Eastridge Manor EMI Nursing and Residential Home

Eastridge Manor Nursing Home is a residential care home providing personal and nursing care to up to 53 people. At the time of the inspection there were 52 people living at the home, who were living with various nursing needs, including poor mobility, diabetes, those living with various stages of dementia and end of life care.

Eastridge Manor is a large detached property, consisting of a main house and purpose-built nursing wing in extensive grounds. Accommodation is provided over two floors, with passenger lifts providing access between floors.

People’s experience of using this service and what we found

People told us they were happy at the home and with the care they received from staff. One person said, “I am very happy here, they make me feel like this is my home. They look after me very well.” One relative said, “I feel they really genuinely care. They make me feel confident that they are doing everything they can. I want (person)to have the best quality of life she can.”

People told us they felt safe living at the home, and relatives said their felt that their loved ones were safely cared for. Risks to people’s health and wellbeing were assessed and mitigated by staff who knew them well. People were protected from the risk of abuse.

Risks to people’s wellbeing had been assessed and staff ensured that these risks were reduced as much as possible. People were supported by enough skilled and trained staff to meet their needs. Training was provided to staff in order to meet the needs of people at the home. People nutritional and hydration needs were met and monitored for those who were assessed as being at risk.

Staff ensured that people were protected from infection throughout the COVID-19 pandemic. Training and guidance had been provided to support staff to do this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us, and we observed, that there were activities and engagement at the home. People’s views were listened to and acted upon and they and their relatives felt confident that concerns would be acted upon.

People, staff and relatives spoke positively about the registered manager. Management was approachable and open to feedback and discussions about people’s care. The quality of people’s care was supported by effective quality assurance systems.

People told us that they were involved in their support and that staff and management sought their views and opinions. The provider and manager continuously looked to improve the service to achieve better outcomes for people. People, staff and relatives spoke highly of the manager.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 4 October 2018).

Why we inspected

The inspection was prompted in part due to concerns received about nutrition and hydration. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and effective sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Eastridge Manor is registered to provide nursing care, personal care and accommodation for up to 53 older people living with dementia. At the time of the inspection there were 52 people living at the home, who were living with various nursing needs, including poor mobility, diabetes, those living with various stages of dementia and end of life care.

Eastridge Manor is a large detached property, consisting of a main house and purpose-built nursing wing in extensive grounds. Accommodation is provided over two floors, with passenger lifts providing access between floors.

At the last inspection on 1 September 2015, we rated the service as Good. At this inspection we found the evidence continued to support the overall rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

This report reflects the comprehensive inspection that took place on 12 June 2018 which was unannounced.

People did not always receive personalised care that was responsive to their needs. People’s experiences at meal time varied where engagement and support was not always person centred and positive. This was identified as an area of practice that needed to improve.

People did receive personalised care in other areas that was responsive to their needs, such as support with dementia and mental health needs,

People and their relatives spoke highly of the staff and said they felt safe living at the home. Risks to people were identified, assessed and managed. Staff understood their responsibilities to keep people safe. People received their medicines safely and there were effective infection prevention and control measures in place.

Staff demonstrated that they could recognise the signs of abuse and what action to take to keep people safe. The provider had safe recruitment practices in place to ensure that appropriate and suitable staff were employed to meet people’s needs. Staff felt supported by the management of the service through supervisions and appraisals. Staff were also provided with appropriate training that met the needs of the people at Eastridge Manor.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. People’s healthcare needs were met effectively and staff ensured that they worked in partnership with other healthcare professionals to support this.

People were supported to have enough to eat and drink and spoke positively of the food on offer. One person told us, “The food is always so nice here, you only have to ask and they get you what you want”.

People were treated with kindness and respect. Staff demonstrated that they knew people well and positive relationships had developed. One family member told us, “I’ve never seen any carer approach any resident with anything but kindness”.

People and their relatives had been involved in shaping their care and care plans were comprehensive. Staff had the information they needed to provide care in a personalised way. Staff recognised and responded to changes in people's needs, especially those people with dementia. People were supported to follow their individual interests as well as having organised activities.

Staff understood their responsibilities with regard to the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People knew how to complain and were confident that their concerns would be responded to. People and their relatives spoke highly of the management of the service. Staff found the registered manager to be open, transparent and approachable.

The provider had robust systems and processes in place to monitor and evaluate the care provided. Clear governance arrangements were in place, with good management oversight to identify shortfalls and drive improvements. Staff had developed positive connections with local organisations and described effective working relationships.

Further information is in the detailed findings below.

This inspection was carried out by an Adult Social Care inspector. We gathered evidence that helped us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, relatives, five care staff who supported them and from looking at a selection of records. They included care assessments and care records, cleaning and hygiene records, staff training records, care worker rotas and records related to the provider's quality assurance systems.

Is the service safe?

People told us they felt safe receiving care at Eastridge Manor. Their relatives had confidence that people were cared for in a safe way. One person told us "Staff are extremely good."

The premises were well maintained and clean. People were protected from the risk of infection because all areas of the home were cleaned regularly and thoroughly. Staff practiced effective infection control practices.

At our inspection on 26 February 2014 we found that people's care and health records were not always accurate and fit for purpose. Where risks were associated with people's needs, this was not always planned for in their care records. We judged that this had a minor impact on people. In response, the provider sent us a report that detailed steps taken to achieve compliance. Since our last inspection the provider had taken action to ensure people's care and health records were accurate and fit for purpose.

Risks to people's health and well-being were assessed and planned for. People were screened for various risks including malnutrition/dehydration, falls and pressure areas. If a risk was identified, this was clearly documented in their care plan with guidance for staff on how to support them.

Fire response systems were in place and regularly checked to ensure the safety of people, staff and others in the building.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us that two people were subject to a DoLS authorisation and records confirmed that this had been done lawfully and in the person's best interest. The manager and staff demonstrated an understanding of the Mental Capacity Act 2005 (MCA) and DoLS as this was part of mandatory staff training. There were also policies and procedures in place that the manager and staff could refer to if needed.

Is the service effective?

At our inspection on 26 February 2014 we found that not all staff had received regular supervision. This meant that not all staff were supported to deliver care and treatment safely and to an appropriate standard. We judged that this had a minor impact on people. In response, the provider sent us a report that detailed steps taken to achieve compliance. Since our last inspection the provider had taken action to ensure that all staff were supported to deliver care and treatment safely and to an appropriate standard.

Staff had received appropriate training, supervision and appraisal to carry out their roles effectively. Staff understood people's needs and had the knowledge and skills necessary meet them.

People's wishes and needs were reflected in their personalised care plans. Staff understood the care plans and followed them. People's care and treatment promoted good health and quality of life.

The building was accessible and fit for purpose. Mobility equipment such as hoists and wheelchairs had ample room to manoeuvre. The interior of the home was nicely furnished and decorated to a high standard. The first floor lounge was designed to support people who lived with dementia. It had items to encourage reminiscence of historical events. The external grounds of the home were accessible and well maintained. One relative said, 'The facilities and grounds are wonderful.'

Is the service caring?

People were supported by staff who cared about them and treated them with respect. People told us that staff were "Good" and "Take good care of me." They were able to make choices and this was respected by staff. Relatives described the staff as 'Wonderful' and 'Lovely.'

Staff spoke warmly about people they supported. One staff member said, "The best thing about working here is the residents.'

The manager and staff listened to people and respected their views. We observed staff interacting with people in a kind manner that protected their privacy and dignity.

Is the service responsive?

The manager sought feedback from people, relatives and staff. Feedback was recorded and acted upon to improve the service. The manager took into account complaints, concerns and incidents and took quick action to address them. People and their relatives were confident that any issues they had would be addressed.

People's care was planned and delivered in line with their assessed needs. Where people's needs or risks changed, their care was adjusted accordingly.

Is the service well-led?

Eastridge Manor had a registered manager in place for the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Staff felt supported by the management and that issues they raised were taken seriously. One staff member said, 'I always feel listened to.' Another stated, 'There is an open door policy.' The manager encouraged a culture of open-ness and transparency.

There were systems in place for recording and evaluating information about the quality and safety of the service. People, staff and the registered manager told us that where issues were identified, these were acted upon. Records confirmed that identified shortfalls were addressed. This demonstrated the home's efforts of continuous improvement.

We found that people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. We observed that people were treated with respect and courtesy by staff.

Care plans were in place which identified people's needs and showed how these should be met. The staff we spoke we demonstrated a clear understanding of people's needs and the risks to their well-being.

We found that there were up to date policies and procedures in place to support staff in protecting people who used the service from abuse. Staff had received training in safeguarding adults and were aware of their responsibilities.

There were enough qualified, skilled and experienced staff to meet people's needs. Staff received appropriate training to support them in carrying out their roles effectively. However, not all staff had received formal supervision with a manager.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people received. This included gaining feedback from people who used the service and their representatives, and taking appropriate action where necessary.

We identified gaps in risk assessments regarding people's health needs and behavioural problems. This placed people at risk of receiving inappropriate care or treatment.

During our observation we saw that staff interacted well with people when they were supporting them. We saw that staff were knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence. For example staff knocked on people's door before entering and where possible they checked on how they wanted their care to be provided before doing so.

We were shown examples of person centred care records which were well organised into separate sections. This provided clarity for staff. These had been developed for each need of each individual and documented their wishes and preferences in relation to how their care was provided. A relative's assistance was often sought with this, as a number of people were unable to fully contribute themselves.

Equality and diversity had been considered in the service by looking at each individual's needs. Any equipment or adaptations needed were provided.