About the service: Eastcotts Care Home with Nursing provides accommodation, nursing and personal care for up to 59 older people. There were 47 people living in the home when we visited on 3 April 2019. The home is situated in a rural area on the periphery of the village of Calford Green, Haverhill in Suffolk. We have referred to the home as Eastcotts Care Home within this report.

People’s experience of using this service:

¿ The culture in which people were living required significant improvement; there was institutional and unsafe practices, which went unnoticed and unchallenged by senior staff.

¿ People were not supported by staff who were sufficiently skilled in their roles. The provider also failed to ensure that people were supported by staff who were all of good character.

¿ People were not always cared for by staff who promoted their rights to be treated with dignity and respect.

¿ Interaction between some care staff and people was poor and disrespectful. There were times when people's privacy and dignity were compromised. There was little social stimulation provided to people on occasions.

¿ People’s personal records were not always stored securely to protect their privacy.

¿ The service was not acting in line with the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. This meant that people were at risk of having their liberty unlawfully restricted and inappropriate decisions could be made on a person's behalf if they lacked capacity to make the decision for themselves.

¿ The provider's quality assurance systems were not effective in identifying, responding and maintaining a good standard of service.

¿ People had a choice of meals and regular drinks were available. People were happy with the food they were served.

Rating at last inspection: The service was rated ‘Requires Improvement’ at our last inspection on 24 and 29 January 2018. The report following that inspection was published on 11 April 2018.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

¿ The service met the characteristics of ‘Inadequate’ in all five key questions of safe, effective, caring, responsive and well-led

¿ Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local authority. The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC.

¿ Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

¿ If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

¿ For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be

Eastcotts Care Home with Nursing provides accommodation, nursing and personal care for up to 59 older people. There were 38 people living in the home on the first day of our inspection, with one further person arriving to move into the home during the afternoon. On the second day there were 39 people living in the home. The home was situated in a rural area on the periphery of the village of Keddington, Haverhill in Suffolk. We have referred to the home as Eastcotts Care Home within this report.

Eastcotts Care Home with Nursing is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This inspection took place on 24 and 29 January 2018 and was unannounced.

There was a registered manager in post at the time of our 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 our last comprehensive inspection in February 2017, we had concerns about the management of clinical risks. We found that people at risk of pressure ulcers were identified and had been provided with specialist mattresses. However, some of these were at the wrong setting for people, which meant that they did not work effectively. We also found people’s health needs were not always well managed and staff were not always following best practice. We were also concerned that medicines were not securely stored and checks on clinical equipment were not adequate. We found these concerns were a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We received an action plan from the provider on 10 May 2017 telling us the improvements they intended to make to become compliant. At that inspection, we were also concerned that whilst there were enough staff they were not always effectively deployed. We rated the home ‘Requires Improvement’ overall and in three of the key questions we ask. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Eastcotts Care Home with Nursing on our website at www.cqc.org.uk

We found at this inspection that improvements had been made and the home was no longer in breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The management of clinical risk had improved, we checked that specialist mattresses were set correctly; clinical equipment was now being stored correctly and regularly audited. Medicines were also now being stored securely. We checked the deployment of staff and whilst we received mixed feedback about the levels of staff the deployment was effective. As a result of this inspection we have made one requirement. This is where we have identified a statutory breach of regulations. The regulation requires the registered persons to notify us of key events and incidents and they had not done so. Because of this, we have rated the home ‘Requires Improvement’ in well-led and overall.

Notifications of events and incidents were not always submitted in accordance with statutory regulations. Registered managers and providers are required to submit to CQC statutory notifications in accordance with regulatory requirements however we found a number of serious injuries that had occurred at the home which we had not been notified of. This was a breach of Regulation 18 of CQC (Registration) Regulations 2009.

The home mostly had sufficient staff to meet the needs of the people living there. Staff had received training in how to recognise and report abuse. The registered manager knew how to report any safeguarding conc

The inspection took place on the 22 February 2017 and was unannounced. Eastcotts Nursing Home provides care and accommodation for up to 59 older people. There were 48 people living at the service on the day of our inspection.

The service has a registered manager. 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 last inspected the service in January 2016 and rated the service as requires improvement. At this inspection we found that some improvements had been made. However we continued to have concerns about staff deployment and management of clinical risks. The rating therefore remains as requires improvement.

People spoke positively about the service and the care that was provided. They told us that the staff were kind and caring. There were sufficient staff, however they were not always deployed effectively and this placed people at risk of poor care. Risks were identified but not always managed effectively. For example, people at risk of pressure ulcers were identified and provided with specialist mattresses but we found that some of these were set at the wrong setting for people, which meant that they did not work effectively to prevent people from acquiring a pressure ulcer. Peoples health needs were not always well managed and staff were not always following best practice, for example in how they managed and documented the support provided to people with wounds and catheters. This could lead to confusion as to what care had or had not been provided and failed to mitigate the risks to people’s welfare and poor care.

People were given their medicines as prescribed but they were not always stored securely. The checks on clinical equipment were not sufficient and as a result may not work effectively.

The systems in place to recruit staff were thorough and references and other checks were undertaken before staff started work at the service. Staff had a good understanding of abuse and the steps that they should take to protect people. A training programme was in place to ensure staff had the skills and knowledge to undertaken their role. There were however still some gaps and we found that staff had a limited understanding of the Mental Capacity Act 2005 (MCA).

Staff told us that they were well supported when they started work at the service and told us that they received regular supervision.

People enjoyed the meals provided and supported to eat well.

Care plans were in place and staff had a good understanding of people’s needs. Activities were provided which promoted peoples wellbeing and we were told that these were being extended to weekends

The manager was approachable and promoted an open culture. Complaints were taken seriously and investigated. People’s views were sought in a variety of ways including resident meetings and questionnaires. The provider had invested in the fabric of the building and there was a new lounge in use for people to use. There were systems in place to drive improvement but these would benefit from being more robust to ensure consistency of practice.

During this inspection we identified a breach of the health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The inspection took place on the 26 January 2016 and was unannounced. Eastcotts Care Home with Nursing provides care and accommodation for up to 59 older people. There were 51 people living at the service on the day of our inspection.

The service has a registered manager. 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.

People spoke positively about the service and the care that was provided. They told us that they were listened to and staff were kind.

Risks to individuals such as those associated with tissue viability and moving and handling were identified but the management plans would benefit from more detail. Environmental risks and damage were not always well managed and meant that some areas of the service looked tired.

Staffing levels were adequate although staff breaks could be better managed. The systems in place to recruit staff were thorough and references and other checks were undertaken before staff started work at the service. Staff had a good understanding of abuse and the steps that they should take to protect people.

People were supported to take their medicines but practice did not always follow the recommended professional guidance.

A training programme was in place but it was not up to date and staff practice did not always reflect best practice. Staff had a limited understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff told us that they were well supported when they started work at the service and told us that they received regular supervision.

People had access to health care support when they needed it and were provided with a balanced diet.

Care plans documented people’s needs and were regularly reviewed. Staff had a good understanding of people’s needs. People told us that they were supported to maintain relationships which were important to them. Activities were regularly provided but there was only one member of activity staff and they were not always able to meet people’s needs and individual interests.

The manager was approachable and promoted an open culture. Complaints were taken seriously and investigated. Staff knew what was expected of them. People’s views were sought in a variety of ways including resident meetings and questionnaires. There were systems in place to drive improvement but these would benefit from a greater focus on people experience Thereby ensuring consistency of practice and reflecting the training undertaken across the service.

At this inspection we followed up on the three compliance actions we had made on 10 March 2013. In April 2013 we received an action plan from the service stating how they expected to achieve compliance. At this inspection we found that the service had taken appropriate steps in line with their action plan. We found that people were safe because the service had effective systems in place to reduce the risk and spread of infection. The service had installed a sluice, purchased commodes and trained staff. We found that there were safe and appropriate arrangements in place for the management and administration of medication. We found that appropriate measures were now in place to protect people in the event of a fire.

We spoke with relatives who told us that they were confident in the service and that staff were kind. We spoke with seven staff who were compassionate and observed them supporting people with dignity and kindness.

We looked around all areas of the service, met the newly appointed manager and spoke with three staff, four sets of relatives and three people who used the service. People told us they liked living at this service and felt well looked after. Relatives were happy with the care and support given to their relative. One relative told us they had been given a good update by staff as to their relative’s condition and health. One person using the service said, “The staff here are very friendly and caring”.

We found non compliance with medication. The provider confirmed that staff had received training and we saw evidence that a medication policy was in place, but staff were not following their training or adhering to the policy when administering medication. This, along with some errors on the records, was placing people at risk.

There have been some positive developments with the environment and the number of single rooms had increased. We found that the fire safety risk assessment had not been reviewed and some equipment was not serviced or in place. We have referred this matter to the local fire service as well as making a compliance action because people were at risk.

There were ineffective systems in place to reduce the risk and spread of infection because staff were sluicing shared commodes in a toilet and did not have any guidance on best practice cleaning methods.

People’s privacy, dignity and independence were respected.

We spoke with five people living in Eastcotts Care Home. They told us that they were respected, had their privacy and dignity maintained, and that they were able to express their views and individuality

They told us about the opportunities they had to be part of the local community and that the service organised outings and activities in the service they could take part in if they wanted to.