Archived: Eastgate Manor

Updated 5 July 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 10 May 2016 and was unannounced. It was carried out by one inspector and an inspection manager.

During the inspection we displayed a poster to inform people that we were inspecting the service and invited them to share their views.

We spoke with six people who lived at the service and four relatives during our inspection. Prior to the inspection we spoke with local authority commissioning team and safeguarding officers. Both teams were aware of the concerns raised at the previous inspection and were working closely with the service.

We spoke with a community matron before the inspection, and a GP and district nurse who visited the service regularly on the day of the inspection.

We spoke with the nominated individual, operations manager, deputy manager (also a registered nurse), and five care workers on the day of our inspection. We also spoke with kitchen and domestic staff.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk to us.

We looked at the care records of four people who used the service, and four staff recruitment files. We also reviewed safety and maintenance records and records relating to the management of the service.

Prior to the inspection we reviewed all of the information we held about Eastgate Manor including any statutory notifications that the provider had sent us and any complaints we had received. Notifications are made by providers in line with their obligations under the Care Quality Commission (Registration) Regulations 2009. They are records of incidents that have occurred within the service or other matters that the provider is legally obliged to inform us of. We took this information into account when planning our inspection.

Updated 5 July 2016

Eastgate Manor is situated Mickley, Northumberland, close to the town of Prudhoe. The service provides accommodation and personal care including nursing care, for up to 44 people some of whom are living with dementia. On the day of the inspection there were 28 people living at the service. Care was provided over three floors. Personal care was provided on the lower ground “residential” unit, the middle floor provided nursing care and the top floor provided care to people living with dementia.

The service was last inspected on 06, 09, 12, 25, 26 November 2015 where we found seven breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, good governance, and staffing. There was also one breach of Care Quality Commission (Registration) Regulations 2009 related to notification of incidents. The service was rated inadequate in all five domains and placed in special measures.

The provider sent us an action plan to show us how they would address our concerns. The action plan stated that all actions would be completed by 4 December 2015

At the last inspection in November 2015, we asked the provider to take action to make improvements to dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, governance, staffing and notification of incidents, and this action has been completed.

There was no registered manager in post. A manager had been appointed who was in the process of registering with the Care Quality Commission (CQC). 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.

Health and safety checks on the premises and equipment had been carried out. Risk assessments related to the building and individual risks to people were in place. Regular spot checks and audits had been carried out by managers. However, the provider was unable to locate the most recent legionella risk assessment and an electrical test being carried out on the day of the inspection was overdue.

A safeguarding policy and procedure was in place and staff had received safeguarding training. Staff were knowledgeable about the procedures to follow in the event of concerns. A number of issues were being looked into by the local authority safeguarding team who were working closely with the service.

The premises were clean and well maintained and recently refurbished. Infection control procedures were followed and person protective equipment (gloves and aprons) used to help to prevent the spread of infection were available, but was not always distributed effectively to enable staff to locate them in a timely manner.

Suitable numbers of staff were on duty during the inspection. The service continued to use high numbers of agency staff but arrangements were in place to employ the same staff to provide consistency. A recruitment drive was ongoing, and staff had been deployed to the home from other services to improve the skills mix and leadership while recruitment took place. We have recommended that the skills mix continues to be monitored until more permanent staff are in post.

Safe recruitment procedures were followed. There were a small number of gaps in recruitment records but the overall process was robust. A record of accidents and incidents was maintained and analysed monthly to identify trends or concerns.

Training was provided in key areas and updated regularly. Systems of staff supervision and appraisal were in place and staff told us they felt well supported.

People had access to health care in a timely manner. This had been a concern at the last inspection. Some professionals felt however, that there was now a tendency to over report health concerns for fear of failure to act. This was impacting upon the workload of all involved. Advice from visiting professionals was acted upon however, we found one occasion when a piece of equipment had been recommended and had not been sourced in a timely manner. We found that where a professional had not visited a person as planned, that prompt action had been taken by staff to ensure that the appointment was rearranged for the following day.

People were supported with eating and drinking, and we were told that meals had improved. Food and fluid intake was recorded and weights of people were monitored. A new chef was in post. Appropriate support was given to people during their meal although people living with dementia would benefit from further support to make meal choices.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. it also ensures unlawful restrictions are not placed on people in care homes and hospitals.

The service was operating within the principles of the Mental Capacity Act (2005) and capacity assessments had been carried out. Applications had been made to deprive people of their liberty and best interest’s decisions were recorded. These did not always detail who had had been involved in the decision making process.

People, relatives and visiting professionals told us that people appeared well cared for. Kind, caring, and meaningful interactions with people were observed. People experiencing distress were attended to promptly, with the exception of one person who had to wait some time. Some staff appeared to lack initiative to sit and chat with people and spent periods of time sitting in the lounge with the television on while people slept. Some people had hairstyles which appeared unkempt, but people were generally clean and tidy in appearance.

Care plans were in place and had improved since the last inspection. They were up to date and had been regularly reviewed. They were, however, lacking in person-centred information although steps had been taken to address this with the introduction of personal profiles. This information had not been incorporated into care plans as yet.

An activities coordinator was in post, and we saw records of a number of activities that had taken place. We found little evidence that activities were planned around the specific interests or needs of people, and there was a focus on group activities. Records related to how well people had participated in activities, were brief and made evaluation of activities difficult. We have made a recommendation about this.

An interim manager was in post and was in the process of being registered with CQC. There were plans to replace them with another manager who had been appointed following completion of their probationary period. Relatives and staff said they found the turnover of managers unsettling and were hoping for a period of managerial stability.

Quality assurance systems had been improved and there were regular checks audits and spot checks carried out by senior managers.

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