This inspection took place on 30 and 31 May 2018. It was unannounced.

At our last inspection on 27 and 28 February 2017, we found a breach of regulation relating to how the provider carried out assessments for people who lacked capacity or were at risk of being deprived of their liberty. We found improvements were needed in a total of three key areas. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question effective to at least good.

At this inspection we found improvements had been made in all key areas, and the provider was meeting the fundamental standards required by regulation.

Eastfield Nursing Home 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 regulates both the premises and the care provided, and both were looked at during this inspection.

Eastfield Nursing Home is registered to provide residential and nursing care for up to 52 older people who have a range of needs, including older people, people living with dementia, and people living with a physical disability. The home is situated in the village of Liss and includes a secure garden for people to enjoy at the rear of the home. Facilities include a dining room, a conservatory seating area and three shared lounges. At the time of the inspection 42 people were living at the home.

There was a registered manager in post. A registered manager is a person who has registered with CQC 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.

The provider had arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely. Recruitment processes were in place to make sure the provider only employed workers who were suitable to work in a care setting. There were arrangements in place to protect people from risks associated with the management of medicines and the spread of infection.

Care and support were based on thorough assessments and care plans, which reflected professional standards and were kept up to date. Staff received appropriate training and supervision to maintain and develop their skills and knowledge to support people according to their needs. People were supported to eat and drink enough to maintain their health and welfare. People were supported to access healthcare services, such as GPs and specialist nurses. 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.

Care workers had developed caring relationships with people they supported. People were supported to take part in decisions about their care and treatment, and their views were listened to. Staff respected people’s independence, privacy, and dignity.

People’s care and support took into account people’s abilities, needs and preferences, and reflected their physical, emotional and social needs. People were able to take part in a range of leisure activities and entertainment. People were kept aware of the provider’s complaints procedure, and complaints were managed in a professional manner.

The provider had a clear vision and strategy, which was shared with staff. Systems were in place to make sure the service was managed efficiently and to monitor, assess, sustain and improve the quality of service provided.

The inspection took place on the 27 and 28 February 2017 and was unannounced. At the last inspection on 22, 26 and 28 October 2015 we found the provider (who is also the registered manager) had breached seven of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA 2014). These breaches related to Regulation 9 (Person centred care), Regulation 10 (Dignity and respect), Regulation 11 (Need for consent), Regulation 12 (Safe care and treatment), Regulation 17 (Good governance), Regulation 18 (Staffing) and Regulation 19 (Fit and proper persons employed).

At our last inspection the registered manager had not always ensured people’s preferences in relation to their food choices were met, that people were treated with compassion at all times and that appropriate action had been taken to ensure consent had been sought for all aspects of people’s care. The registered manager had also not always ensured that people were protected from risks associated with falls, the registered manager did not have effective quality assurance processes in place and records did not reflect the care and treatment people received. The registered manager had also not always ensured that staff received the appropriate supervision and support in their role and that people were protected from the employment of unsuitable staff.

We told the registered manager they needed to take action and we received two reports setting out the action they would take to meet the regulations. At this inspection we reviewed whether or not these actions had been taken and whether the registered manager was now meeting the requirements of the HSCA 2014. We found improvements had been made regarding the breaches identified; however, additional time was required to ensure these improvements were embedded and sustained in staff’s working practices.

Eastfield Nursing Home, to be referred to as the home throughout this report, is a home which provides residential and nursing care for up to 52 older people who have a range of needs, including those living with Parkinson’s disease and dementia, sensory impairments as well as epilepsy and diabetes. The home is situated in a residential area in the village of Liss and has approximately five and a half acres of land which includes a secure garden for people to enjoy at the rear of the home. Facilities include a small dining room, conservatory seating area and large lounge on the ground floor with two smaller lounges on the first floor. At the time of the inspection 46 people were using the service.

The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

People were kept safe as the registered manager ensured sufficient numbers of staff were deployed in order to meet people’s needs. In the event of unplanned staff shortages the registered manager sought to use familiar and known agency staff to support people with their care. However, people told us they often had a protracted wait to receive care after requesting staff assistance. Staff deployment was not always monitored to ensure that people were receiving care at the time they required. Plans were in place to address this immediately following the inspection; however, time is needed to ensure this system is effective and improves the response people experience when using their call bells.

Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people during their daily interactions. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. However, we could not always see that people had always been accurate

We looked round the home and met most of the people living there. A new wing was recently opened, with spacious bedrooms giving views across fields and a sitting room with space and facilities for activities such as baking.

We spoke with four people who used the service and five relatives who were visiting people that day. One person who used the service said “It’s very good here. I can’t fault it”. Another said “The staff are very good.” One visiting relative said “I couldn’t praise the home enough.” Another said “(my relative) is really well looked after.”

The owner/manager was away at the time of the inspection. We spoke with the two nurses on duty, three care staff, the cook and one of the management team from the sister home nearby. Staff told us “It’s really lovely here – it’s down to the owner.”

We reviewed care records for three people living at the home. We found that people experienced safe and effective care because their needs were assessed and reviewed, and care plans kept current.

People could choose from a varied menu and had the support they needed to help them eat and drink.

People were protected from the unsafe management of their medication because there were effective systems in place to minimise the risk.

Staffing levels were flexible and there were sufficient staff to meet the needs of the people using the service.

When we visited the service there were 39 people in residence, all aged over 80 and the majority suffering from dementia.

We asked about how people and their relatives were involved in the care planning and delivery process. We were told by staff that there was a great deal of involvement and to some extent this was confirmed by the relatives we spoke to.

We asked about the level and quality of care in the home. Most of the people who used the service and their relatives seemed very happy with the service and the staff. The provider had introduced a computerised system for recording and monitoring care plan information which provided useful guidance to assist staff in carrying out their care duties.

Measures were in place to ensure the safeguarding of people living at the home. Staff had undertaken training related to safeguarding vulnerable people and were able to assure us of their knowledge and understanding in this regard.

We looked at support for staff, and were told by staff members that they had undertaken a wide range of training and were being encouraged to work towards further qualifications. Supervision processes were in place to support staff.

We looked at the way service quality was assessed and monitored and identified concerns regarding the auditing of the service.

From talking to residents and observing care we found that people had positive experiences living at Eastfield Nursing Home. We were told that staff were polite and respectful and provided assistance in a caring way. We saw that people were helped with their meal in a way that encouraged them to enjoy their food. People told us they felt safe and that staff were competent in looking after them.

This inspection took place on the 22, 26 and 28 October 2015 and was unannounced.

Eastfield Nursing Home is a care home which provides nursing and residential care for up to 52 older people who have a range of needs including those living with dementia. At the time of our inspection 47 people were using the service.

The service has 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.

Although people told us they felt safe living at Eastfield Nursing Home, we found risks to people from falls were not always assessed. These were not always monitored in line with the provider’s procedures in use to ensure people’s safety from the risk of falls and post falls complications.

There were sufficient staff to support people’s needs and keep them safe. However, recruitment procedures were not fully completed to protect people from the employment of unsuitable care staff. The provider had not ensured that a full employment history had been obtained from care staff.

Most staff we spoke with were aware of the signs of abuse and how to report their concerns. Information and guidance on safeguarding people available to staff in the home was not up to date. However, staff training on safeguarding was underway at the time of our inspection.

Risks to people from pressure sores, behaviours that challenge and poor nutrition had been assessed and plans were in place and acted on to reduce and manage these risks. Staff were made aware of people’s individual risks and changed needs through daily handover.

There were enough staff on duty to ensure people were cared for safely and their needs were met. People’s medicines were administered, dispensed and stored safely.

Staff completed an effective induction into their role. The training required to ensure staff were suitably skilled to carry out their responsibilities was underway at the time of our inspection. Nursing staff did not receive regular supervision to ensure their competence was maintained or to explore and monitor their professional development and concerns. Some nursing staff did not feel they were given an appropriate level of responsibility or that their skills and experience were acknowledged and developed to improve the service. Care staff were subject to ongoing observations of their care delivery to ensure they were competent in their role.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). Applications for Deprivation of Liberty Safeguards (DoLS) had been made appropriately. However the provider had not carried out mental capacity assessments and best interest decisions where people’s freedom of movement was restricted. This is to ensure people’s rights under the Mental Capacity Act 2005 are upheld. For example; people’s capacity to consent to the use of bed rails and bucket chairs had not been fully assessed although they can present a restriction to people’s freedom of movement.

Some people living with dementia were given a ‘soft diet’ which was provided as pureed food and were not offered a choice of meal. It was not evident in people’s records why they were given a soft diet and whether their food preferences were considered in the meals they were given. People were supported to maintain or gain weight through the use of high calorie and food supplements when they were at risk of poor nutrition.

People had access to the healthcare they required from nursing staff in the home and other healthcare professionals as appropriate for their needs.

We found there was mixed feedback about the caring approach of staff from people and their relatives. We made some observations of practices in the home and staff interactions with people which were not always dignified and caring. This included the uniform use of identical beakers called non-spill cups, to serve a nutrition supplement and people’s confidential information being shared in a communal area.

People’s needs were assessed and care plans were in place to address their needs. Care plans were not always sufficiently detailed or person centred. Improvements were underway to ensure care plans reflected people’s interests and personal histories. People had access to a range of activities provided in the home.

The provider had not effectively implemented quality assurance systems to asses, monitor and improve the quality of the service people experienced. People’s care records were not always accurate and up to date. People and their relatives found the registered manager to be helpful and approachable and they felt they were listened to.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.