We carried out an unannounced inspection of the service on 27 June 2017. Eastlands provides accommodation for up to 20 people who require nursing and personal care services. On the day of our inspection 17 people were using the service with one of those attending for a short period of respite.

On the day of our inspection there was not a registered manager in place and there had not been for a period of six weeks. An application had not yet been submitted for a new registered manager, although we were assured by a representative of the provider that recruitment was on-going. 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 the recruitment and application process and will address any further delays with the provider.

During our previous inspection on 8 September 2016 we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the safe management of people’s medicines. During this inspection we checked to see whether improvements had been made and we found they had. We did find one omission in a person’s medicine administration records; however stock levels suggested the person had received their medicines. Other areas of safe medicine management such as; storage, administration and timely ordering were now managed effectively.

Staff could identify the potential signs of abuse and knew who to report any concerns to. Risks to people’s safety were continually assessed and reviewed. There were enough staff to keep people safe and to meet their needs.

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

People were supported by staff who completed an induction prior to commencing their role. Staff training had taken place, with refresher courses booked for the staff that needed them. Staff felt supported by the manager.

People were supported to maintain good health in relation to their food and drink. People’s day to day health needs were met by staff and referrals to relevant health services were made where needed.

Staff were kind and caring and provided people with dignified, respectful and compassionate care and support. Staff were knowledgeable about people’s needs and listened to and acted upon their views. People’s privacy and dignity were maintained. People were involved with decisions made about their care and were encouraged to lead as independent a life as possible. People were provided with information about how they could access independent advocates, although this information needed to be placed in a more accessible part of home. People’s friends and relatives were able to visit whenever they wanted to.

People were encouraged to take part in activities, as well as following their own hobbies and interests. Two activities coordinators were in place to support people with this. People living at the home had detailed person centred care plans in place which contained their preferences and likes and dislikes. Staff were knowledgeable about people’s preferences. Some care plan documentation required archiving to ensure all records available for staff were reflective of people’s current health needs. People were provided with the information they needed if they wished to make a complaint and relatives felt their complaint would be acted on.

A registered manager was not in place at the time of the inspection. This had led to some complaints received by relatives not being responded to in a timely manner. The current manager was respected and well-liked by all. People were invited to regular reviews with their key

We carried out an unannounced inspection of the service on 8 September 2016. Eastlands is registered to accommodate up to 20 people at the home who require nursing or personal care and treatment of disease, disorder or injury. At the time of the inspection there were 16 people using the service.

On the day of our inspection there was not a registered manager in place. 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 time of our inspection an application to be registered as the manager had been made by the person managing the home. We will monitor the progress of this application.

People were supported by staff who could identify the potential signs of abuse and knew who to report any concerns to. Risks to people’s safety were assessed and reviewed, although the frequency of these reviews was inconsistent. There were enough staff to keep people safe.

People’s medicines were not always managed safely. Processes for the timely ordering of people’s medicines were not effective. There were also discrepancies in the stock levels of some medicines and people’s medicine administration records were not always appropriately completed. Guidance for the administration of ‘as needed’ medicines was in place, although a review of the administration of these medicines was needed to ensure they were administered appropriately.

People were supported by staff who completed an induction prior to commencing their role and had the skills and training in place to carry out their role effectively. Not all staff received regular supervision of their work and an effective appraisal system was not yet in place.

The principles of the Mental Capacity Act (2005) had not always been followed when decisions were made about people’s care. Some assessments were comprehensively completed, whereas others were too generic and increased the risk of decisions being made for people that were not in their best interest. Applications to the authorising body to legally deprive people of their liberty had been made for the people who had been assessed as most at risk; however, further applications for others within the home were required.

Staff communicated effectively with people. People received a varied diet that took into account their food and drink preferences. People’s day to day health needs were met by staff and external professionals where required.

Staff treated people with respect and dignity and listened to and acted upon their views. Staff respected people’s privacy and people were involved with decisions made about their care. People were encouraged to lead as independent a life as possible. People were provided with information about how they could access independent advocates, although this information was not easily accessible. People’s friends and relatives were able to visit whenever they wanted to.

Whilst some people received support in following the hobbies and activities that were important to them, others did not. People’s support records were person centred and focused on providing them with care and support in the way in which they wanted. People were provided with the information they needed if they wished to make a complaint, however the format in which the complaints process was written, could make it difficult for people with communication needs to understand.

The manager acknowledged that improvements were required to ensure that people received a high quality of care and support at the home. Although relatively new to their role, the manager had plans in place to address these issues. The manager held regular discussions with representatives of the provider to discuss and agree how to make these improvements.

The manager was visib

We spoke with two people that used the service who told us that they were well looked after and that they felt safe. One person told us “It’s really good here, the food is good and the staff are understanding and patient.” Another person told us “the staff are very friendly and they know how to meet my needs”.

We spoke with a relative of a person that used the service who told us that staff at the service were very caring towards their relative and that they were able to meet their needs. We spoke with three staff members who told us that they received the training that they needed to meet people’s needs. One staff member told us “We adapt the care here to meet people’s routines and needs.” However, we did identify some concerns about the way in which people’s mental capacity was being assessed and recorded despite evidence that training had been provided to staff.

We found that people’s needs were assessed and people’s preferences were recorded. We saw that there were care plans and risk assessments put in place to ensure people’s safety and welfare. We found that staff had a good understanding of people’s needs. We found that staff received appropriate training and supervision and that people that there were effective safeguarding procedures in place.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences.

We observed the care and support that people were receiving, looked at their care records and spoke with one person using the service, one relative, three staff, the manager and regional manager.

A visitor who was an advocate of a person using the service told us, “The staff are very friendly, they always keep me informed of everything. I have also been able to see my relatives GP regularly and discuss things. My relative could not be in a better place.”

A person using the service told us that they were cared for in their preferred way.

We found that people who used the service had their care and treatment planned in consultation with them and their advocates. There were accurate records that detailed how staff were supporting them safely. All risks to their health and welfare were assessed to encourage the early detection of ill health. The systems in place demonstrated that people were protected from abuse and the provider monitored the quality of the service provided.

A person said, “They get you doing things for yourself so that you are more independent.” They also said, “They take you places where you want to go.”

A person told us they have discussed their care plans and signed them to say that they agreed with them. They also said that they had attended a residents’ meeting and were able to make comments and they would speak to the nurse in charge if they had any complaints. They told us they felt listened to.

People told us they were well cared for and felt safe. A person told us they had been involved in their last review of care and had been able to make comments about their care. They also said, “There are no improvements they could make. They are doing everything they can.”

People told us they liked their rooms and that the environment did not need any improvements. One person said, “I have a well decorated room and it includes everything I need.”

People told us staff were well trained and good at their jobs. One person told us they completed a survey last year. Another person told us they had not received a survey or been asked their opinion on the service.