We carried out an unannounced inspection of the service on 23 January 2017.

Eastwood House is a care home with 23 places for older people and people living with dementia. On the day of our inspection there were 17 people living at the service.

Eastwood House is required to have a registered manager in post. 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 the inspection the registered manager had left the service and a new manager was in post. They were in the process of submitting their registered manager application with CQC, we will monitor this.

At our last inspection of the service on 14 December 2015 2016 we identified the provider was in breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured the Mental Capacity Act and Deprivation of Liberty Safeguards were being applied appropriately. At this inspection we found action had been taken to make the required improvements.

People’s rights were protected under the Mental Capacity Act 2005. Staff were aware of the principles of this legislation. Correct action had been taken when people lacked mental capacity to consent to their care or if concerns were identified with their freedom and liberty.

Staff had received training in adult safeguarding and therefore were aware of how to protect people from harm. Risks associated to people’s needs had been assessed and planned for. However, this information was either limited or missing for some people. Accidents and incidents were recorded, monitored and analysed for themes and patterns and action was taken to reduce further reoccurrence.

Following a fire service audit completed by the local fire authority in September 2016, the provider had an action plan in place to make the required improvements to fire safety.

People’s dependency needs were monitored to ensure sufficient staff were available at all times. Some concerns were identified with staffing levels at a particular time of the day. The provider took action and staffing levels increased with immediate effect to meet this shortfall. Staff were recruited through safe recruitment processes.

People received their medicines as prescribed and these were managed correctly.

Staff received an induction, training and appropriate support. There were sufficient experienced, skilled and trained staff available to meet people’s needs.

People received a choice of what to eat and drink and these met people’s needs and preferences. People were supported appropriately with their healthcare needs and the service worked well with external healthcare professionals.

Staff were caring, kind and compassionate and had a good approach with supporting people. People were involved in opportunities to discuss and review the care and support they received. Information about independent advocacy services was available should people have required this support.

Care plans to support staff to know how to meet people’s needs in the main were informative and were reviewed regularly. However, an electronic care record system used was difficult for staff to access and manage, and impacted on the detail and reliability of information recorded about people’s needs.

People who used the service, relatives and staff received opportunities to be involved in the development of the service. The manager was clear about the action required to continually improve the service and staff were aware of their role and responsibilities.

The provider had met their regulatory requirements because they had notified us of events and incidents which they are required to do. There were systems in place to monitor the safety and quality o

We carried out an unannounced inspection of the service on 14 December 2015.

Eastwood House provides accommodation and personal care for up to 19 older people including people living with dementia. At the time of our inspection there were 17 people living at the service.

Eastwood House is required to have a registered manager in post. 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 the inspection a registered manager was in post.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and to report on what we find. This is legislation that protects people who are unable to make specific decisions about their care and treatment. It ensures best interest decisions are made correctly and a person’s liberty and freedom is not unlawfully restricted. People’s rights were not fully protected.

People told us that they felt staff provided a safe service. Staff were aware of the safeguarding procedures and had received appropriate training. However, safeguarding incidents and concerns had not always been reported to the local authority who have the responsibility of investigating safeguarding’s or CQC.

People received their medicines as prescribed and were managed correctly. Safe recruitment practices meant as far as possible only people suitable to work for the service were employed. Staff received an induction, training and appropriate support.

Accidents and incidents were recorded and appropriate action was taken to reduce further risks. However, there was no analysis or review of this information to help identify any themes, patterns or concerns. Risks plans were in place for people’s needs and were regularly monitored and reviewed. Some concerns were identified in relation to the internal and external environment.

People told us that there were sufficient staff to meet their needs. People’s dependency needs had been reviewed and plans were in place to increase the morning staffing levels.

People received sufficient to eat and drink and were positive about the choice, quality and quantity of food and drinks available. People were supported to access healthcare services to maintain their health. People’s healthcare needs had been assessed and were regularly monitored.

People we spoke with who used the service and visiting relatives were positive about the care and approach of staff. People’s preferences, routines and what was important to them had been assessed and recorded. People we spoke with raised some concerns about the opportunities they received to pursue their interests and hobbies.

The provider enabled people to be actively involved in the development and review of their care and support if they wished. This also included meetings to discuss and share feedback about how the service was provided and additionally were asked to complete feedback questionnaires.

People told us they knew how to make a complaint and information was available for people with this information. The provider did not have a clear process of recording complaints. Confidentiality was maintained and there were no restrictions on visitors.

The provider had checks in place that monitored the quality and safety of the service. However, the provider did not have a system or plan in place that gave them oversight of the action required to continually improve the service.

We identified a breach of Regulation 11 of the Health and Social Care Act 2008 Regulations 2014: Need for Consent. The provider had failed to act in accordance with the provisions of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We identified concerns where the provider had placed restrictions upon a person’s care and support without the correct authority to make these decisions. You can see what action we told the provider to take at the back of the full version of the report.

During the inspection we spoke with three people who used the service and asked them about their experiences of living at the care home. We also spoke with two relatives. We observed the care that was given to people. We also spoke with three staff, including the registered manager. We looked at some of the records held in the service including the care records for three people.

During the inspection we gathered information 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 we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

People who used the service told us they felt safe. Relatives also told us they felt their family members were safe. A relative said, “When I get in my car I know that [family member is] safe and well looked after.”

We found care plans and risk assessments on many subjects. However, it was not always clear from the information recorded whether all of the care plans and risk assessments had been reviewed monthly, who had been involved and what changes had taken place.

We saw there were appropriate arrangements in place for the safe handling, storage and administration of medicines. People told us they received their medication on time.

People told us they felt there were enough staff to meet their needs. Staff also told us they felt there were enough staff to meet people’s needs.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw that a DoLS application had been made following our inspection on 27 September 2013. However, a DoLS policy was not in place within the care home. Staff we spoke with did not have a clear understanding of DoLS.

Is the service effective?

People who used the service told us they received good care. One person said, “They’re [staff] there if I need them.”

We saw people had care plans which set out their care needs. However, we saw staff had not always acted in accordance with a person's identified needs regarding pressure area care.

The provider and staff did not understand their responsibilities under the Mental Capacity Act 2005. We found gaps regarding Mental Capacity Act 2005 assessments.

We also found gaps in staff training.

Is the service caring?

People were supported by kind and attentive staff. A person said staff were, “Very caring.” Relatives also told us staff were caring. One relative said, “They’re kind and they are very thoughtful.”

We saw staff interact with people. We saw they treated people with respect and were kind and caring. We saw they were patient and communicated warmly with people.

Is the service responsive?

A person who used the service told us, “If something’s wrong there’s somebody there in no time at all.”

Staff had a good understanding of people's care and support needs. We also saw they arranged for people to access other services such as opticians and chiropody services.

We found people's needs were assessed and care plans and risk assessments were in place. However, information was sometimes unclear when new information had been added to care plans.

Is the service well-led?

People told us they felt they would be listened to if they raised any concerns. One person said, “The manager is really brilliant.”

Staff told us they felt supported and listened to by the manager. A staff member said, “She’s a good manager.” They told us they felt they could contribute their views and staff meetings took place.

A visiting health professional told us they felt the service was well-led.

However, the provider did not have effective processes in place to regularly monitor the quality of the service provided. We found gaps regarding audits.

We reviewed this outcome to follow up on the enforcement action issued and to check whether the required improvements had been made after our previous inspection on 27 September 2013.

One person said, “All the staff know me and what I like. It’s very good; it’s lovely here."

One relative said, “Things have been changing slightly for the better during the last few months. I’m very happy with the service."

We saw that people’s individual needs and risks had been assessed and reviews had been completed on a monthly basis since our last inspection.

We found that care plans had been updated since our last inspection and risk assessments had been completed regularly. We found that staff recorded daily the food and fluid intake for people identified at higher risk of poor nutritional intake and the manager had assessed people’s fluid intakes on a regular basis.

One staff member said, “We’re more aware of people’s individual needs now, like the need to record people’s food and fluid intakes. We’ve got more staff now and we’re running more smoothly.”

We saw that the service had made improvements in the planning and delivery of care for people who used the service following our last inspection in September 2013.

We asked people whether they had seen their care plans or been involved in drawing them up. We spoke with one person who told us, “I don’t have a care plan. I didn’t speak to anyone about my needs when I came here.”

We found that Mental Capacity Assessments had not always been done when it would have been appropriate to do so. We also found that a deprivation of liberties safeguarding application had not been done for one person when it would have been appropriate to do so. This meant that the home did not have appropriate arrangements in place to obtain people’s consent.

Most people told us that they were happy with the care they received at Eastwood House. Relatives of one person told us, “The staff bend over backwards to help.”

However, we found that people were not protected against the risks of receiving care that was inappropriate or unsafe. This was because care plans and risk assessments were not regularly updated to reflect their changing needs.

Medication was not administered safely. This was because medications were not given in line with people’s medication care plans. Records were not accurate or sufficient enough to protect people from the risks associated with taking medication.

There were insufficient numbers of staff to meet the needs of people.

A complaints policy was in place and was displayed throughout the home. People and their relatives told us that they felt confident that they would be listened to if they made a complaint.

A person told us they had not seen their care plans. They also told us they would speak to the manager if they wanted to make any comments or complaints about their care.

A person told us they were happy with the care that they received. They were also able to visit the GP and the optician when they needed to.

A person told us they felt safe and said, “There is no one who wants to frighten you.” They told us the home was very clean and tidy and that the home was “kept nice.”

A person told us there were enough staff on duty and that the staff usually arrived quickly when they were asked for help. They said, “The staff more or less know what to do.”

Prior to our inspection we reviewed all the information we had received from the provider. We used a number of different methods to help us understand the experiences of people who used the service. We spoke with six people who used the service, one visiting relative and three care staff to establish their views on the quality of service provision.

We spoke with the manager and the provider’s representative. We also looked at some records held in the service which included the care files for three people. We observed the support people who used the service received from staff and carried out a tour of the home.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who were using the service, their relatives and the staff told us.

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

Is the service safe?

People who used the service told us they felt safe.

We found care plans and risk assessments had been improved and work was on-going to ensure they were kept up to date and protected people who used the service from avoidable harm.

We found the provider had taken steps to protect the rights of people who did not have the capacity to consent, and there were systems in place to ensure they acted in accordance with the legal requirements of the Mental Capacity Act (2005).

We found the home to be clean and well maintained. However, the manager had not yet determined whether the infection control systems such as, policies, procedures and guidance were in line with relevant national guidance. This meant the manager did not know if people were fully protected from the risk of infection.

Is the service effective?

Systems were in place to ensure that people's individual support needs could be identified and met.

We observed people's support was delivered in such a way as to meet their individual needs and preferences. We saw people's care files had been reorganised since our last inspection. Staff told us the care files provided them with up to date information on how to support people safely.

Is the service caring?

People who used the service told us they were treated with kindness. Throughout the day of our inspection we found staff were friendly and caring in their approach.

Staff we spoke with told us, “We want to provide the best care for people.”

A person who used the service told us, “I am only here for a short stay but I come regularly. The staff are so kind to me and nothing is too much trouble really.”

Is the service responsive?

We found systems were in place to identify changes in people’s health quickly to enable an effective response.

We found that people were supported in accordance with their individual needs and wishes.

Is the service well-led?

We found that some of the planned improvements to ensure the manager assessed the quality of the services provided had not been completed. The manager had made significant improvements since the appointment of two senior care staff to assist with managerial responsibilities. However more work was needed to ensure the systems of quality audits were fully implemented to drive continuous improvement and ensure best practice is sustained.

We found the manager to be caring and knowledgeable about people who used the service. The manager had made significant improvements to the care planning and record keeping since our last inspection.

We found the manager was being supported by two senior care staff to implement systems of audit around the quality of the services provided.