Eastbourne Grange

About the service

Eastbourne Grange is a residential care home in an adapted building, providing personal care for older people including people who were living with dementia and memory loss. The service can support up to 25 people. At the time of the inspection there were 19 people living at the home.

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

Peoples care needs had increased. Eastbourne Grange provided support to people with advanced dementia, some with increased level of care and support needs. This impacted on staff as people needed a higher level of support.

Safe recruitment had not been maintained. Documentation was not in place to ensure the provider could be sure staff were safe to work in the home. There were not enough trained staff to administer medicines in accordance with people’s prescriptions. Only one senior carer and the registered manager were currently able to give people medicines when needed. There were no medicine audits or checks being completed. This meant issues related to safe medicine storage had not been promptly identified.

Accidents and incidents were not being robustly monitored. Actions had not been implemented following a suspected head injury and it had not been identified when an accident had not been reported externally to the local authority

Infection prevention control measures were not being followed in line with current government guidance. Staff were not wearing masks and no rationale or risk assessment had been recorded in relation to this decision.

The provider had not ensured there was adequate oversight of the service or support in place for the registered manager in light of a number of staff vacancies. New staff were not experienced and lacked the skills to provide care without being supported by other staff. This meant the registered manager was having to cover care tasks and administer medicines. This had impacted on the registered manager completing checks and audits to ensure the safety and management of the service had been maintained.

There was not an effective system in place to manage the environment and to review overall maintenance and safety in the home. A number of checks had not been completed in line with required timescales, this included water safety checks and fire safety. Window restrictors had not been checked and serviced. Fire safety systems needed to be improved to ensure people were safe. and staff were appropriately trained to respond to an emergency and evacuate people in the event of a fire.

The provider had failed to ensure there was adequate governance at the home. Auditing was not robust or consistently completed. Required checks had not all been completed. Care documentation needed to be improved to ensure care plans and risk assessments provided the most up to date information. When decisions had been made, for example, regarding medicine administration or in relation to PPE, no risk assessment or rationale had been recorded.

Improvements were being implemented in relation to people’s consent and best interest meetings being recorded when needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The registered manger had been working with the local authority to ensure best interest meetings and capacity assessments where in place to support decisions made.

Relatives spoke positively about the service and the care their loved one received. People told us they liked staff but would like more consistency as they felt they responded better to staff they knew and trusted.

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 15 July 2021). At this inspection breaches were identified. The service has now been rated as requires improvement.

Why we inspected

The inspection was prompted in part due to concerns received about staff recruitment and training, moving and handling guidance not being followed, how decisions about people’s care are made and medicine practices. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

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 safety, staffing, recruitment, infection prevention control and good governance. 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 request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Eastbourne Grange is a residential care home providing personal care for older people, some of whom were living with dementia. The service can support up to 25 people and at the time of the inspection there were 14 people living at the home.

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

People told us they felt safe and were protected from harm and abuse. Similarly, relatives spoke of their confidence in the service, knowing that their loved ones were safe. A relative said, “It’s so reassuring to know how well she is looked after and that they are safe.” Staff had been trained in safeguarding and risk management and were able to tell us the actions they would take if needed. Care plans contained bespoke risk assessments that were regularly updated and easy to access and understand. The storage, provision, disposal and recording of people’s medicines was completed safely. Accidents and incidents had been reported and recorded and audits completed by the manager ensured that any lessons learned were acted on and shared with all staff. Staff had been recruited safely and we saw staff rotas that confirmed there were enough staff on duty every shift. Safety checks and reviews had been completed on fire, gas and electrical equipment.

The manager at the service had been in place for six months at the time of the inspection and had created a positive culture at the service where all people and staff had their views listened to and acted upon. Everyone spoke highly of the manager. The manager maintained oversight of the service through a thorough system of monthly audits and was quick to identify any issues and share any learning. The manager was open and honest throughout the inspection and although no formal meetings had taken place recently, there were many opportunities for people and staff to raise concerns if needed. The service had strong working relationships with other health and social care professionals.

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 18 March 2020).

Why we inspected

This inspection was prompted by our data insight analysis which assesses potential risks at services. We received concerns in relation to the safe provision of care at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Eastbourne Grange is a residential care home providing personal care for older people some of whom were living with dementia. The service can accommodate up to 20 people and at the time of the inspection there were 16 people living at the home.

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

The registered manager was new to the service and had identified that improvements were needed regarding the management of accidents and incidents. A new system for recording these issues had been introduced which identified risks and trends. Staff training in moving and handling had been refreshed and staff were confident in procedures and what actions to take in the event of, for example, a person falling. Risk assessments were in place to cover all risks and were audited monthly, or more frequently in the event of an accident. People told us they felt safe, one said, “Oh yes, I am very safe here.”

Infection prevention and control was well managed with the appropriate use of personal protective equipment (PPE) and compliance with the latest government guidelines.

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 18 March 2020)

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The concerns were about the management and recording of accidents and incidents for example, falls management and moving and handling. Further concerns had been raised relating to PPE not always being used by staff. We inspected using our targeted methodology developed during the COVID-19 pandemic to examine those specific risks and to ensure people were safe.

We looked at infection prevention and control measures under the safe 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 coronavirus and other infection outbreaks effectively.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Systems and processes to assess, monitor and improve the quality and safety of the service provided were in place. However, there were areas of peoples’ documentation that needed to be improved to ensure staff had the necessary up to date information to provide consistent, safe care. Whilst care plans identified a care need, there was a lack of clear guidance and changes to care needs were not clearly defined. Individual risk to some people, whilst known by staff, was not documented and risk assessed against care delivery.

People received safe care and support by staff who had been appropriately recruited, trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “I am comfortable and safe.” A visitor told us, “Staff keep people safe.” People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We saw that people were supported to be as independent as possible with the use of walking aids and specialised cutlery for eating. We observed medicines being given safely to people by trained and knowledgeable staff, who had been assessed as competent. There were enough staff to meet people's needs. The provider used a dependency tool to determine staffing levels. Staffing levels were regularly reviewed following falls or changes in a person's health condition. Safe recruitment practices had been followed before staff started working at the service.

Staff had all received training to meet people’s specific needs. During induction, they got to know people and their needs well. One staff member said, “I really enjoy my job, I get training and support.” People’s nutritional and health needs were consistently met with involvement from a variety of health and social care professionals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Everyone we spoke to was consistent in their views that staff were kind, caring and supportive. One visitor said, “Very kind and polite staff, the atmosphere is good, I feel welcomed every time I visit.” People were relaxed, comfortable and happy in the company of staff. People’s independence was considered important by all staff and their privacy and dignity was promoted.

Staff were committed to delivering care in a person-centred way based on people's preferences and wishes. The staff team were knowledgeable about the people they supported and had built trusting and meaningful relationships with them. Activities were tailor-made to people’s preferences and interests. People were encouraged to go out and form relationships with family and members of the community. Staff knew people’s communication needs well and we observed them using a variety of tools, such as pictures and objects of reference, to gain their views.

People were involved in their care planning. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives. End of life care was delivered with respect and dignity.

People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated.

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

Rating at last inspection and update:

The last rating for this service was Requires Improvement (published 2 March 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The overall rating for the service has improved to Good.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Eastbourne Grange Residential Care Home is a residential care home in the Meads area of Eastbourne. The home provides accommodation for up to 25 older people some of whom are living with dementia. At the time of the inspection there were 19 people living at the home.

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

People’s experience of using this service:

The registered manager completed some audits but there were inconsistencies in people’s records. Improvements were needed to audits. Some care plans and risk assessments had not been completed. Mental capacity assessments were not consistent. A lack of audits for complaints and incidents meant that there were some areas where the registered manager did not have clear oversight of the service. Lessons learnt and best practice could not be established in some areas. The registered manager had sought feedback from people, relatives and professionals within the last year. However, few surveys had been received and this did not allow for oversight of issues. The results that were received had not been analysed for patterns or trends, nor had feedback been given.

Where people were not able to make decisions themselves, some mental capacity assessments had been completed. Five people had Deprivation of Liberty Safeguards (DoLS) where they were not able to understand about the security of the building. The registered manager was not aware that two people’s DoLS had conditions attached for restricting their liberty and therefore, these conditions had not been met.

On the first day of inspection, we observed that lunch-time was quiet, with minimal interaction from staff. The registered manager was aware that this was an area for improvement and assured us they would act to improve this. On the second day of inspection, music was played and people were more engaged.

People told us they felt safe. Staff understood the risks associated with the people they looked after. Staff had knowledge of individual people and they were aware of what to do should a safeguarding situation arise. Staffing levels were sufficient to provide a good level of care and support for all people. There were regular health and safety checks of the environment and people had person centred evacuation plans. Medicines were stored and given appropriately and infection control procedures were well managed.

Staff had the skills and knowledge to meet people needs. Staff received appropriate training and support to enable them to look after people. They received regular supervision to support them in their roles.

People and their relatives thought that staff were caring and that people were well cared for. Staff interactions were observed throughout the inspection and it was clear that all were very attentive and understanding of people’s needs. People’s dignity and privacy was promoted. People were asked discreetly if they needed help with personal care. When entering bedrooms, even if the door was open, staff would knock before entering.

The service responded well to people’s needs. Person centred care was evident and people were provided with choices throughout each day. There was a comprehensive activities programme and the feedback from people was positive.

Staff responded to people in a way that suited their needs. One person who had difficulty verbally communicating was seen with staff who were speaking clearly and made their messages clear by holding the person’s arm or putting their arm around them. This made the person smile. People’s communication needs were met. Both daily activities and menu choices were displayed in pictures around the home. There were easy read signs on all toilets and bathrooms to familiarise people with the layout of the building.

The registered manager was very well thought of by staff, residents and relatives. It was clear that they knew all the people well and that they spent time helping with day to day care and support when needed. Links with the local community had been established and the home’s Statement of Purpose clearly set out aims and objectives.

Rating at last inspection:

At the last inspection the service was rated Good (June 2016).

All domains were rated as Good apart from Safe which was rated as Requires Improvement. The overall rating of Good had not been maintained and the service is now rated Requires Improvement.

Why we inspected:

We inspected the service as part of our inspection schedule methodology for ‘Good’ rated services.

Enforcement:

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Follow up:

The registered manager addressed some of the issues raised during the inspection straight away. We will ask the provider to send us an action plan to address the remaining issues and continue to monitor the service until the next inspection. This will be within a year of the publication date of this report.

Eastbourne Grange provides personal care and accommodation for up to 21 older people. There were 16 people living at the home during the inspection. Most people were independent and needed minimal assistance. Others required some assistance with looking after themselves with personal care and moving around the home and staff provided end of life care.

The registered manager was present during the inspection. 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 comprehensive inspection on 2 March 2015 the overall rating for this service was requires improvement. The inspection found improvements were required in relation to the management of medicines and there was no registered manager in place.

The provider sent us an action plan and told us they would address the issues by 30 June 2015.

During our inspection on 6 and 9 June we looked to see if improvements had been made and a manager had been appointed. We found improvements had been made and the provider was now meeting the regulations and a registered manager was in place.

Staff had attended relevant training including moving and handling people safely, although we saw they did not use appropriate aids to assist a person to sit up in a chair and they were available.

People were assessed before they moved into the home to ensure staff could meet their needs and care plans were developed for this information. Care plans were reviewed and people and their relatives were involved in discussions about the care and support provided.

Staff understood people’s needs and provided the support and care they wanted in a kind and patient way. Risk assessments had been completed to identify where people may be at risk. Staff demonstrated a clear understanding of the steps that were in place to ensure risk to people was reduced, whilst enabling them to make choices and be as independent as possible. One person told us, “They have taken a risk assessment of me and I can go anywhere (into the town).”

Staff had attended safeguarding training, policies were in place and staff had a clear understanding of abuse and what action to take if they had any concerns. Medicines were managed and given out safely and assessments had been carried out if people wanted to be responsible for their own medicines.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were aware of current guidance to ensure people were protected. DoLS applications had been when requested to ensure people were safe and the registered manager was waiting for a response from local authority.

People said the food was very good, choices were provided and drinks and snacks were available throughout the day. Systems were in place to monitor the amount people ate and drank, to ensure they had a nutritious diet, and staff contacted the GP if they had any concerns.

There were enough staff to provide the support people needed and the recruitment procedures ensured only suitable people worked at the home. People said the staff were very caring and, “You only have to ring the bell and they come quickly.” There was a relaxed atmosphere in the home, people said they were comfortable and were confident if they had any concerns the staff and manager would address them.

Quality assurance and monitoring systems were in place, questionnaires were given to people living in the home, relatives and visitors, and staff to obtain feedback about the services provided. An audit system was in place and looked at all areas of the support provided, including the care plans, medication and meals, and the maintenance of the home.

People told us that they were very comfortable at Eastbourne Grange. One person said, 'The staff know just what we need to be happy'. Another person said they had the support they needed and could make choices about how they spent their time. They said, 'I feel safe here and feel comfortable enough to help out if I want to'.

We issued a warning notice, which stated that the Care Quality Commission required Eastbourne Grange to have achieved compliance with the warning notice by 24 June 2014. From the information gathered during the inspection 7 July 2014 we found that some improvements had been made in relation to records. However, the provider had not met the specific requirements of the warning notice.

We issued a further warning notice, which stated that the Care Quality Commission required Eastbourne Grange to have achieved compliance with the warning notice by 4 September 2014. At this inspection we found that improvements had been made, but additional work was required to meet this essential standard.

People we spoke with told us they were well supported by staff at the home. One person said, 'This is the best place for me, I am able to live my life as independently as possible and have support in the areas that I need it.' Another person told us they were very happy, they were able to do what they liked throughout the day. They said, 'The staff are lovely.' Someone else told us about the care they had just received from a member of staff. They told us how this had made them feel better about themselves.

We observed the interactions of staff with people who lived at the home. We saw that there was an open and friendly relationship. Staff spoke to people with kindness and respect. Staff that we spoke with knew people well and were able to tell us about their care.

At our previous inspection 23 April 2014 we found that staff had not received appropriate training or supervision. We issued a warning notice, which stated that the Care Quality Commission required Eastbourne Grange to have achieved compliance with the warning notice by 24 June 2014. We found that from the information gathered during the inspection 7 July 2014 the provider had met the requirements of the warning notices, although some of the processes required time to be fully embedded into practice. We judged this had a minor impact on people who lived at the home.

At our previous inspection 23 April 2014 we found that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate records were not maintained.

We issued a warning notice, which stated that the Care Quality Commission required Eastbourne Grange to have achieved compliance with the warning notice by 24 June 2014. From the information gathered during the inspection 7 July 2014 we found that some improvements had been made in relation to records. However, the provider had not met the specific requirements of the warning notice.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

We saw that people's assessments, care plans and risk assessments were not accurate and did not reflect the current needs of people who lived at the home.

People had been cared for in an environment that was safe. We saw that regular electrical and gas safety checks took place. There had been a recent fire check and legionella risk assessment undertaken. There was evidence of a passenger lift service and repair contract.

We observed a medication round and saw there were procedures in place that ensured people were protected against the risks associated with medicines.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. There were no policies and procedures in place and staff had not received training to understand when an application should be made. Staff we spoke with were unable to demonstrate knowledge of DoLs.

Staff were able to tell us about their understanding of, and what actions they would take if they believed people in the home were at risk of abuse.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from our observations and from speaking with staff that they understood people's care and support needs and knew people well. One person told us. "I need more help at the moment but I couldn't have better care than I get here.'

We saw that staff had not received induction or mandatory training and there was no supervision taking place.

There was not enough appropriate equipment to promote the independence and comfort of people with specific care needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People told us they were able to do things when they wanted to. Our observations confirmed this. One person told us, 'I like all the girls, I think they're wonderful.'

Is the service responsive?

Most people's needs had been assessed before they moved into the home. However for people who had moved into the home more recently these were not detailed and did not indicate who had been spoken to in relation to people's care needs. There was no information about people's individual choices and preferences.

A 'This is me' booklet had recently been completed and this reflected people's individual likes and dislikes.

People had access to a wide range of activities and these were important to people. One person told us, 'Activities really get us together.' We saw that people had access to a range of healthcare professionals.

Is the service well-led?

There was no evidence that feedback surveys had been undertaken. People we spoke with told us they could raise their concerns with staff and the appointee manager. They told us they were listened to and action was taken appropriately.

We saw evidence that when concerns had been raised about staff who had previously worked at the home, the provider had taken appropriate actions in a timely manner. We saw that staff were referred to the appropriate bodies when they had a concern.

There was no evidence of any regular assessment and monitoring the quality of service that people received. Not all relevant policies and procedures were in place.

The service had failed to notify the Care Quality Commission (CQC) of any incidents or deaths of people who used the service.

At the time of the inspection the named registered manager and nominated individual was not in post. The provider and appointee manager were currently responsible for the running of the home.