inspection, we spoke to the registered manager after the inspection. We were supported by the team leader during the inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

Risks to people were identified and assessed and guidance was provided for staff to follow to reduce risks to people. People received their medicines safely and on time.

Staff knew about abuse and knew what to do if they suspected abuse. Staff knew about the whistle blowing policy and the ability to take concerns outside of the service. Staff were confident that any concerns raised would be investigated to ensure people remained safe.

The provider had a recruitment policy and processes in place, these had recently been updated, the processes ensured that staff were of good character. There were consistent numbers of staff on duty. There were staff vacancies at the time of the inspection, these were covered by agency staff, who worked regularly at the service. Staff completed regular training, had one to one supervisions and annual appraisals to discuss their development.

Staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. Staff knew the importance of giving people choices and gaining their consent.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed with the local authority as being required to protect the person from harm. Some people had an authorised DoLS in place and these were reviewed regularly.

People enjoyed home cooked meals. Some people required special diets, as recommended by healthcare professionals; these meals were appetising and met people’s needs. People’s health was assessed and monitored; staff took prompt action when they noticed changes or any decline in a person’s health. Staff worked closely with health professionals and followed any guidance given to them to ensure people received safe and effective care.

People told us they were happy at the service. Staff spoke with and engaged with people in a kind and compassionate way. Staff respected people’s dignity and treated them with respect. People had been encouraged to be involved with the planning of their care, when they were able to. Staff involved relatives and advocates when planning care for people who were unable to participate. People had a detailed, descriptive plan of the support they needed.

The provider had a complaints policy and procedure. People and relatives knew how to complain, management had followed the procedure and used any complaints as a learning experience.

People’s family and friends were welcome to visit at any time. People were encouraged to visit relatives; staying with them for holidays. Staff, including an activities co-ordinator, spent time with people on a one to one basis. Staff encouraged people to be as independent as possible.

Relatives, staff and health professionals felt that the service was well led. There was effective and regular auditing and monitoring. People, relatives, staff and health professionals were asked their views on the quality of the service provided.

The provider had submitted notifications to CQC in a timely manner and in line with CQC guidelines.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

As part of this inspection we followed up on a compliance action given at the last inspection that required improvements to be made to the building. At this inspection we found that all required improvements had been made. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

The service was safe because assessments had been undertaken to ensure that people received safe and appropriate care. People told us or expressed that they felt safe. Assessments had been undertaken to ensure that people received safe and appropriate care. Checks and audits were carried out to make sure the building and equipment was maintained and safe. The registered manager supervised and checked staff competency so that staff had the skills they needed and worked in a safe way.

Is the service effective?

The service was effective because specialists, including the local community physiotherapist and speech and language therapist, had been involved in people's care and had given advice to staff. People's health and care needs were assessed with them and/or their representatives. Specialists, including the local community physiotherapist and speech and language therapist, had been involved in people's care and had given advice. Staff had received the training they needed and there was an ongoing training programme to make sure staff had the skills they needed to support people appropriately.

Is the service caring?

The service was caring because staff spent time with people and occupied them with activities. People were treated with respect and dignity by the staff. Staff had got to know the people using the service well and had developed ways to communicate with them.

Is the service responsive?

The service was responsive because care was consistently planned and delivered in response to people's changing needs. People's health and care needs were assessed with them and /or their representatives. Staff had received support and training to provide individual care. People were able to participate in meetings to discuss the running of the home and their individual preferences.

Is the service well-led?

The service was well-led because the service had an experienced registered manager who had worked in the home consistently for several years and who kept up to date with current good care practice. People using the service and staff participated in discussions in meetings about the running of the home and activities. There were systems in place to provide on-going monitoring of the home. This included checks for the environment, health and safety, fire safety and staff training needs. The staff had individual supervision and staff meetings that enabled them to share ideas and concerns.

People's care was planned and delivered so that it met their individual needs. We found that people's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and wellbeing. People were provided with appropriate equipment that was regularly serviced and well maintained.

We saw that the home needed repairing and redecorating in parts. Some leaks from the roof had caused damage to the ceilings and walls in various parts of the home. The carpet was worn and stained in some communal areas and there were tears in the stair carpet.

There was a thorough recruitment process that included checks to make sure staff were suitable with the people using the service. People had the opportunity to meet new staff before they started working in the home. New staff were given initial training and support.

People told us that they felt safe and well looked after. People told us that they could express any problems to the staff who would listen and act.

People said that they thought the staff were kind and caring. One person said 'I like all of the staff. I have no favourite, they are all good.'

Staffing was planned around individual needs and activities. This meant that people had the support they needed when they needed it. Personal hobbies and interests were supported.

People looked relaxed in the company of each other and staff. We saw that people took part in a range of community based activities that they enjoyed and were involved in the local and wider community. One person said 'I am quite happy here. The staff are alright and I am happy with my room. I have no complaints.' Another person said 'I am going out for lunch today with my family.'

A visiting relative said 'I am kept well informed. I feel I can turn up at anytime; I am always made to feel welcome. I am very satisfied with the service and I know that my relative is in good hands.'

People's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and well being.