Easthill Home for Deaf People is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection in November 2015, we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. The service was meeting all relevant fundamental standards of care. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

This inspection took place on 14, 15 and 29 June 2018 and was unannounced.

The home accommodates up to 15 people and specialises in supported older deaf people whose primary means of communication is British Sign Language (BSL). At the time of our inspection 10 deaf people, were living at the home. The home was based on three levels connected by stairwells, a passenger lift and a stair lift. All bedrooms had sink facilities and bath or shower rooms were available on each floor, together with communal areas where people could socialise.

There was a registered manager in post at 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 and associated Regulations about how the service is run.

People felt safe living at the home. Staff knew how to identify, prevent and report abuse. They assessed and managed risks to people and risks posed by the environment effectively.

Arrangements were in place for the safe management of medicines. People received their medicines as prescribed. The home was clean and hygienic and staff followed best practice guidance to control the risk and spread of infection.

There were enough staff to meet people’s needs in a timely way. Appropriate recruitment procedures were in place and pre-employment checks were completed before staff started working with people.

People’s needs were met by staff who were competent, trained and supported in their role. Staff acted in the best interests of people and followed legislation designed to protect people’s rights and freedom.

People’s dietary needs were met and they received appropriate support to eat and drink enough. Adaptations and improvements had been made to the home to make it supportive of the people living there.

People were supported to access healthcare services when needed. Staff made information available to other healthcare providers to help ensure continuity of care and supported communication between people and health professionals.

People were cared for with kindness and compassion. Staff knew people well and built positive relationships with them. They were skilled at communicating and engaging with people and adapted BSL to effectively meet people’s communication needs.

Staff protected people’s privacy and dignity. They encouraged people to remain as independent as possible and involved them in planning the care and support they received.

People’s needs were met in a personalised way. Each person had a care plan that was centred on their needs and reviewed regularly. Staff empowered people to make choices and responded promptly when people’s needs changed.

People had access to a range of activities based on their individual interests, including regular access to the community. They knew how to make a complaint and an accessible complaints procedure was in place.

Staff took account of people’s end of life wishes and preferences. They supported people to remain comfortable and pain free.

People and professionals who had regular contact with the home felt it w

We spoke with three out of 13 people using the service at the time of our visit and observed the care and support provided in the shared areas of the home. People told us they were satisfied that the care they received met their needs. They were given choices. They said care staff were gentle and supportive when they helped them with their personal care. People said they felt safe in the home and would not wish to move elsewhere. One said, “It’s lovely”. People told us they occasionally had problems communicating with staff who were still learning British Sign Language (BSL).

We found people’s care and support were provided in an environment where the specific needs of deaf people and deaf culture were understood. Suitable adaptations had been made to the building so people were living in a safe environment. Staff were aware of people’s care needs and supported them in a caring manner. Care and support were delivered with people’s consent. However where people did not have the capacity to consent, there was incomplete awareness of the legal requirements. Staff were not supported by an effective system of appraisal and supervision, and training in compulsory topics was not refreshed regularly. The provider’s systems for monitoring the quality of the service were not effective or comprehensive.

We carried out this inspection with an expert- by-experience who was a counsellor and advocate for deaf people, and a BSL interpreter. They found it to be “a nice home" where people received appropriate care according to their needs and where they were safe from harm.

In this report the name of a registered manager appears who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. An interim manager was managing the regulated activity and is referred to as “the manager” in this report.

At the time of our visit Easthill was registered for the regulated activities "Personal Care" and "Accommodation for persons who require nursing or personal care". The manager confirmed they were not currently providing personal care in people's own homes, so our inspection did not include that activity.

We spoke with three out of 14 people using the service and a social worker who was visiting one of their clients. They told us Easthill was a friendly place with “good relationships between staff and residents”. They said that care and support were delivered according to people's needs, and that they were given choices. People's care was adapted to the individual and their independence and privacy were respected.

We found that people were involved in their care and support, which was delivered according to person centred care plans. People using the service were protected against the risk of abuse. The provider had effective recruitment and induction processes and made the necessary checks before new staff started work. There were systems in place to monitor and improve the quality of the service.

We carried out this inspection with an expert-by-experience who was an advocate for deaf people. They found it to be a “nice home where residents received appropriate care and [attention to their] needs to make sure they were safe from harm.” There were members of staff who understood deaf culture because they were themselves deaf or had deaf family members.

The inspection took place on 5 and 6 November 2015 and was unannounced. The home is registered to provide accommodation for up to 15 older people and specialises in caring for deaf people. There were nine people living at the home when we visited, some of whom were living with dementia or had a learning disability.

At the time of our inspection the manager had applied to be registered with CQC and their application was being processed. 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 our previous inspection on 5 and 7 May 2015, we identified breaches of five regulations. We issued two warning notices in relation to the safety of the care provided and the lack of quality assurance processes. We also issued requirement notices in relation to the need for consent; safeguarding people from abuse; and the suitability of the premises. The provider sent us an action plan on 12 August 2015 stating they had taken action and were meeting the requirements of all regulations.

At this inspection we found all areas of concern had been addressed. This was confirmed by comments made by people, relatives and staff, who reported significant improvements had been made in the quality and safety of the service.

People said the most important aspect of living at the home was the opportunity to mix with other deaf people and to be able to communicate with staff effectively. A mix of deaf and hearing staff were employed, who were skilled in communicating with people using British Sign Language (BSL). They understood how to adapt BSL to people’s individual needs and used this effectively.

Staff acted as advocates for people when they became ill and supported them to access healthcare services. BSL interpreters were arranged for all medical appointments to help people communicate effectively with doctors and specialists.

People were treated with kindness and compassion. Staff spoke fondly about the people they supported and knew them well. People were encouraged to remain as independent as possible, their privacy was protected and they were treated with respect.

People told us they felt safe. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. Individual risks to people, such as developing pressure injuries or falling, were assessed and managed effectively. Arrangements were in place to deal with emergencies, including suitable fire safety measures.

Care and support were provided in a personalised way by staff who understood and met people’s needs well. Care plans were comprehensive and were regularly reviewed. A range of activities was provided and the home had set up a deaf club to encourage deaf people living in the community to visit.

The home was clean and staff followed guidance to reduce the risk of infection. Medicines were managed safely and people received their medicines when they needed them.

There were enough staff to support people at all times and recruitment processes helped make sure only suitable staff were employed. Staff received appropriate training, support and supervision in their work and felt valued.

Staff followed legislation designed to protect the rights and freedom of people living at the home and sought consent from people before providing care or support.

The dining room and some people’s bedrooms had been decorated and people had been involved in choosing the colour schemes. Plans were in place to improve the building further.

People were satisfied with the quality of the food and received a choice of suitably nutritious meals. If people started to lose weight, they were referred to specialists and given appropriate support.

People were involved in discussing and planning the care and support they received and were consulted about all aspects of the service. The provider acted on feedback from people, for example by changing the menu and introducing new foods. The provider’s complaints policy had been translated into BSL and people knew how to complain.

There was a clear management and staffing structure in place and people and their relatives said they considered the service was well run. Staff and management had a shared vision to provide high quality care. Staff were happy in their work and well-motivated.

There was an open and transparent culture. Community links were being developed, visitors were welcomed and staff enjoyed good working relationships with external professionals. Audits of key aspects of the service were conducted. The results showed the service was making continual improvement.