This inspection took place on 18 July 2018 and was unannounced.

We completed our last inspection at this service in December 2017 to check improvements had been made to meet the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection we found the provider had acted and implemented sufficient improvements to their systems, processes and practice which meant they were no longer in breach of regulation.

During this inspection we checked and found evidence the provider had sustained the actions for improvement of the service from our last inspection.

Eastfield Farm Residential Home Limited 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.

The care home accommodates 26 people in one adapted building. At the time of this inspection 22 people were living at the home and receiving a service.

We were assisted during our inspection by a manager who was registered 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.

Systems and processes were in place to ensure staff recognised signs of abuse and any concerns were appropriately investigated to help prevent similar events.

The provider had reviewed systems and processes in place to monitor and improve the quality and safety of the service provided.

Risk assessments were in place for activities of care and support and the environment, to ensure the service remained safe for everybody.

The provider was compliant with the Mental Capacity Act 2005. Where the provider had concerns about people's capacity to consent to particular decisions, assessments were completed and decisions were made in the person’s best interest. Where people were unable to agree to restrictive practices to keep them safe the provider had submitted Deprivation of Liberty Safeguards applications to the local authority for further assessment.

The provider was in the process of implementing new technology to record the daily activities staff assisted people with. Staff had access to information reflective of people's individual needs. We found one instance where information was not up to date but this was remedied during our inspection.

People’s needs were assessed to ensure they received appropriate support to take their medicines safely as prescribed. Medicines were managed and administered according to national guidelines and best practice by staff who had been assessed as competent in this role.

The home was clean but despite regular deep cleaning of people's rooms on a rotating basis we found three people’s rooms had an unpleasant odour. Records confirmed the rooms were checked daily and the provider informed us new carpets were fitted the weekend following our inspection to remove the odours.

The laundry room was organised with new storage boxes for people's clothes.

The provider continued to use a tool which helped evaluate people's individual needs to identify the amount of staff required. This had resulted in increased staffing.

People were supported with their health and wellbeing. Drinks were provided throughout the day and a menu was provided with a choice of food for people. People received additional support from dietary and nutritional specialists where this was required.

People received information in a format they could understand. People's personal preferences and wishes were recorded and staff were aware of any diverse needs.

People continued to enjoy activities of their choosing and live fulfilled lives. Staff were

This inspection took place on 13 and 21 December 2017 and was unannounced.

The service was last inspected in June 2017, when we found a continued breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. The provider was in breach of Regulation 9, 12, 14 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider wrote to us with an action plan with details on how they proposed to improve and meet with the breaches of regulation for Person centred care; Safe care and treatment; Need for consent; Meeting nutritional and hydration needs; Staffing and Good governance and management.

This inspection was to check that the provider was now meeting legal requirements we had identified at the inspection in June 2017. We found that the provider had taken action and implemented sufficient improvements to their systems, processes and practice which meant they had met the breaches of regulation imposed at the previous inspection.

The provider was compliant with the Mental Capacity Act 2005. Where the provider had concerns about people’s capacity, assessments were completed. People were encouraged with their independence and best interest decisions were made where people were unable to consent, to protect them against the associated risks of providing care and support that they were unable to agree to.

The provider had reviewed systems and processes in place to monitor and improve the quality and safety of the service provided in the carrying out of the regulated activity. Risk assessments were in place for activities of care and support, and around the home to ensure the service and environment remained safe for everybody.

Staff had access to information reflective of people’s individual needs. We found some instances where information had not been updated and where records were not completed. The provider acknowledged there was further work to do and was responsive, implementing corrective actions to the concerns we raised.

People received their medicines safely as prescribed. The provider had reviewed and improved their practice to record medicines administered from transdermal pain relief patches. Body maps were used to record the application of creams prescribed for use, 'as and when required'. The provider was working with an external health organisation to further improve medicines management and administration.

The home was clean and free from unpleasant odours. Infection control practices had been reviewed and improved. Deep cleaning of people’s rooms was completed on a rotating basis. New equipment had been purchased for bathroom and toilet areas and access to and from the kitchen improved to ensure the risks from trips was reduced.

The laundry room had been refurbished to include new storage boxes for people’s clothes and a dedicated office was used by the housekeeper to maintain associated paperwork and cleaning schedules. Drying equipment had been purchased and installed in the laundry to prevent clothes being dried on radiators outside people’s rooms. This reduced the risks from contamination and air borne viruses.

The provider had reviewed and implemented a staff dependency tool which helped evaluate people’s individual needs against the support they required and this had resulted in increased staffing. The registered manager confirmed the tool would be used to ensure they could continue to meet the changing needs of people and when an increase in people living at the home became apparent.

People were supported with their health and wellbeing. Drinks were provided throughout the day and a menu was provided with a choice of food for people. People received additional support from dietary and nutritional specialists where this was required.

People’s personal preferences and wishes were recorded and staff were aware of any diverse needs. Where people h

This inspection took place on 7, 9 and 16 June 2017 and was unannounced.

Eastfield Farm Residential Home Limited is a renovated farm house situated in open countryside in the village of Halsham, close to the seaside town of Withernsea in East Yorkshire. The service was originally built to provide residential care to the farming and rural community in an environment they were used to. It offers care for up to 26 older people, some of whom may be living with dementia. On the day of the inspection there were 23 people living at the home.

During our inspection we were supported by 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. The registered manager will be referred to as 'manager' throughout the report.

The service was last inspected on 14 and 15 November 2016, when we found people who used the service were not protected against the risks associated with receiving care and treatment they had not consented to or which had not been agreed in a best interest forum. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 11: Need for consent. The provider submitted an action plan with information on how they intended to meet with the breach we identified, by 30 April 2017.

During this inspection we checked and found that the action had not been completed or reviewed. The provider was not always compliant with the Mental Capacity Act 2005. People were not supported to have maximum choice and control of their lives and people were not supported in the least restrictive way possible; the policies and systems in the service did not support this practice. People were still not protected against the risks associated with receiving care and treatment they had not consented to or which had not been agreed in a best interest forum. This was a continued breach of Regulation 11.

At the previous inspection in November 2016 we found the provider did not have effective systems in place to assess, monitor and improve the quality and safety of the service provided in the carrying out of the regulated activity. The provider failed to maintain accurate up to date records to mitigate associated risks for people. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 17: Good governance. The provider submitted an action plan with information on how they intended to meet with the breach we had identified, by 30 April 2017.

During this inspection we saw the provider had failed to meet all the actions they told us they were implementing to meet the breaches of this regulation identified in the previous inspection in November 2016. We found the provider did not have effective systems in place to assess, monitor and improve the quality and safety of the service provided in the carrying out of the regulated activity. The provider failed to maintain accurate up to date records to mitigate associated risks for people. This was a continued breach of Regulation 17.

At the previous inspection we found the provider failed to protect people against the risks associated with the unsafe use and management of medicines by the inappropriate arrangements for recording and handling of medicines used for the purposes of the regulated activity. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 12: Safe care and treatment. The provider submitted an action plan with information on how they intended to meet with the breach we had identified, by 26 January 2017.

During this inspection we checked and found that the action had been completed. However, we found manufacturer’s instructions had not been fol

This inspection was carried out on 14 and 15 November 2016 and was unannounced. This meant the registered provider and staff did not know we would be attending. The service was last inspected on 28 and 29 July 2015 and concerns were raised in relation to the number of staff who had received training in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The service was complaint with all other regulations at that time.

Eastfield Farm is a renovated farm house situated in open countryside in the village of Halsham, close to the seaside town of Withernsea in East Yorkshire. The service was originally built to provide residential care to the farming / rural community in an environment they were used to. It offers care for up to 26 older people, some of whom may be living with a dementia type illness. On the day of the inspection there were 23 people living at the service.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered 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.

Medicines at the service were not well managed, and people did not always receive there medicines safely and in line with their prescriptions. Concerns were raised in relation to storage, recording, administration and auditing of medicines. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered manager was able to demonstrate they had an understanding of Deprivation of Liberty Safeguards (DoLS) and the Court of Protection. However, we found that Mental Capacity Act (2005) guidelines were not always followed. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered provider had a quality assurance system in place, but the system was not effective in assessing, monitoring and improving the quality and safety of the service. We also found record keeping at the service to be inconsistent. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we asked the provider to take at the end of the report.

The registered manager had not informed the CQC of all significant events. This meant we could not check that appropriate action had been taken. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009: Notifications of other incidents.

People had their health and social care needs assessed and care and support was planned and delivered in line with their individual care needs. Care plans were individualised to include preferences, likes and dislikes and contained detailed information about how each person should be supported. However, not all care plans were fully reflective of people’s current needs. We made a recommendation about this in the report.

Accidents and incidents were recorded and people’s relative’s told us they were kept informed of these. However, when people had experienced repeated falls the response taken by the service was not always thoroughly documented.

People enjoyed a good choice of food and drink and were provided with snacks and refreshments throughout the day. Food and fluid charts were being used to monitor nutritional intake, although record keeping in relation to these charts was inconsistent.

We saw that staff completed an induction process and they had received a wide range of training, which covered courses the service deemed essential, such as safeguarding, medication and MCA.

We found that staff had a good kn

At the last inspection of the home in July 2013 we had concerns about the systems in place to control the risk of infection. At this inspection we saw that improvements had been made and the home was now compliant in this area.

We did not speak to people who lived at the home on this occasion. We observed positive interactions between people who lived at the home and staff, and saw that people were well groomed and dressed. We saw that the ground floor of the premises was clean and well maintained, although building work was continuing on the first floor.

The manager had produced documentation and introduced systems that were designed to prevent and control the risk of infection, such as cleaning schedules, risk assessments and audits. All of these were being used on the day of the inspection. the laundry room had been re-designed and this had reduced the risk of cross infection.

We spoke with two people who lived at the home, two members of staff, the manager and one of the providers as part of this inspection.

People told us that they were well cared for by staff. One person said, “Staff are very good – they chat to us and help us when we need it”. We saw good interaction between people who lived at the home and staff on the day of the inspection. Care planning documentation included the information needed by staff to provide the care that people needed.

The home was clean on the day of the inspection but we had concerns about the risk of infection posed by the arrangements in place in the laundry room. Other aspects of the infection control guidance policy needed to be implemented.

We saw that staff were recruited safely and that they worked alongside long standing staff to gain experience before they worked unsupervised with people who lived at the home.

There were sufficient numbers of staff on duty, although staff said that they would have liked more time to spend with people who lived at the home, and people who lived at the home said that they would like more outings.

Monitoring systems were being used to measure the quality of the service that was provided at the home and there were numerous ways for people who lived at the home to express their opinions about the service they received. Staff also had regular meetings.

We spoke with a small number of people who lived at the home and observed the interaction between other people and care workers. The people we spoke with told us that they were happy with the care they received and said that the staff were ‘very nice’ and ‘kind’. One person said, “They are always around if I need them – if I ring the buzzer during the night they always answer quickly”.

People said that they were supported to make day to day decisions about how to live their lives.

We did not speak directly to people living at the home about safeguarding adults from abuse but people told us that they felt safe living at the home.

The people that we spoke with told us that they could speak to staff and they would listen to their concerns and try to support them through any worries.

People spoken with told us they were treated with respect and supported to maintain their independence.

They said they were involved in decisions and felt able to complain when the need arose.

People liked the home and loved the views from the sitting room. They also said they enjoyed watching and feeding the wild birds and ducklings that hatched annually.

We did not speak to residents on the day of our visit. We conducted a SOFI inspection;

this is a way of inspecting that is based on dementia care mapping. The inspector sits with

a group of residents and observes the interaction between residents/residents and

residents/staff. This type of inspection is designed to observe the experiences of people

living at the home who are not able to tell us verbally how they feel about the service they

receive.

People told us that they are able to make decisions about their day to day care and that staff respect their privacy, dignity and independence. They said that they were well cared for and that they felt safe at the home.

People told us that the home was always clean and that their own bedrooms were kept clean and tidy. They told us that there were no unpleasant smells in the home.

People told us that they would be able to speak to various members of staff and the manager if they had a complaint or a concern and that they were quite confident that their comments would be listened to and acted upon.

We carried out this unannounced inspection on 28th and 29th July 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 registered provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

During the last inspection of the home, which was carried out on 4 November 2013 found the provider was compliant with 4 of the regulations assessed although concerns about the systems in place to control the risk of infection were identified. An inspection to make sure that the improvements required had been made was carried out on 4 November 2013 and the home was found to be fully compliant at this visit.

Eastfield farm is a renovated farm house situated in open countryside in the village of Halsham, close to the seaside town of Withernsea in East Yorkshire. The home was originally built to provide residential care to the farming/rural community in an environment they were used to. It offers care for up to 26 older people; some of whom may have a dementia type illness. On the day of the inspection the home had 23 people living in the home.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC); they had been registered since 12th September 2013. 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 who used the service told us they felt safe and thought the staff were caring and would be able to answer their questions and help them if needed. They told us they felt staff treated them with respect, never spoke down to them and spoke in a calm manner. They told us they could have a laugh and a joke with all staff and other people who lived in the home. We observed interactions that supported this statement.

People lived in a safe environment. Staff knew how to protect people from abuse and equipment used in the service was checked and maintained. Staff made sure risk assessments were carried out and took steps to minimise risks without taking away people’s independence or rights to make decisions.

People told us there were enough staff on duty to give them the support they needed and our observations confirmed this.

Medicines were stored, administered and disposed of safely. Training records showed the staff had received training in the safe handling and administration of medicines.

The home was clean and free from odour during our visit but some equipment including hoists and bath hoists required deep cleaning.

We found the home was meeting the requirements of the deprivation of Liberties safeguards (DoLS). These safeguards provide a legal framework to ensure that people are only deprived of their liberty when there is no other way to care for them or safely provide treatment.

Staff we spoke with had some understanding of the Mental Capacity Act 2005 but the majority had not received training in this subject. We didn’t see any documentation to support decisions made in a person’s best interest and we also saw that some people who lacked the capacity to consent to their care had been asked to sign consent forms in their care plans. We have therefore recommended that the registered manager accesses training for staff on the Mental Capacity Act 2005 and DoLS

We found people who used the service were provided with a balanced diet. People told us they enjoyed the food and the choices available. We saw people who required support with eating received this in a dignified manner.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes and to effectively assess risk. People who used the service received additional care and treatment from health based professionals in the community.

Staff involved people in choices about their daily living and treated them with kindness and respect. All the people we saw looked well-presented and cared for. They told us they could have a bath whenever they wanted and food was available throughout the day.

People who used the service were seen to have the opportunity to engage in a variety of activities both within the service and the local community. However some people stated they would like to go out more often on day trips.

Staff received regular supervision and felt well supported by the registered manager and providers. Staff had had access to a range of training and newly recruited staff completed an induction, which included competency checks.

The manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns