Eastham

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service had systems and processes in place to keep people safe. Risk assessments were in place with all updated information; however, more work was needed to ensure all areas of the care plan reflected updated information. Safe recruitment practices were followed. Whilst there was enough staff to meet people’s needs, the manager had identified a need to review deployment of staff. Minor concerns were found with medicine management; however, the manager took immediate action following the assessment to resolve these concerns.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives told us they felt safe. A person told us, “I do feel safe here.” A relative said, “I do think [person] is safe. If I go back to looking for a care home this one seemed the best.” Another relative said, “I do feel [family member] is safe there. I do think they take time over their care.”

During the assessment, people were supported safely with their mobility with and without equipment. When we observed a hoist transfer the staff member explained the process to the person and reassured them throughout. The person looked relaxed and safe during the transfer.

Staff knew how to protect people from harm and had received relevant training in this subject. Staff had a good understanding of different types of abuse. They understood their responsibilities to report any concerns to the manager and knew they could report allegations and/or suspicions of abuse to the local authority safeguarding team, CQC, and police. A staff member told us, “I would go to the manager first, then to regional. Or I would raise a safeguard.”

There were processes in place to protect people from the risk of abuse or harm, and these contributed to people's safety. The manager understood their responsibilities to report concerns to the local safeguarding authority and to work with them to keep people safe. The manager kept an overview of all safeguarding incidents and discussed these with staff for future learning and to prevent reoccurrence. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The provider was working in line with the Mental Capacity Act and staff had received training in this area.

Our observations showed staff worked safely and were aware of people’s needs, preferences, and risks. Staff interaction was positive and throughout this assessment, we observed staff who spoke with people respectfully.

People and relatives told us they were involved in managing risks. A relative told us, “I am updated all the time, and I am talking with both the home and the GP about a situation at the moment. Staff are trained and I know they have had meetings to discuss my [family member].”

The staff knew people well and had a good understanding of people’s current risks. A staff member told us, “The seniors let us know of any changes to risk and we read our handheld devices. We work together to let seniors know if things change.”

The provider had processes in place to ensure people were involved in their care and support, including risk. Whilst risk assessments were updated and staff were aware of these changes, not all sections of the care plans had been updated to reflect the changes. This resulted in inconsistency of information and a risk to care being provided. The manager told us they would immediately review the care plans.

We observed the equipment within the environment was clean and had been checked regularly to ensure it remained safe and in good working order.

There were systems and processes in place to ensure the environment was safe. Health and safety checks were in place and carried out regularly. A fire risk assessment had taken place, and an action plan recorded all actions taken.

The manager used a dependency tool to help them work out how many staff were needed to support people. We also noted the manager was undertaking work to improve the deployment of staff to meet people’s needs and had increased supervision for people who chose to get up earlier. Support during the evening was also being reviewed. The manager told us they were able to be flexible with staffing if required. Staff had received training to enable them to have the skills and knowledge they needed to support people. Safe recruitment practices were in place to make sure that all staff, including agency staff and volunteers, were suitably experienced, competent, and able to carry out their roles.

We visited the service very early in the morning following concerns about the lack of staff at night. When we arrived, there were people up and moving around in the communal area. However, it was not long before a staff member arrived for their shift early and started work and another staff member also arrived. We observed that for a very short time staff visibility in the communal area was minimal. We discussed our concerns with the manager as if the staff member had not started work early, supervision of people in the communal space would not have been possible as night staff were supporting other people in their rooms. The manager responded immediately to our concerns and asked staff to change their rota to come in earlier. Throughout the rest of the day, staff were visible in communal areas and responded to people’s requests immediately.

People and relatives told us they would like to see more staff at the service and whilst they thought people’s needs were met, they would like to see staff have more time to spend with people. A person told us, “I know there are 20 other people, but I have to wait 5-10 minutes sometimes.” A relative told us, “In all honesty they should have more [staff], staff work very hard and are good.”

The staff we spoke with told us there were enough staff to meet people’s needs. However, staff were concerned about staffing if an accident or incident were to occur particularly at night. A staff member told us, “It would be nice to have another member of staff, but I believe the residents are still safe.” Another staff member said, “It would be nice to have more as we could give a little bit more. They do not go without, but I would like to have more time with them.” The management team had undertaken some night visits and told us they had reiterated to night staff that the manager and deputy were available to be called to come in if another staff member was needed in an emergency. The manager gave us an example where extra support had been made available following an accident at the service. This meant the staff member was available to support the person so rostered staff could continue providing people with their usual support.

The service was clean and odour free. The equipment we observed to be used was clean which was an improvement from the last inspection. Staff had access to personal protective equipment (PPE) and used this when it was required.

Infection control procedures were in place. Staff had also completed infection control training. The new manager had already identified and carried out improvements to the environment and had replaced yellow bins and some rusted handrails. Infection control audits were in place and had highlighted areas for improvement, however, the action taken and completion date had not always been recorded.

Staff told us they had received the training to enable them to administer medicines safely. A staff member told us, “We have training and competency checks.” The manager told us about the checks in place. They said, “We do daily audits, and the deputy does a monthly audit. I also do a regular trolley spot check.”

People were supported to receive their medicines safely. Although we did identify some minor concerns during our assessment the manager responded to our feedback immediately and sent us information to confirm these concerns had been resolved.