This inspection was unannounced and took place over two days; 21 and 24 October 2016. The service was previously inspected in March 2015 where we found improvements were needed in four of the five key areas we inspect. We issued requirements in relation to improving records to ensure people got the right food and drink to help prevent the risk of choking. We found where best interest decisions were needed, these were not always documented. Further requirements were issued to ensure staffing was deployed in the right way to ensure people’s safety and comfort and to make sure there was sufficient equipment in place. The registered manager and director sent us an action plan to show how they intended to meet these requirements. In January 2016 a focussed inspection was completed by a pharmacist inspector who found there was safe systems to ensure people received their medicines safely and at the prescribed times.At this inspection we found the service had made improvements in all four of the requirements we had set previously.
Following our inspection in March 2015, the registered manager and director met with staff and agreed the right deployment of staff to ensure there was sufficient staffing at night in all areas of the home. Previously night staff had based themselves in one area of the home which left some people vulnerable, especially if they were unable to use their call bell for assistance due to their dementia. New slings and a new hoist was ordered and delivered shortly after the March 2015 inspection. This ensured that each person who used the hoisting equipment had their own named sling. All catering staff as well as care staff had a detailed list of what type of diet each person required to keep them safe. In particular it stated the consistency of food to be served for people who were assessed as requiring a special consistency diet. Previously this information was not always available or recorded for all staff to refer to.
The service is registered to provide care and support without nursing for up to 56 older people. At the time of this inspection there were 48 people living at the service.
There is a registered manager in place who has worked at the service for several years, but had just gone on maternity leave. 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. As an interim arrangement the provider had given the day to day responsibility of running the service to two assistant managers. Both had experience and knowledge of people and the staff who worked at the service. The two assistant managers were being supported by the director who was on site at least three- four days per week, and accessible via phone 24 hours per day if needed.
People, their families and visitors were extremely positive about the care and support provided by staff at Eastleigh. Comments included ‘‘I couldn’t be happier, staff are marvellous’’ One family contacted us following our inspection as they had seen the inspection poster. They wanted us to know ‘We, the family of (name of person), have been very pleased with the care provided for him. Staff have been very patient and imaginative when caring for him when his behaviour has been challenging - when one strategy has not worked they have tried another and have been consistently kind and good-humoured. There is always a friendly atmosphere at the home with staff cheerful and willing to help.’
There were enough staff with the right skills, training and support to meet the number and needs of people living at the service. Staff said they felt valued and were encouraged to contribute to how the service was run and how care and support was being delivered. Staff understood people’s needs and knew what their preferred routines and wishes were. This helped them to plan care in a person centred way. Some staff could benefit from further training in working with people with dementia. When we fed this back to the director, she had some ideas for ‘‘quick wins for this.’’ They had used a video (in another service) seeing things through the eyes of a person with dementia and planned to show this to all staff following our inspection.
Staff understood how to ensure people’s human rights were protected and people were continually offered choice throughout their day. They worked within the principles of the Mental Capacity Act (2005) to ensure people’s capacity was assessed and monitored. Where people lacked capacity, any decisions were considered with people who were important to the person as part of a best interest decision. Staff were able to describe how they gained people’s consent and how they worked in a way to ensure people were offered choice in their everyday lives.
The home was cleaned and decorated to a high standard and homely features made it welcoming. Systems were used to ensure the environment was kept clean and safe with audits being completed on all aspects of the building and equipment.
There were two activities coordinators who strived hard to ensure people were engaged in meaningful activities throughout the weekdays. This included sing-alongs, quizzes, flower arranging, visits from various animals including PAT dogs as well as regular paid entertainers and visits form community groups such as local school children and local choirs.
Medicines were well managed and kept secure. People received their medicines in a timely way and where errors were noted, staff acted quickly to ensure people were not at risk. People were offered pain relief and received their medicines on time.
Care and support was planned to ensure that risks were assessed and monitored. People’s choices and preferences were included within care plans to ensure staff understood how to assist people in way they preferred and wishes met. People were protected from harm because staff were only recruited once they had all the checks in place to ensure they were suitable to work with vulnerable people. Staff understood what may constitute abuse and how and to whom they should report any concerns.
People were offered a variety of meals and snacks to ensure good health. Where people were at risk of losing weight due to their health condition, staff monitored what people ate closely. Some people were on supplementary drinks prescribed by the GP. Additional snacks and higher calorie foods were also offered. Catering staff were aware of people’s allergies and special diets and knew how to provide daily nutritional meals with increased calories for those who were at risk of losing weight.
People, visitors and staff were all able to voice any concerns or suggestions to help improve the quality of the service. This was done in a variety of ways, including annual surveys, meetings and one to one time spent with people living at the service.