The inspection took place on 13 and 14 September 2018 and was unannounced on the first day.

At the last inspection in August 2017, we rated the service requires improvement. We found breaches in regulations which related to information in care plans, consent and overall governance of the service. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Responsive and Well-led to at least good. Whilst we found some improvements in aspects of care recording, there were some continued concerns with consent and governance. We identified new concerns in relation to the management of risk, medicines, staffing and notification of incidents. At this inspection, we have rated the service as requires improvement again.

Providers should be aiming to achieve and sustain a rating of 'Good' or 'Outstanding'. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not fully effective. As this is the second time in a row the service has been rated Requires Improvement, we will meet with the provider to discuss their action plan for improvements.

Eastwood House accommodates up to 19 elderly people. The building is a converted domestic house that has been extended. Bedrooms are provided on both the ground and first floors with access via a passenger lift. There is a lounge and conservatory area that is used as a dining room. At the time of this inspection 17 people were using the service.

Eastwood House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service was owned by an individual person and they were the registered manager. They also managed their other care service in Lincolnshire. We have referred to this person as the provider throughout the report. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The provider had appointed a deputy manager to manage the day to day running of the service, this had been a long standing arrangement.

We found the application of mental capacity legislation remained inconsistent. Documentation showed some capacity assessment and best interest decision-making records had not been completed appropriately. It was not clear if some people had legal representatives appointed to support them or make decisions on their behalf. We found some people may meet the criteria for a deprivation of liberty safeguard but this had not been completed.

There was a lack of robust risk management; areas of risk had not been accurately assessed and planned. There was a lack of systems to check on-going concerns. This related to the environment, equipment used in the service and people's individual risk assessments. There were shortfalls with the management of medicines and some people had not received their medicine as prescribed due to staff error.

We found there were shortfalls of staff on duty during the day, this had impacted on observation of communal areas at specific times of the day to prevent accidents and distract people whose behaviour could be challenging.

Although the provider had put a new audit programme in place, we found some continued concerns regarding effective quality monitoring. Shortfalls had been missed when audits were completed or action plans had not been put in place to address all the improvements needed. Examples included care records, the environment and accident analysis. We also found the

Eastwood House is a care home for 19 elderly people, some of whom may be living with dementia. The home is situated in a central area of Grimsby, close to local amenities. The building is a converted domestic house that has been extended. Bedrooms are provided on both the ground and first floors with access via a passenger lift. There is a lounge and conservatory area which is used as a dining room. At the time of this inspection,13 people were using the service.

The service was owned by an individual person and they were the registered manager. They also managed the organisation’s other service in Lincolnshire. We have referred to this person as the provider throughout the report. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

We found the quality monitoring programme was limited. This had resulted in shortfalls being missed when audits and checks were completed and when some issues were identified, these had not been addressed in a timely way. Areas included care records, incident recording, safety checks, equipment, training and the environment. Accidents and incidents had not been analysed to help find ways to reduce them.

There was some inconsistency with the application of mental capacity legislation. Some people had assessments of capacity and records of best interest meetings when restrictions were in place, but this was not consistent throughout the service.

People had assessments of their needs completed and care plans developed but these were not always thorough and information was missing from them. This meant important care could be missed or care delivered which wasn’t in line with people’s preferences.

You can see what action we told the provider to take regarding consent, care planning and quality monitoring at the back of the report.

The staffing levels were reviewed and increased on the second day of the inspection to ensure there were sufficient staff on duty in the evenings. The provider confirmed they would review and increase the number of hours allocated to the deputy manager to complete the management and administration duties. People were cared for by a stable staff team who knew them well.

Staff were recruited safely which ensured employment checks were in place prior to new staff starting work. Staff understood how to protect people from harm and abuse and were clear about reporting procedures. Generally, there were safe systems in place to manage risks to people’s health and safety although there were gaps in some safety checks and assessments.

People who used the service and their relatives were complimentary about staff approach. They said staff were kind and caring and respected people’s privacy and dignity. The atmosphere was relaxed and we saw staff knew people well. People's views were sought during care reviews, resident meetings and surveys.

Staff had access to training, supervision and support. Gaps in training had been identified, plans made and courses booked to address shortfalls. An appraisal system was scheduled to start the following month. Staff told us they felt very supported by the deputy manager and were able to raise concerns. There were staff meetings which enabled them to receive information and express their views.

Overall medicines were managed safely; we found some minor shortfalls with recording and stock control which the provider was addressing.

People had access to community health professionals for advice and treatment. Staff generally knew when to consult these professionals, we found there had been a delay in requesting an assessment from an occupational therapist for a person’s whose needs around mobility support had changed. This was followed up during the inspection.

This inspection was carried out by a social care inspector over one day. We were accompanied by a member of staff from the local authority contracts department, following an allegation of concern about short staffing arrangements in the home.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found.The summary is based on our observations during the inspection, speaking with relatives and people who used the service and speaking with staff. We also looked at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been maintained and checked regularly. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw an appropriate application had been made about this for one person to ensure their rights were protected.

There were not enough staff always available to meet the needs of all the people who used the service.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring there are sufficient numbers of suitably qualified, skilled and experienced persons available at all times to safeguard the health, safety and welfare of people who used the service.

Is the service effective?

People told us they were happy with the support they received and felt their needs were met. It was clear from what we saw, and from speaking with staff, that they understood people’s care and support needs and knew them well.

Is the service caring?

People told us they were supported by kind and attentive staff. We saw that care staff were patient and gave reassurance and encouragement when supporting people.

Is the service responsive?

People’s needs had been assessed before they moved into the service. Care records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes.

Is the service well-led?

Staff had a good understanding of the ethos of the service and quality assurance processes were in place. People told us they were asked for their views about the service. We saw people’s views about the food served had been listened to and as a result, changes to the menu had been made.

What people who used the service and those that matter to them said about the care and support they received:

A group of visiting relatives told us they had recently made an active choice about using the home and were very happy with the service given.

One relative told us, “I am more than happy with the patience and dedication shown by staff.” Whilst another told us their member of family had, “Come to life” since moving into the home

On the day of our inspection, a review of a person’s placement in the service was completed by staff from the health authority. We spoke with the health professional involved in the review. They told us they had no concerns and were happy that this person was supported appropriately and the service was meeting their needs.

We saw evidence of investment into the building since the last time we visited, with the entrance area newly decorated and we observed the home was neat, tidy and had no unpleasant smells.

There was evidence that administrative systems had been developed to enable the provider to monitor the health, safety and welfare of people who used the service. We saw this included regular checks of care plans, incidents and accidents that had occurred.

A programme of regular monthly meetings with staff had been implemented since the last time we visited, to ensure they were aware of their responsibilities and to enable leadership and direction to be provided to them.

We found that surveys which covered different aspects of the home had been recently issued to people who used the service, their relatives, staff and professionals. The outcome from these was overall very positive. We saw comments in these which included, “Staff very respecting”, “Everyone very friendly”, “Welcoming”, “Bright and cheerful”. We saw that a district nurse had commented in a survey that staff were; “Very approachable” and that they had “Never had any problems.

People told us staff were, “Great” and “Very kind.” People said they were supported with consideration and their wishes and needs were respected. We found a variety of opportunities were provided to enable people’s wellbeing to be promoted.

People who used the service told us they were happy with the way they were given their medicines and received these at regular times.

People told us they were, “Comfortable” and liked their rooms. We found that whilst the home was neat and tidy, the provider may find it useful to note we observed that arrangements to ensure it was kept clean would benefit from further improvement.

People told us staff were, “A good bunch “and “Do a good job”. People said staff supported them well and that they had no complaints. They also told us they were happy with the care and support delivered. People told us they were, “Confident” that appropriate action would be taken to resolve concerns that were raised and were, “Satisfied“ with the service they received.

Whilst the provider had some systems in place to assess and monitor the quality of service that people received, we found that the operation of these had not been applied in a planned or consistent way. The failure to provide an effective system to regularly assess and monitor the quality of the services limits the provider's ability to identify shortfalls in the quality of the service delivered, which may put people at risk of inappropriate or unsafe care.

People that used the service told us staff listened to them and that they were given choices about their support and participated in decisions about this to ensure their wishes and personal preferences were respected.

One person told us that “Staff treat you well” whilst another, said they had made a positive choice about moving into the home. People told us they were supported to remain as independent as was possible and one person said they liked to “Do their own thing” and keep to their “Own personal routines.”

People told us that staff and supported them well and that prompt action was taken to get them medical attention when it was needed.

People that used the service said staff were “Helpful” and “Kind.”

People told us they had “No concerns” about their support and that they felt “Safe” using the service.

People told us that that staff kept the home "Nice" and "Very clean."

People that used the service said they were happy with the service they received. People said they had “No complaints” and that staff listened to them and took action to follow up any concerns.

Eastwood House is a care home for 19 older people, some of whom may be living with dementia. The home is a converted domestic house that has been extended. Bedrooms are provided on both the ground and first floors with access via a passenger lift. There is a lounge and conservatory area that is used as a dining room. The home is situated in a residential area of Grimsby and is on a bus route to local areas and the city centre.

There was a registered manager for the service. 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.

This inspection took place on 25 and 26 June 2015 and was unannounced. The service was last inspected in July 2014 when we made a compliance action about staffing levels in the home. At the time of our inspection visit, there were 12 people living at the home. In addition there was one person who used the service for day care.

We found additional staff had been recruited to ensure the wellbeing of people who used the service was promoted. People’s needs were regularly assessed to ensure there was enough staff available.

Training had been provided on safeguarding vulnerable adults to ensure staff knew how recognise potential signs of abuse. Staff were familiar with their roles and responsibilities for reporting safeguarding or whistleblowing concerns about the service and staff.

Assessments about risks to people had been carried out to ensure staff knew how to support them safely. People who had difficulty with making informed decisions were supported by staff. We found staff had received training on the promotion of people’s human rights to ensure their freedom was not restricted. Systems were in place to make sure decisions made on people’s behalf were carried out in their best interests.

A range of training was provided to staff to ensure they could safely carry out their roles. Regular supervision and appraisals of staff skills were carried out to enable their individual performance to be monitored and help them develop their careers.

Recruitment checks were carried out on staff to ensure they were safe to work with people who used the service.

People’s nutritional needs and associated risks were monitored with involvement of specialist health care professionals when required. People were able to make choices from a variety of nutritious and wholesome meals.

People were supported to make informed decisions about their lives and a range of opportunities were provided to enable them to engage and participate in meaningful activities. This helped to ensure their wellbeing was promoted.

People received their medicines as prescribed and systems were in place to ensure their medicines were managed safely.

People knew how to make a complaint and have these investigated and resolved, wherever this was possible.

Regular management checks were carried out which enabled the quality of the service people received to be assured and potential shortfalls to be identified and addressed.