Archived: Eastbury Manor Care Home

Eastbury Manor is registered to provide accommodation and personal care for up to 24 people who may have a nursing need, a disability or may be living with dementia. There were 19 people living at the service at the time of our inspection.

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

There were not always sufficient staff to support people when they needed care. The management of risks was not always robust. People in their rooms sometimes felt socially isolated as staff did not have time to spend with them. There were not always meaningful activities for people. People fed back that they wanted to go out on trips more frequently, but this did not happen due to the lack of transport available. Care plans did not always have accurate information about people’s care.

People, relatives and staff felt that there could be improvements around the communication at the service. We have made recommendations in these two areas.

Staff received training and supervisions and staff said they were able to speak with their line manager when they wanted to. Staff were adhering to good infection control practice and equipment that was needed in an emergency was in place. People were supported with their health care and staff followed guidance provided by healthcare 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.

People and relatives told us that staff were kind, caring and respectful. We saw examples of this during the inspection. People were supported and encouraged to remain as independent as possible and were involved in decisions around their care. Relatives and visitors were welcomed as often as they wanted.

People and relatives knew how to complain and were confident that complaints would be listened to and addressed. There were quality assurance processes in place that were effective. Where shortfalls had been identified this had not been addressed.

Previous Inspection

The last rating for this service was Good (Report published 19 April 2017.)

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvement. Please see the Safe, Responsive and Well Led sections of this full report.

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.

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

There was a registered manager in post and present on the day of 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.

There was sufficient numbers of staff deployed at the service to meet people's needs. People told us they were safe at the service. Staff understood the signs of abuse and were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from the risks of harm and to keep people safe. Recruitment practices were safe and relevant checks had been completed before staff started work.

Medicines were managed, stored and disposed of safely. Any changes to people's medicines were prescribed by the person's GP and administered appropriately.

Fire safety arrangements and risk assessments for the environment were in place and updated regularly. The service had a business contingency plan that identified how the service would function in the event of an emergency.

Staff had received appropriate training and supervision that promoted their development. We found the staff team were knowledgeable about people's care needs. People told us they felt supported and staff knew what they were doing.

Staff were up to date with current guidance to support people to make decisions. Where people had restrictions placed on them these were done in their best interests using appropriate safeguards. Staff had a clear understanding of Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) as well as their responsibilities in respect of this.

People told us that they enjoyed the food. People had enough to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The provider worked effectively with healthcare professionals and was pro-active in referring people for assessment or treatment.

Staff treated people with compassion, kindness, dignity and respect. People's preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people's wishes. People's privacy and dignity were respected and promoted when personal care was undertaken. People told us that the staff at the service were caring and attentive to their needs.

People's needs were assessed when they entered the service and on a continuous basis to reflect changings in their needs. Care plans were detailed and provided guidance to staff to provide effective care.

People had access to activities and more work was being undertaken to provide more person centred activities. People were protected from social isolation through systems the service had in place. There were a range of activities available within the service and outside.

People were encouraged to voice their concerns or complaints about the service through meetings and regular requests for feedback. Concerns and complaints were used as an opportunity to learn and improve the service.

The provider actively sought, encouraged and supported people's involvement in the improvement of the home.

The provider had systems in place to regularly assess and monitor the quality of the care provided. Records were kept securely and were in good order.

People told us the staff were friendly and management were always approachable. Staff were encouraged to contribute to the improvement of the service. Staff told us they would report any concerns to their manager. Staff felt that management were very supportive and staff felt valued.

There was no registered manager at the service as they had recently left. The service was being managed by an interim manager from another service. 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. We were also assisted by the regional manager and quality manager.

There were not always enough staff deployed in the service to consistently meet people’s needs. People sometimes waited long periods of time before they received support from staff. There were times where there were less than the required staff needed to care for people safely.

People were not always receiving care from staff who had received appropriate training. There was a risk that people were receiving care from staff who did not have the necessary skills as they were not always kept up to date with the mandatory training including dementia and health and safety training. Nursing staff were not up to date with their clinical training.

Staff were not always supported in their work and said that they did not have regular supervision with their manager. There had been a lack of opportunity for staff and their manager to discuss their performance or any on-going training needs.

Risk assessments detailed the support people needed. We found that the environment was safe and incidents and accidents were recorded and acted upon. Before staff started work appropriate recruitment checks had been undertaken.

People’s rights were not always met under the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect them from harm. Assessments had not always been completed specific to the decision that needed to be made around people’s capacity. DoLS applications had been submitted to the local authority. Other staff did have an understanding of MCAs and DoLS and were able to explain to us the reasons why assessments were undertaken.

Staff at the service were caring and considerate to people. People were complimentary about the staff. One person said “ The carers are polite and respectful ”

People felt safe and staff had good knowledge of safeguarding adult’s procedures and what to do if they suspected any type of abuse. There were clear policies in place to guide staff should they have any concerns. Medicines were stored appropriately and audits of all medicines took place. Medicines Administrations Records (MARs) charts for people were signed for appropriately and all medicine was administered, stored and disposed of safely by staff who were trained to do so.

Steps were being taken to ensure that each person’s care plan was up date and reflected the needs of the person. People received care that met their needs. Communication was shared with staff about people’s care needs.

There were sufficient activities on offer for people living at the service and people in their rooms had visits from the activity coordinator.

There were effective systems in place to assess and monitor the quality of the service. Audits and surveys had been undertaken with people, relatives and staff and were being reviewed to look at ways of improving the quality of care for people.

Other records were completed accurately and were complete. 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 provider had informed the CQC of significant events in a timely way.

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.

Where people needed to have their food and fluid recorded this was being done appropriately by staff. Intake and output of food and fluid was recorded on forms that were kept in people’s rooms.

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, nurse and chiropodist. However we did raise with the interim manager the need to involve particular health care professionals for two people which they told us they were addressing.

There was a complaints procedure in place for people to access and complaints were dealt with appropriately.

During the inspection we found 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 the report.

Below is a summary of what we found. The summary is based on our review of records, speaking with people and their relatives who used the service and speaking with staff who supported the people who used the service.

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

Is the service safe?

People who used the service told us they were treated with respect and dignity. For example, one person said, 'I am fully involved in my care'.

We observed the service had a system in place to ensure that people's risk assessments were kept under regular review. Any trends identified were dealt with to minimise risks related to people's health, welfare and safety.

We saw documented evidence that the service used a range of quality monitoring tools to measure the quality of care and support people received from the service. People told us they felt safe with the staff.

Is the service effective?

We found that people's care plans provided detailed information on how they wished to be supported with their care needs. For example, care needs had been clearly stated. We observed that records of people's daily and nightly care were documented. Care staff spoken with told us they used the work book to document and highlight any changes to the person's care to ensure continuity of care. We saw that these were appropriately maintained to ensure all members of staff would be able to deliver care safely and effectively.

We found that people's health care needs were kept under review and they had been involved in the reviews. For example, people had access to health care professionals such as the GP, dentist, optician and specialist nurses. This meant that people were supported to keep healthy and well.

Is the service caring?

People told us that care staff spoke to them in a kind and respectful manner. One person said, 'The staff are OK. I get on well with them'. All members of staff spoken with were knowledgeable about people's care needs including their preferences and personal histories. We observed that people were listened to and care staff responded to them in a positive and caring way.

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when they supported people. People told us, 'Staff always helps me, and they listen to what I have to say.' People told us that the staff were very good.

Is the service responsive?

The people we spoke with told us they were supported to express their views and be actively involved in making decisions about their care, treatment and support. In the care plans we looked at, we saw evidence which reflected that people and their relatives were involved in making their views known about how they wished to be cared for and supported. If people were not able to sign their care plans these were signed by family members. We saw evidence that regular care plan reviews took place. This meant that people's care needs were kept under regular review.

We found the service had received five complaints during the last year which had been dealt with to the satisfaction of the complainants. People we spoke with said they knew how to make a complaint, and had done so in the past.

Is the service well led?

Staff spoken with said that they had felt supported by the deputy manager/head of care, and by the peripatetic manager. The home has been without a registered manager for the last four months.

Staff meetings had continued and they were able to raise questions related to the delivery and implementation of best practice. This meant that staff felt supported and well-led.

Staff spoken with said that they were provided with adequate training. This enabled them to perform their roles and to be accountable for their actions.

People spoken with told us normally the manager or deputy manager was always available in the home. They said, 'The deputy manager spoke daily with us to check if we were happy with the care and if the care workers were performing satisfactorily'.

People and their relatives told us that they were happy with the care and support provided at Eastbury Manor. One person told us, 'They arrange lots of activities and visits. This week we've had a singer and a flautist. The hairdresser came yesterday. There's lots going on if you want it'.

People who used the service told us that they felt safe in the service and we found that staff were trained and confident about using the procedure for safeguarding people from abuse. One member of staff said, 'We had safeguarding training quite recently. I'm quite clear on what I'd do if I was concerned or suspicious about abuse. I'd go straight to the manager or higher if necessary'.

We found that there were sufficient suitably trained staff with a balance of skills and experience to meet the needs of people who used the service.

We found that the service provided formal and informal opportunities for people, their relatives and staff to provide feedback on the care provided at the service. We saw evidence that the management team was responsive and keen to improve care standards where possible.

A new manager had recently been employed following the previous manager leaving, and had been in post for two weeks at the time of our inspection.

At the time of our visit, 20 people were living in the home. We spoke with seven people living there who told us they felt cared for and supported by staff. One person said, 'It's lovely here and everyone looks after us.' Another person said, 'The staff are very kind to me.' One person had recently moved into the home and said they thought the home was 'wonderful'.

We observed staff providing respectful care and support to people, and saw this was delivered in line with the care records we reviewed to meet people's needs.

Due to the location of the home, we saw that each person's bedroom overlooked the vast grounds which were well maintained. One person told us, 'I see all sorts of wildlife from my window, including deer. It's lovely to watch.'

We saw that the home had received a number of compliments and thank you letters which were displayed for people and visitors to read. Clear processes were in place to manage any concerns or complaint made, although we saw these were low in number.