Archived: Eton Park Care Centre

On the day of our inspection there was not a registered manager in place, however an application had been submitted for the new home manager to be registered. 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 will continue to monitor application process and will address any delays with the provider.

Staffing numbers on the day of the inspection exceeded those required on the provider’s internal dependency assessment. Howver, people, relatives and staff raised concerns about the number of staff working at the home. Staff could identify the potential signs of abuse people could face; however only some knew what external agencies any concerns could be reported to. People’s medicines were managed safely; however people’s preferred way to receive their medicines was not always recorded within their records. People’s medicine administration records were not always correctly completed. Risks to people’s safety were continually assessed.

The principles of the Mental Capacity Act (2005), including Deprivation of Liberty Safeguards, had been followed when decisions were made about people’s care.

People were supported by staff who completed an induction prior to commencing their role. However, some training was not currently up to date. Staff received supervision of their role, although the frequency, in which staff received this, was inconsistent. Staff felt supported by the deputy manager and the manager.

People were supported to maintain good health in relation to their food and drink. However, the serving of the lunchtime meal was disorganised, with some people waiting too long for their meal and a drink, which did not promote a positive mealtime experience. People’s day to day health needs were met by staff and referrals to relevant health services were made where needed.

People and relatives spoke positively about the staff and felt they were kind and caring and supported them or their family member in a respectful and dignified way. Staff responded quickly to people when they showed signs of distress or had become upset, showing genuine warmth and compassion. Staff understood people’s needs and listened to and acted upon their views. People felt able to contribute to decisions about their care, although people’s care records did not always reflect this. People were provided with information about how they could access independent advocates. People’s privacy was maintained and respected. People’s friends and relatives were able to visit whenever they wanted to.

People were encouraged to take part in activities. The majority of relatives felt there was enough stimulation for their family members. Before people came to live at the home assessments had been carried out to determine whether their needs could be met. This, in majority of cases led to timely detailed care plans being put in place. The care people received was provided in line with their care plans, although a small number of examples were identified where improvements in this area were needed. People living at the home had person centred care plans in place that recorded their preferences and likes and dislikes. Staff were knowledgeable about people’s preferences.

People were provided with the information they needed if they wished to make a complaint and they felt their complaint would be acted on.

The new manager had started to identify and act on areas that required improvement within the home. Quality assurance processes were in place, with roles delegated to senior staff to manage on-going improvements to the home. The manager was well-liked by the people, relatives and staff we spoke, although some people said they would like see more of the manager. People were encouraged to provide feedback about the quality of the service, although formal meetings were rare.

At the time of the inspection there was no registered manager in place at this home. We have discussed this with the operations manager and plans are currently in place to ensure that a registered manager is appointed to the service as a matter of urgency.

During the inspection we focused on these five key questions; Is the service safe, effective, caring, responsive and well-led?

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

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

Is the service safe?

People spoken with told us they felt safe. One person who used the service told us, 'I have not seen or heard any abuse [at the home].' Another said, 'The majority of staff have the correct skills to care for me but the temporary staff are not that good, they don't know how to use the apparatus but I feel safe here.'

The provider's policy on the use of restraint and the recording and review of when restraint was used was inconsistent. Records viewed showed staff referred to a specific type of restraint technique that was not reflected in the provider's restraint policy. We were advised that only four members of staff had received training on this specific restraint technique, however when used, it was not always recorded which member of staff had used the technique.

Improvements to the building had been made since our last inspection. Mirrors had now been placed in 'blind spots' that enabled staff to be aware if a person who used the service had entered an area not monitored by staff. Improvements had also been made to other areas of the home.

Staff recruitment files viewed showed some gaps. Some staff files did not contain the required number of references. One member of staff also had difficulty answering our questions and appeared to have limited capacity to communicate in English.

Staffing levels throughout the home were varied. Throughout the inspection there were enough staff to meet people's needs although the views of people who used the service were mixed. One person who used the service told us, 'I don't feel there is enough staff on duty at times, but I don't feel rushed in my care and I generally don't have to wait long for staff to respond to my call bell of a night time.' We had concerns that there were not enough staff working on the nursing unit at night. Rotas showed one nurse and one care assistant supported 14 people who lived on the nursing unit. Due to the lack of an overall dependency assessment for the service we were unable to judge whether the number of staff working on this unit was sufficient to meet people's needs.

Is the service effective?

We observed the care plan and bedroom of a person who was confined to their bed. We noted there was a lack of stimulation for this person in their room. Care plan records stated there had been no input from the activities co-ordinator since May 2014. We also saw staff, when supporting this person, did not communicate with them in the way that had been recommended in their care plan.

There was a common theme from speaking with people who used the service that the limited activities provided were not sufficient for their needs. One person we spoke with told us, 'I want to go outside more often.' Activities logs in people's care plans also had substantial gaps between entries.

People were given choices about their food and drink. One person who used the service told us they were fully involved in decisions relating to the food they chose to eat. They told us they had instructed staff not serve them chips as they would prefer salad. This was to help maintain a healthy diet and lifestyle. During the inspection we saw staff adhere to this request.

Is the service responsive?

We saw referrals to external professionals such as Speech and Language Therapists (SALT) and GP's were made in good time.

We saw recommendations had been made by a SALT to weigh a person every two weeks as they had been at risk of weight loss. However records showed that at the time of the inspection there was almost a three week gaps since the last time this person had been weighed.

Signage in the male mental health unit was confusing with some signs not correlating correctly to the use of each sign. For example, the 'Quiet Lounge' was being used for an activity.

Is the service caring?

We saw examples of staff interacting positively with people who used the service using respectful language and showing a genuine interest in supporting people in a caring way. However we also saw some poor examples. We saw a member of staff ignore a person when they were spoken to and this had a negative impact on the person's behaviour.

Is the service well-led?

Whilst we saw some elements of good management at the home and people spoke positively about the management team, we had concerns with the overall management of the service.

There was a lack of structured quality assurance and monitoring throughout the home. There was limited review of staff performance. Care plans were not regularly reviewed and whilst a new care planning process was being implemented we were not provided with a future plan which showed which care plans were to be reviewed first.

We also identified concerns in relation to the lack of the manager's review of when restraint was used by staff to manage behaviours that challenged. We were shown a new review form that was to be completed by management when restraint had occurred, but, at the time of the inspection, this had not yet been implemented.

Questionnaires were sent to relatives of people who used the service and a process had just started to be implemented where a representative from Age UK would attend the home to obtain feedback from people who used the service. The manager told us this would enable people to give their views to a person independent of the home. The manager told us they would use this information to drive improvement in the home.

Accidents and incidents were recorded and where appropriate notifications were sent to the relevant authorities such as the CQC. However, whilst some analysis had started to be conducted into the trends around when and where accidents had occurred, there was not yet a plan in place for how the manager would use this information to try to reduce the numbers of accidents in the home.

The manager told us that individual dependency assessments were conducted to establish people's current level of need. However, there was no dependency assessment that took account of the needs of the home as a whole. This meant we were unable to judge the level of dependency throughout the home to ensure that people received prompt and appropriate care.

At the time of the inspection the home manager had only been in their role for three weeks. They had no yet applied for their registration with the Care Quality Commission (CQC) but told us they would do so immediately. We will monitor this application to ensure a registered manager is in place.

Throughout this inspection we focused on these five key questions; is the service safe, effective, caring, responsive and well-led?

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

Is the service safe?

People were cared for in an environment that was clean and tidy. Areas identified within the home that posed a risk to people's safety at our last inspection performed on 3 and 11 March 2014 had been addressed and made safe. Areas of the home, both inside and out had been improved and there were now some inviting spaces for people to socialise.

Care planning documentation was not of a sufficient standard to enable staff to be confident they were providing care appropriate to people's needs.

Procedures and individual circumstances for each person, in respect of Deprivation of Liberty Safeguards (DoLS) needed to be reviewed.

Is the service effective?

Documentation relating to the recording of pressure care management was not always accurately completed. Some care planning documentation contained conflicting information and could therefore reduce the effectiveness of the care provided.

Is the service caring?

We saw staff interact with people in a respectful and caring manner.

A relative we spoke with told us, 'The carers are great, I have never seen any of them being disrespectful.' And another said, 'I am impressed with the care they get. They [family member] can be difficult at times, but they [staff] are patient and caring in their approach.

Is the service responsive?

Staff responded to needs in a timely manner. People were encouraged to be involved with activities or their privacy was respected if they declined.

Is the service well-led?

There has been a change in management recently. The new manager has begun to implement a variety of monitoring and auditing processes designed to continually assess the quality of the service people received. At the time of the inspection the processes had only recently been implemented and therefore we were unable to judge their effectiveness.

We asked relatives of people who used the service what they thought of the management at the home. One relative we spoke with said, 'The manager keeps changing hands, I hope the new stays, he seems lovely.'

We asked staff what they thought of the management. One staff member said, 'There has been a lot of change of management, they're [the new manager] doing their best to make the home better. I hope this one stays longer.'

We were concerned that people's needs were not always assessed and care and treatment was not always planned and delivered in line with their individual care plan, and to ensure their welfare and safety. We were concerned that people were not always supported to maintain adequate levels of nutrition and hydration.

We were concerned that people were not always protected from the risk of abuse.

We found the systems the provider had in place for identifying and managing cleanliness and infection control, and the maintenance of the premises was not working as required and was not ensuring the safety of people who used the service.

We were concerned that recruitment checks were not fully carried out prior to new staff members starting work with the service.

We saw staff interactions with people who use the service were generally caring and polite. However, we found there was not always sufficient numbers of suitably qualified and experienced staff to meet people's identified needs.

We found the systems in place to identify, assess and manage risk were not effective. We found areas of concern in relation to other essential standards of quality and safety. The provider had not identified these areas of concern.

The provider was introducing a new way of caring for people and these changes were having a positive effect on people on the residential unit.The mood was up-beat. People were occupied in different activities and were using the garden. Visitors with children came from the local community and people who lived at the home said how much they enjoyed this. We were told, 'They treat me well and I'm well looked after. It was wonderful to see the children.'

A senior member of the organisation acknowledged there was a contrast between the quality of the residential and nursing units and the mental health unit, particularly the male side.They stated their commitment to improve the experience of people living in this part of the home in line with the new model of personalised care.

We found that improvements were needed in how the provider recognised and managed their quality assurance processes. They did not always identify problems and provide lasting solutions. This was particularly evident in how people's nutrition was supported and how the home was maintained and kept clean.

Most people were happy with the care they received and we were told relationships and communication between people using the service, their relatives and the staff was good. One person told us their relative was, "Well cared for and supervised," and the staff were "dedicated and know the service users well."

People spoke positively about the staff working in the home saying they worked "incredibly hard" and provided imaginative activities. We saw examples of care that was planned and delivered safely and appropriately according to people's assessed needs; however we also saw where improvements were needed to ensure people received safe and dignified care.

We found that procedures were not always followed in response to injuries sustained by people who use the service. This may place people at risk of potential abuse.