East Dean Grange Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were generally safe at the home, however improvements were required to make this more robust. Wound care was not being effectively managed, and documentation around this was poor. Areas of the home were not clean; we observed dirty bathrooms. There was a swimming pool full of discarded items, some of which posed a fire risk. This had not been addressed through fire risk assessments or audits. These concerns collectively were a breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The issues were raised with the registered manager and providers at the time of assessment visit and action was taken to address them quickly. When we returned for the second visit and a feedback session, there was notable improvement at the home. People and their relatives told us they felt safe at East Dean Grange. Staff demonstrated a strong knowledge of safeguarding and knew how to recognise signs of potential abuse and where to report these.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us staff responded promptly to any issues raised. One person said, “If I raise an issue staff are very responsive.” A relative told us, “As far as complaining a few minor issues not formal complaints.” The relative explained their concern and added, “Staff were quick to rectify this.”

Staff were aware of what actions they needed to take following an accident or incident. Staff told us they were updated following an accident or incident, so they were aware of any changes and learning following an investigation. The registered manager gave an example of changes they had made following an incident. This included a person moving room to a smaller environment as this reduced the number of falls.

Processes were in place to analyse accidents and incidents monthly. No trends had been identified however no analysis had taken place over a longer period and this had led to patterns being missed. For example, we saw over 3 months most falls happened between 10am and 12 midday and then 10pm to 2am. This had not been noticed by management and an opportunity to minimise risk had been missed. Staff were completing accident and incident forms but were filling in the box which should have been done by management, meaning oversight was at risk of being missed. We found 1 injury had not been reported to CQC but this was done promptly after the assessment.

People’s needs were assessed before they moved into East Dean Grange and regularly whilst there to ensure they could be met. One relative told us about their loved one’s experience moving into the home. They spoke about how they visited the home and had discussions with the registered manager. Following an assessment their loved one successfully transferred to the home.

The management team worked closely with people, their relatives and external agencies to gather as much information about a person before they moved into the home. This enabled a safe transfer. The registered manager explained how they assessed people before they moved into the home to ensure their needs could be met safely.

The home worked well with external professionals to support people appropriately. We received positive feedback from professionals who worked alongside the home. One health care professional told us how staff worked with them to ensure the person received the appropriate care and support as their needs changed.

Processes were in place to ensure safe transitions for people between services. Assessments of people’s needs took place before they moved into the home to ensure their care needs could be met. This included ensuring the room the person was due to move into or return to remained suitable for their needs.

People told us they felt safe at East Dean Grange. Their relatives also agreed. One relative told us, “[Person] has never expressed any concerns for his personal safety, no worries, no abuse.” Another said, “I know [person] is safe. Safeguarding is very good here.”

Staff received safeguarding training and they knew what actions to take if they were concerned someone was at risk of harm through abuse or discrimination. One staff member said, “There are many forms of issues bullying, discrimination neglect and emotional, we know what to look for.” Staff told us if concerns were identified they would inform the management team. They were aware how to contact the local authority safeguarding team if concerns were not addressed. The registered manager identified and reported any safeguarding concerns. They told us they were confident that staff would identify and report safeguarding concerns appropriately.

We observed staff treating people with kindness and used their knowledge of people to provide them with the support they needed. Safeguarding information was displayed on a noticeboard which included contact details for the local authority safeguarding team.

Staff received safeguarding training; however they told us, “We did get training but no one checked that we understood it (the process).” This was raised with the registered manager to consider further competency checks. Safeguarding and whistleblowing policies were in place and discussions with staff demonstrated they knew the procedures to follow. Safeguarding incidents were reported to the relevant organisations, including the local authority and the Care Quality Commission.

People and their relatives told us staff supported them to manage risks and stay safe. Comments included, “I feel very safe, don’t even think about it,” and, “I feel very safe around everyone.” One relative told us their loved one was helped to stay safe because staff were, “Calm and focussed.” Some people were at risk of falls, and they told us how they were supported to stay safe. One person said, “I have a Lifeline watch if I fall out of bed.” Another told us, “Staff look after me well, but I can fall over so not always safe.”

Staff knew people well and were able to tell us about people and the risks associated with their care. They told us how they supported people safely. For example, pressure area management, mobility support and how to assure someone when they become distressed. Information was not always fully documented in a person’s care plan and daily notes were not always detailed enough to highlight any changes to risks to people.

Staff were responsive to people’s needs and we saw them attending to people in a timely way. On occasions call bells would be ringing for a while, staff explained this was usually when people had pressed their portable bell and staff had to find where the person was. When people were upset or distressed, staff spent time with them to try and identify the cause of their distress. Some people required support with their mobility, we observed staff reminding people to use their walking aids and providing support when required. Equipment related to managing risks was in place. We saw pressure relieving mattresses where people were at risk of pressure damage and sensor equipment where people were at risk of falls. Information about some people was displayed on their doors. This included information related to their safety, for example, to remind the person to use their walking aids.

Processes were not always robust to minimise risk to people. Some people had sustained wounds. There were no clear care plans or written information about the wounds. There were no body maps to demonstrate the size or location of the wound so this could be monitored for healing or deterioration. Photographs of the wounds had been implemented by the second site visit however, these still did not include size or the location on the body. It was difficult to identify from the photographs either the size or the location of the wound. Some staff had been assessed as competent to do certain levels of wound care. Staff told us how and what they should do but this wasn’t being robustly followed. There was no record of dressing which were applied, when and who by. It was not clear which staff had been assessed as competent to do wound care and oversight of this was lacking. This left people at risk of receiving care that was not appropriate or safe. Action was taken by the registered manager and provider to address this but this required time to embed in practice.

Feedback regarding the environment was mixed. People told us, “In the main I feel safe, this is a combination of the staff and building.” Relatives told us they liked the building as it enabled people to have freedom of movement throughout the home. However, they also told us, “There is not enough lounge seating space, if you don’t watch TV there is nowhere else to sit but outside the dining room.”

The registered manager had some oversight of the environment but the issues we found as part of the assessment had not been addressed or actioned. There was a plan in place to update the environment and they told us that staff were redecorating in the communal areas. However, staff reported that risks were known but not always addressed in a timely manner, such as the fire risk in relation to the swimming pool area.

Observations confirmed that the environment was not always safe. Although not accessible by people, we saw that the swimming pool and barn, which were connected to the home, were full of clutter, CoSHH products, old mattresses, and many other items. This presented a fire risk and had not been addressed at the point of our first site visit. This was rectified by our second visit to the home. The laundry room was in a state of disrepair however the providers had a plan to address this. There was a platform lift to the dining area which was not working. We saw evidence of ongoing communication with a contractor to repair this. The ground floor had been redecorated and work was ongoing for the other floors.

Processes were in place to ensure regular servicing of the environment and the providers had a home improvement plan which they were working through. The oversight of environmental risk was not always robust. For example, concerns raised in an external fire risk assessment in 2022 had not been fully addressed in relation to the swimming pool. Environmental risk assessments had not identified the fire risks we found. The registered manager and provider were receptive to our feedback and had taken action to address matters by our second site visit.

We received mixed feedback from people and their relatives about staffing numbers and skills. People’s comments included, “Some staff are nice some are not, I like the young ladies, I do like most of them;” “I had a fall and the member of staff was extremely helpful and on the ball;” “Always someone around, there has to be, if you call it depends on what they are doing as to how quickly they come.” Relatives told us, “My observation would be that they need more care staff, new residents needing more care so not enough carers to cope in the morning,” Another added, “In the main there are enough staff but short at night I feel.”

Feedback from staff demonstrated that improvements were needed in relation to training and staffing numbers or deployment of staff. Staff told us that they received yearly training, and this was generally online. Competency assessments were also completed; however, some staff did not feel these were robust enough to promote their confidence. Some staff who were newer to the home told us they had not completed any training at the time of our inspection. Staff received a brief induction and some reported that it was not enough time to get to know the people and the general running of the home. For example, where specific documents such as Respect Forms or Do not attempt resuscitation forms could be found. One staff member said, “Induction was 2 shadowing shifts, it’s not enough.” Staff told us there were not enough of them each shift to provide support to people in a timely way. One staff member said, “[We’re] rushed and don’t have enough time to help with personal care.” Another staff member told us that although they tried to give people options of a bath or shower, on occasions people would be given a quick wash down. The registered manager told us they were recruiting staff and currently care staff were needed to backfill vacancies, such as housekeeping. They told us this was managed by ensuring more care staff worked each shift.

There was not always a visible staff presence in communal areas throughout the day. We saw staff were busy during each shift. They attended to people in a timely way and responded to call bells and alarms promptly. However, people spent time sitting in lounge areas or walking around the home with little or no interaction from staff as staff were busy elsewhere. Due to staffing levels and reliance on staff taking on multiple roles they were not able to spend quality time with people.

Processes and systems were in place to ensure safe and effective staffing, however there were some improvements needed. Rotas were not always reflective of who was on shift. For example, some swaps had taken place, but the rota had not been updated, this could risk confusion regarding staffing numbers. Better managerial oversight of this was required. A training matrix was utilised however there were some gaps in this. Once this was highlighted to the registered manager, it was addressed. Recruitment processes were mostly robust however one staff member did not have a full Disclosure and Barring Service (DBS) check through. At the time of our first site visit, verbal assurance around this was received however a robust risk assessment was not documented. This was in place by our second visit. The staff member was working under supervision until the check was completed. Supervision was taking place every 3 months however not all staff found these beneficial. There is more detail about this in the workforce well-being section in caring. Following the inspection the provider and registered manager confirmed more recruitment had taken place and measures put in place to drive improvements, however these would require time to become embedded.

People and relatives told us the home was not always clean. Comments included, “They need more cleaners for a building this size.” “[Person] is safe but not always clean and the floor in her room is not always clean.” “Cleaning is not adequate.” However, one person said, “My room is kept clean and tidy,” and a relative said staff helped make sure their loved one’s room was clean and tidy.

Deployment of staff was not always effective to safely meet people’s needs, especially regarding cleaning and laundry. Staff told us they were responsible for the cleaning of the home and the laundry in addition to caring for people. This at times made it difficult to complete all tasks needed in relation to cleanliness. The registered manager told us a staff member was allocated to undertake housekeeping duties each morning and all staff were responsible for the laundry. They were receptive to feedback in relation to staff deployment and the impact of this on infection prevention and control (IPC). During our visit to give feedback to the provider, a new head of housekeeping was in post.

The environment did not always promote good infection prevention and control (IPC). In the laundry area we observed broken floor tiles and carpet in parts. This posed an IPC risk as it would not be able to be cleaned thoroughly in case of spillage. The carpet was removed following our first site visit. The laundry area was damp, we saw laundry bags left full waiting to be processed. Clean washing was stored in the laundry rather than being brought straight over to people’s rooms. There were other areas of the home which were not clean, such as the bathrooms. There were also unpleasant odours throughout the home. Several hand gel stations were empty and there was a lack of hand soap available at several sinks. The bathroom by the dining room had no toilet roll in for the duration of the first site visit day and surfaces throughout the home were tacky to the touch. The registered manager was receptive to the feedback regarding cleanliness and improvements had been made by our second visit to the home. This improvement needed time to embed. We did see that plenty of personal protective equipment (PPE) was available, and staff were wearing this appropriately.

Processes were not always robust to ensure good infection prevention and control (IPC). There was a lack of oversight from management. Cleaning schedules were not fully completed and not signed off by management and issues were not identified in environmental audits. Following the site visit, a newly employed housekeeper started their role. Improvements had already started to be made with regards to the cleanliness of the home and oversight of this. These improvements needed to continue and be fully embedded into everyday practice. The provider had a policy in place which was relevant to the home. Staff had undertaken IPC training and personal protective equipment (PPE) was readily available.

We received mixed feedback from people about medicines. Some people told us they didn’t receive their medicines in a timely way. Comments included, “My Parkinsons medication is not always given to me on time, the night staff need more training on the importance of it being given on time to optimise the effect on my condition”; “Medication mainly on time, can be late but I don’t moan”; and “My medication can be hit and miss.” Other people did not have any concerns and told us, “Medicines are fine” and “Minimal medication, but it’s given correctly as far as I know.”

Feedback from staff regarding medicines was mixed. All staff who gave medicines told us they had received medicine training and had been assessed as competent. However, not all staff felt confident in giving medicines. One staff member said, “I had meds training then 2 days later was on a night shift and on meds.” The staff member told us they didn’t really feel confident when giving medicines. Another staff member told us that they did feel confident with the training and competency assessments they had.

Improvements were needed to the processes associated with medicines. Some people required their medicines to be given at a specific time. Medicine administration records (MARs) had been signed when medicines were given but the actual time had not been recorded. Therefore, it was not clear if the person had received their medicines at the correct time. This was fed back to the registered manager who had taken action to improve this. Protocols for ‘as required’ (PRN) medicines were inconsistent, and for one person who had been prescribed a medicine for anxiety there was no protocol in place. MARs were not consistently completed. For example, a code had been used to indicate a person had refused a medicine, but this was actually out of stock. There was inconsistent recording of the number of medicines in stock. Fridge temperatures not recorded consistently to demonstrate safe storage. When handwritten changes had been made to the MAR these had been signed appropriately by 2 staff. However, words and numbers had been scribbled out and this made the MAR difficult to read. These issues could leave people at risk of receiving treatment that was not safe, inconsistent, or not appropriate for their needs. Medicine audits were completed each month. These had identified the issues we found related to use of codes, fridge temperatures and correct documentation in relation to PRN medicines. However, these were ongoing and had not been addressed. Medicines were stored in a trolley, this was well organised and not overstocked. We saw a good example of a short-term care plan for a person who had been prescribed antibiotics. This included all the details staff may need including length of treatment, effects and side effects of the medicine. Following the assessment, we were told about improvements that had been made, this included a review of PRN protocols. There had also been an inspection by the local Medicines Optimisation Team who did not identify any concerns.