Archived: Eastlands Care Home

Eastlands Care Home is a residential care home providing accommodation and personal care to eight people aged 65 and over, some of whom were living with dementia, at the time of the inspection. The service can support up to 35 people.

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

Whilst we found overall improvements had been made, we identified issues at this inspection that had not been identified within the provider’s own governance systems. Whilst the issues identified did not significantly impact on the safety of people’s care it meant we could not be confident that the governance systems in place were robust enough to capture areas of concern. We found further work was required to strengthen systems supporting the delivery of person-centred care within the service, relating to activities and care planning.

Despite these findings it was clear the service had made progress and improvements were evident. Everyone we spoke with told us there had been a marked improvement in the care provided. Communication with people, relatives, and staff had greatly improved.

People were supported to stay safe. Risks were assessed and actions taken to address these. A programme of refurbishment was taking place and improvements in relation to the management of the premises and equipment had been made. Everyone we spoke with noted improvements in staffing, people were now being supported with enough consistent staff. People received their medicines safely and actions had been taken to reduce the risk of infection.

People received care that met their individual needs. Whilst there was lack of formal involvement in care planning, people and their relatives told us they felt informed and consulted on the delivery of the care provided. Staff knew people well including their life histories and this helped them provide care that was in line with people’s needs and preferences.

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 inadequate (published 10 April 2021). This service has been in Special Measures since April 2021.During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

Prior to the inspection we carried out a monitoring review of the service. A monitoring review considers a range of information such as the current rating, any ongoing or planned regulatory activities, information about safeguarding, whistleblowing, incident reports (we call these statutory notifications) and whether the service has a registered manager, feedback from people who use services and their family and friends, and other contextual information. This prompted us to carry out this inspection.

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.

Enforcement

We have identified a breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality. 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.

Eastlands Care Home is a residential care home providing personal care to 24 people aged 65 and over at the time of the inspection. The service can support up to 35 people.

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

At this inspection we found a continuation of failings at this service. Sufficient action had not been taken to address the two breaches of the regulations found at our last inspection. At this inspection in October 2020, we found an additional four breaches of the regulations.

Management of risk remained poor. Risks relating to people’s health and wellbeing had not always been identified, planned for and managed. Risk assessments in place were not reflective of people’s most current care needs.

Reviews of accidents and incidents were not always completed, and those that had been completed were not effective in identifying lessons learnt.

There was poor planning and assessment of risks relating to COVID-19. There were no risks assessments in place for those who were clinically vulnerable, and guidance issued was incorrect.

The management of people’s medicines remained unsafe, and medicines errors had increased. Topical medicines were found to be unsecured and there was a lack of written guidance in relation to people’s medicines.

Infection control practice was poor, and areas of the home were found to be dirty. Premises and equipment were not appropriately maintained.

People were not adequately safeguarded from potential abuse. Some staff had not received training in safeguarding and policies in relation to safeguarding had not been updated.

Most of the staff working at the service were agency staff. Whilst there were enough staff, we were not assured they had the right skills and knowledge to perform the role expected of them.

Quality monitoring systems to measure the quality of service being delivered remained ineffective. The lack of managerial and provider oversight led to a decline in the service being delivered.

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 13 February 2020) and there were two breaches of the regulations which were safe care and treatment and good governance. At this inspection we found the provider remained in breach of these regulations with a further four additional breaches.

Why we inspected

We received multiple concerns in relation to medicines management, risk management and governance. As a result, we carried out 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. Therefore, we did not inspect them. Ratings from the previous comprehensive inspection for those key questions were used to calculate the overall rating at this inspection.

The overall rating for this service has changed from requires improvement to inadequate. This is based on the seriousness of concerns found at this inspection.

We have found evidence that the provider needs to make significant improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this report.

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

Enforcement

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.

At this inspection we have identified breaches of regulation in relation to safe care and treatment, safeguarding service users from abuse, premises and equipment, good governance, staffing and notification of incidents.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.

Eastlands Care Home is a residential care home providing personal care to 26 people aged 65 and over at the time of the inspection. Eastlands Care Home is a purpose built-single storey care home that can support up to 35 people.

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

Quality monitoring systems and governance structures were not effective in improving the quality of the service delivered in a timely manner. Gaps and inconsistencies in records relating to people’s care meant regulatory requirements in relation to record keeping were not being met. Systems to ensure people’s care needs were discussed and reviewed needed to be improved.

Systems to assess and monitor risks were not effective. Risks to people were not robustly assessed and monitored due to gaps in records such as fluid charts and bowel charts. People’s risk assessments did not always accurately identify risks. People’s medicines required improvements to ensure they were managed safely.

We have made a recommendation in respect to the service staffing levels and deployment of staff. This was because whilst we found staffing levels did not significantly impact on people we found some people waited too long for assistance with their meals and we received variable feedback on staffing levels particularly in the mornings.

We have made a second recommendation in relation to care planning. This was because people’s care plans were not person centred and did not provide enough information for staff on how to support people’s needs.

We have made a third recommendation in relation to people's nutritional intake. There was limited oversight and analysis of food monitoring records to help assess people’s nutrition and fluid intake and people were not always supported to eat.

People did not have access to formal systems and opportunities to discuss and review their care plans. Further worked was needed to develop people’s leisure and social care plans to ensure activities in the service were delivered in a person-centred way.

A complaints process was in place. Whilst management responded to complaints there was a lack of documented outcomes and actions. People’s care needs were not always holistically assessed or planned for in line with best practice. This included in relation to people’s end of life care needs.

People’s communication needs were assessed however we found improvements were needed in how information, such as on activities or meals, were communicated to people.

The home environment was clean and well maintained. Infection control risks were managed. The home environment met people’s needs, the provider had taken action to ensure areas of the home could be accessed regardless of people’s mobility. People were supported by trained and well supported staff.

People’s health care needs were supported and people could access a range of health care services. People’s capacity to consent to their support was considered. 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.

People were supported by kind and thoughtful staff. Staff appreciated people’s diverse backgrounds and used their knowledge of people to support their interactions with them. People were supported with their personal care and their dignity was up held. Staff supported people’s individual interests and hobbies.

There were opportunities for people, relatives, and staff to provide feedback on the quality of the service provided. Staff felt well supported by the management team. The management team had worked with other stakeholders to try to improve the service provided.

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 8 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe management and care, including in relation to the management of medicines, and good governance.

Please see the action we have told the provider to take at the end of this report.

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.

The quality of care provided, leadership and oversight of the home had deteriorated since our last inspection. The provider had recently identified this and taken actions to address it. This included the deployment of a temporary manager experienced in service recovery and improvement. These actions had already begun to improve aspects of the quality of care in the service, but were not yet embedded.

A wide range of checks were completed by staff, the manager and provider to check the quality and safety of the service. We found some areas for improvement which the provider had not recognised. The provider agreed to review their approach and make necessary changes to include these.

People, their relatives, staff and local authority officers were positive about the arrival of a new manager in the home and the actions they had already taken. A deterioration in communication with people and their relatives about recent events had caused anxiety and frustration. The provider and manager recognised this and were taking steps to improve communication with people and the staff team.

There was enough staff on duty to keep people safe but included high numbers of temporary staff supplied via an employment agency. Several staff including senior carers had recently left. The recruitment of new staff had not been successful and remained a challenge. The provider was reviewing how this could be improved, an ongoing project to recruit suitable permanent workers was in place.

People felt the use of agency staff at times effected the experience they had of the service. The manager worked hard to provide consistent agency workers to overcome this.

People were supported to take their medicines in a safe way, but staff did not always have robust details on when to give medicines that were prescribed 'as and when required'. Staff did not consistently complete records to show if people had been given their medicines.

The environment was safe and people had access to appropriate equipment where needed. Staff understood and implemented procedures to reduce the risk of the spread of infection, using personal protective equipment where required.

Staff understood the need to keep people safe and what was required to do this. Staff had received training in this area, and were clear they would report concerns to a manager or appropriate outside agency without delay.

More information is in Detailed Findings below:

Rating at last inspection: At the last inspection the service was rated Good (Report published 4 May 2017). At this inspection we changed the overall rating to Requires Improvement.

About the service: Eastlands Care Home is a residential care home that is registered to provide accommodation and personal or nursing care to a maximum of 35 people. At the time of our inspection, 23 people were living there.

Why we inspected: This focused inspection was carried out in response to incidents that had occurred in the service and concerns that had been raised about the safety and management of the service. We did not inspect the key questions of Effective, Caring and Responsive because ongoing monitoring did not raise any information about risks or concerns in these areas.

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve the rating of the service to at least Good. We will require them to provide an action plan detailing how this will be achieved. We will revisit the service in the future to check if improvements have been made.

There was a registered manager in the home. 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, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good

People were supported by staff who knew how to protect them from harm and risks to people’s health and wellbeing were managed and mitigated. There were enough staff to meet people’s care and support needs.

Medicines were stored and managed in a safe way and people received them as prescribed.

Staff received training relevant to their role and were supported further through regular supervisions. People had a choice of food and staff supported them with dietary requirements. Referrals to external healthcare professionals were made in a timely manner and people were able to request when they wanted to see a doctor or nurse.

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.

Occupation was supported by an activities coordinator. The activities coordinator would have benefited from more time and resources being allocated. People’s visitors were welcomed and there were no restrictions on when they could visit.

There was clear and visible leadership in place and the staff team felt supported by the management team. There were effective systems in place to monitor and assess the quality of service being delivered.

Further information is in the detailed findings below.

We found that care was provided according to people's assessed needs, wishes and preferences and helped them to maintain their independence. People's nutritional needs were being met.

We saw that there was a complaints policy and procedure in place and that staff were aware of the complaints procedure. People who used the service told us that they were aware of how and who to complain to.

This visit on 6 December 2012 gave us the information not found at the last inspection. Records were completed comprehensively, the information was current, all actions to minimise or prevent risks had been written and the care plans had documented that a monthly review had taken place since the last inspection.