About the service:

Eastbourne Grange Residential Care Home is a residential care home in the Meads area of Eastbourne. The home provides accommodation for up to 25 older people some of whom are living with dementia. At the time of the inspection there were 19 people living at the home.

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

People’s experience of using this service:

The registered manager completed some audits but there were inconsistencies in people’s records. Improvements were needed to audits. Some care plans and risk assessments had not been completed. Mental capacity assessments were not consistent. A lack of audits for complaints and incidents meant that there were some areas where the registered manager did not have clear oversight of the service. Lessons learnt and best practice could not be established in some areas. The registered manager had sought feedback from people, relatives and professionals within the last year. However, few surveys had been received and this did not allow for oversight of issues. The results that were received had not been analysed for patterns or trends, nor had feedback been given.

Where people were not able to make decisions themselves, some mental capacity assessments had been completed. Five people had Deprivation of Liberty Safeguards (DoLS) where they were not able to understand about the security of the building. The registered manager was not aware that two people’s DoLS had conditions attached for restricting their liberty and therefore, these conditions had not been met.

On the first day of inspection, we observed that lunch-time was quiet, with minimal interaction from staff. The registered manager was aware that this was an area for improvement and assured us they would act to improve this. On the second day of inspection, music was played and people were more engaged.

People told us they felt safe. Staff understood the risks associated with the people they looked after. Staff had knowledge of individual people and they were aware of what to do should a safeguarding situation arise. Staffing levels were sufficient to provide a good level of care and support for all people. There were regular health and safety checks of the environment and people had person centred evacuation plans. Medicines were stored and given appropriately and infection control procedures were well managed.

Staff had the skills and knowledge to meet people needs. Staff received appropriate training and support to enable them to look after people. They received regular supervision to support them in their roles.

People and their relatives thought that staff were caring and that people were well cared for. Staff interactions were observed throughout the inspection and it was clear that all were very attentive and understanding of people’s needs. People’s dignity and privacy was promoted. People were asked discreetly if they needed help with personal care. When entering bedrooms, even if the door was open, staff would knock before entering.

The service responded well to people’s needs. Person centred care was evident and people were provided with choices throughout each day. There was a comprehensive activities programme and the feedback from people was positive.

Staff responded to people in a way that suited their needs. One person who had difficulty verbally communicating was seen with staff who were speaking clearly and made their messages clear by holding the person’s arm or putting their arm around them. This made the person smile. People’s communication needs were met. Both daily activities and menu choices were displayed in pictures around the home. There were easy read signs on all toilets and bathrooms to familiarise people with the layout of the building.

The registered manager was very well thought of by staff, residents and relatives. It was clear that they knew all the people well and that they spent time helping with day

We inspected Eastbourne Grange on 6 and 9 June 2016. This was an unannounced inspection.

Eastbourne Grange provides personal care and accommodation for up to 21 older people. There were 16 people living at the home during the inspection. Most people were independent and needed minimal assistance. Others required some assistance with looking after themselves with personal care and moving around the home and staff provided end of life care.

The registered manager was present during the inspection. 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.

At the comprehensive inspection on 2 March 2015 the overall rating for this service was requires improvement. The inspection found improvements were required in relation to the management of medicines and there was no registered manager in place.

The provider sent us an action plan and told us they would address the issues by 30 June 2015.

During our inspection on 6 and 9 June we looked to see if improvements had been made and a manager had been appointed. We found improvements had been made and the provider was now meeting the regulations and a registered manager was in place.

Staff had attended relevant training including moving and handling people safely, although we saw they did not use appropriate aids to assist a person to sit up in a chair and they were available.

People were assessed before they moved into the home to ensure staff could meet their needs and care plans were developed for this information. Care plans were reviewed and people and their relatives were involved in discussions about the care and support provided.

Staff understood people’s needs and provided the support and care they wanted in a kind and patient way. Risk assessments had been completed to identify where people may be at risk. Staff demonstrated a clear understanding of the steps that were in place to ensure risk to people was reduced, whilst enabling them to make choices and be as independent as possible. One person told us, “They have taken a risk assessment of me and I can go anywhere (into the town).”

Staff had attended safeguarding training, policies were in place and staff had a clear understanding of abuse and what action to take if they had any concerns. Medicines were managed and given out safely and assessments had been carried out if people wanted to be responsible for their own medicines.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were aware of current guidance to ensure people were protected. DoLS applications had been when requested to ensure people were safe and the registered manager was waiting for a response from local authority.

People said the food was very good, choices were provided and drinks and snacks were available throughout the day. Systems were in place to monitor the amount people ate and drank, to ensure they had a nutritious diet, and staff contacted the GP if they had any concerns.

There were enough staff to provide the support people needed and the recruitment procedures ensured only suitable people worked at the home. People said the staff were very caring and, “You only have to ring the bell and they come quickly.” There was a relaxed atmosphere in the home, people said they were comfortable and were confident if they had any concerns the staff and manager would address them.

Quality assurance and monitoring systems were in place, questionnaires were given to people living in the home, relatives and visitors, and staff to obtain feedback about the services provided. A

Eastbourne Grange provides personal care and accommodation for up to 21 older people. There were 13 people living at the home during the inspection most people were independent and needed minimal assistance and others required some assistance with looking after themselves, including personal care and moving around the home.

We inspected the home on 7 July 2014 and found that some improvements had been made, but further improvements were needed, we still had serious concerns about the standard of record keeping. During our inspection on 30 September 2014 we found improvements had been made and we made a compliance action for records.

This inspection took place on the 2 March 2015 and was unannounced.

The home has been without a registered manager since May 2014. 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. A manager was appointed in November 2014 and had applied to register with CQC as the registered manager of the home. The manager was present on the day of the inspection.

At the last inspection we found the provider had not met the regulations in relation to respecting and involving people who use the services, consent to treatment, care and welfare of people who use services, assessing and monitoring the quality of service provision, notification of death of a person who used the service, notification of other incidents and records. At this inspection we found some areas needed improvement, but did not amount to breaches of regulations.

Some assessments did not include specific details about people’s choices and the provider had no clear systems in place to monitor some prescribed medicines.

Risk assessments had been completed as part of the care planning process; these identified people’s support needs, and had been reviewed with people’s involvement. The care plans followed a generic format; they identified people’s needs and included paperwork that was not specific to each person, but were still under review.

There were systems in place to manage medicines, including risk assessments for people to manage their own medicines. Medicines were administered safely and administration records were up to date.

Staff had attended safeguarding training and a safeguarding policy was in place. They had an understanding of abuse and how to raise concerns if they had any.

People were supported by a sufficient number of staff and appropriate recruitment procedures were in place to ensure only people suitable to work at the home were employed.

Staff told us they felt supported to deliver safe and effective care. Staff demonstrated they knew people well and felt they supported people to maintain their independence.

The manager and staff showed an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). A DoLS application had been made to restrict one person’s freedom to leave the home on their own in order to maintain their safety. The manager was waiting for a response from the local authority.

People told us the food was very good. The cook spoke with people daily and changes were made to the menu if needed. People said there were always at least two choices, and were seen to enjoy lunch.

People had access to health care professionals as and when they required it, and it was clear from the visit records that this was maintained until treatment had been completed. One person said, “We only have to speak to staff and a doctor would be called.”

We carried out this inspection to follow up on a warning notice issued as a result of concerns identified at the last inspection. At our previous inspection 23/25 April 2014 we found that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

People told us that they were very comfortable at Eastbourne Grange. One person said, “The staff know just what we need to be happy”. Another person said they had the support they needed and could make choices about how they spent their time. They said, “I feel safe here and feel comfortable enough to help out if I want to”.

We issued a warning notice, which stated that the Care Quality Commission required Eastbourne Grange to have achieved compliance with the warning notice by 24 June 2014. From the information gathered during the inspection 7 July 2014 we found that some improvements had been made in relation to records. However, the provider had not met the specific requirements of the warning notice.

We issued a further warning notice, which stated that the Care Quality Commission required Eastbourne Grange to have achieved compliance with the warning notice by 4 September 2014. At this inspection we found that improvements had been made, but additional work was required to meet this essential standard.

We carried out this inspection to follow up on warning notices issued as a result of concerns identified at the last inspection.

People we spoke with told us they were well supported by staff at the home. One person said, “This is the best place for me, I am able to live my life as independently as possible and have support in the areas that I need it.” Another person told us they were very happy, they were able to do what they liked throughout the day. They said, “The staff are lovely.” Someone else told us about the care they had just received from a member of staff. They told us how this had made them feel better about themselves.

We observed the interactions of staff with people who lived at the home. We saw that there was an open and friendly relationship. Staff spoke to people with kindness and respect. Staff that we spoke with knew people well and were able to tell us about their care.

At our previous inspection 23 April 2014 we found that staff had not received appropriate training or supervision. We issued a warning notice, which stated that the Care Quality Commission required Eastbourne Grange to have achieved compliance with the warning notice by 24 June 2014. We found that from the information gathered during the inspection 7 July 2014 the provider had met the requirements of the warning notices, although some of the processes required time to be fully embedded into practice. We judged this had a minor impact on people who lived at the home.

At our previous inspection 23 April 2014 we found that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate records were not maintained.

We issued a warning notice, which stated that the Care Quality Commission required Eastbourne Grange to have achieved compliance with the warning notice by 24 June 2014. From the information gathered during the inspection 7 July 2014 we found that some improvements had been made in relation to records. However, the provider had not met the specific requirements of the warning notice.

The focus of the inspection was to answer 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 people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

We saw that people’s assessments, care plans and risk assessments were not accurate and did not reflect the current needs of people who lived at the home.

People had been cared for in an environment that was safe. We saw that regular electrical and gas safety checks took place. There had been a recent fire check and legionella risk assessment undertaken. There was evidence of a passenger lift service and repair contract.

We observed a medication round and saw there were procedures in place that ensured people were protected against the risks associated with medicines.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. There were no policies and procedures in place and staff had not received training to understand when an application should be made. Staff we spoke with were unable to demonstrate knowledge of DoLs.

Staff were able to tell us about their understanding of, and what actions they would take if they believed people in the home were at risk of abuse.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from our observations and from speaking with staff that they understood people’s care and support needs and knew people well. One person told us. "I need more help at the moment but I couldn’t have better care than I get here.”

We saw that staff had not received induction or mandatory training and there was no supervision taking place.

There was not enough appropriate equipment to promote the independence and comfort of people with specific care needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People told us they were able to do things when they wanted to. Our observations confirmed this. One person told us, “I like all the girls, I think they’re wonderful.”

Is the service responsive?

Most people’s needs had been assessed before they moved into the home. However for people who had moved into the home more recently these were not detailed and did not indicate who had been spoken to in relation to people’s care needs. There was no information about people’s individual choices and preferences.

A ‘This is me’ booklet had recently been completed and this reflected people’s individual likes and dislikes.

People had access to a wide range of activities and these were important to people. One person told us, “Activities really get us together.” We saw that people had access to a range of healthcare professionals.

Is the service well-led?

There was no evidence that feedback surveys had been undertaken. People we spoke with told us they could raise their concerns with staff and the appointee manager. They told us they were listened to and action was taken appropriately.

We saw evidence that when concerns had been raised about staff who had previously worked at the home, the provider had taken appropriate actions in a timely manner. We saw that staff were referred to the appropriate bodies when they had a concern.

There was no evidence of any regular assessment and monitoring the quality of service that people received. Not all relevant policies and procedures were in place.

The service had failed to notify the Care Quality Commission (CQC) of any incidents or deaths of people who used the service.

At the time of the inspection the named registered manager and nominated individual was not in post. The provider and appointee manager were currently responsible for the running of the home.