This inspection was unannounced and took place over two days; 21 and 24 October 2016. The service was previously inspected in March 2015 where we found improvements were needed in four of the five key areas we inspect. We issued requirements in relation to improving records to ensure people got the right food and drink to help prevent the risk of choking. We found where best interest decisions were needed, these were not always documented. Further requirements were issued to ensure staffing was deployed in the right way to ensure people’s safety and comfort and to make sure there was sufficient equipment in place. The registered manager and director sent us an action plan to show how they intended to meet these requirements. In January 2016 a focussed inspection was completed by a pharmacist inspector who found there was safe systems to ensure people received their medicines safely and at the prescribed times.

At this inspection we found the service had made improvements in all four of the requirements we had set previously.

Following our inspection in March 2015, the registered manager and director met with staff and agreed the right deployment of staff to ensure there was sufficient staffing at night in all areas of the home. Previously night staff had based themselves in one area of the home which left some people vulnerable, especially if they were unable to use their call bell for assistance due to their dementia. New slings and a new hoist was ordered and delivered shortly after the March 2015 inspection. This ensured that each person who used the hoisting equipment had their own named sling. All catering staff as well as care staff had a detailed list of what type of diet each person required to keep them safe. In particular it stated the consistency of food to be served for people who were assessed as requiring a special consistency diet. Previously this information was not always available or recorded for all staff to refer to.

The service is registered to provide care and support without nursing for up to 56 older people. At the time of this inspection there were 48 people living at the service.

There is a registered manager in place who has worked at the service for several years, but had just gone on maternity leave. 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. As an interim arrangement the provider had given the day to day responsibility of running the service to two assistant managers. Both had experience and knowledge of people and the staff who worked at the service. The two assistant managers were being supported by the director who was on site at least three- four days per week, and accessible via phone 24 hours per day if needed.

People, their families and visitors were extremely positive about the care and support provided by staff at Eastleigh. Comments included ‘‘I couldn’t be happier, staff are marvellous’’ One family contacted us following our inspection as they had seen the inspection poster. They wanted us to know ‘We, the family of (name of person), have been very pleased with the care provided for him. Staff have been very patient and imaginative when caring for him when his behaviour has been challenging - when one strategy has not worked they have tried another and have been consistently kind and good-humoured. There is always a friendly atmosphere at the home with staff cheerful and willing to help.’

There were enough staff with the right skills, training and support to meet the number and needs of people living at the service. Staff said they felt valued and were encouraged to contribute to how the service was run and how care and support was being delivered. Staff understood people’s needs and knew

This was a focussed inspection to look at handling of medicines in the home. This followed the service notifying the Care Quality Commission (CQC) of two incidents, which resulted in people not receiving their medicines as prescribed for them. In both incidents, staff identified their mistakes quickly and took appropriate action to make sure the people involved did not come to harm. When we last inspected in March 2015 we did not find breaches in the way medicines were being managed, but in light of the notifications in relation to medicine errors occurring, we decided to inspect this area.

Two pharmacist inspectors completed this unannounced inspection on 14 January 2016.

We found that safe systems were in place for handling medicines. People told us they got their medicines when they needed them. 

Medicines were stored safely and securely. Staff had received appropriate training to enable them to administer medicines safely and effectively.

Records in relation to medicine management were accurate and up to date and systems were in place to audit the process. Extern audits were also arranged via the local pharmacy.

This report only covers our findings in relation to medicines. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

Eastleigh Care Home is registered to provide care and support for up to 50 people. The home specialises in the care of older people, but does not provide nursing care . One wing specialises in the care of people living with dementia. There is a manager who is responsible for the home. Currently they have applied to become registered with the Care Quality Commission (CQC) and are going through the registration process. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

At the last inspection carried out on 14 January 2014 we did not identify any concerns with the care provided to people who lived at the home. Prior to this inspection in March 2015 we received some concerns from two sources about lack of staff and whether staff concerns were being listened to. We found that although there were enough staff available there were some issues with the way they worked and how they were deployed. Improvements could also be made in providing clearer staff feedback and guidance

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were encouraged and supported to maintain their independence. They made choices about their day to day lives which were respected by staff.

Although people said the home was a safe place for them to live, the service was not always safe. The arrangements relating to the provision of meals for people with swallowing difficulties did not minimise risk and there were issues with the deployment of staff in the afternoons and on the dementia unit at night. There was also a risk of infection due to the use of some communal manual handling equipment.

Staff had a good understanding of people’s legal rights, however the correct processes had not always been followed regarding the Deprivation of Liberty Safeguards and use of restrictive measures intended to keep people safe.

The provider had systems in place to make sure people were protected from abuse and avoidable harm. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff spoken with were confident that any allegations made would be fully investigated to ensure people were protected.

People said they would not hesitate in speaking with staff if they had any concerns. People knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally. One person said “I did have one issue but the manager sorted this out immediately.”

People were well cared for and were involved in planning and reviewing their care. However, one person did not have a completed care plan for staff to refer to. There were regular reviews of people’s health and staff responded promptly to changes in need. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs.

Staff had good knowledge of people including their needs and preferences. Staff were well trained, there were good opportunities for on-going training and for obtaining additional qualifications. However, staff said they did not receive formal one to one supervision sessions on a regular basis. Subsequent to the inspection the provider has provided evidence to show staff did have dates booked for supervisions.

People’s privacy was respected. Staff ensured people kept in touch with family and friends. Visitors said they were always made welcome and were able to visit at any time. People were able to see their visitors in communal areas or in private. People were provided with a variety of activities and trips. People could choose to take part if they wished.

There was a management structure in the home which provided clear lines of responsibility and accountability. The manager showed enthusiasm in wanting to provide the best level of care possible although communication with staff could be improved. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people.

There were some effective quality assurance processes in place to monitor care and plan on-going improvements. There were systems in place to share information and seek people’s views about the running of the home. People’s views were acted upon where possible and practical. Since this inspection, the provider has sent us a detailed action plan showing what they have done to improve care and support. This includes addressing the areas of improvement we have highlighted such as the purchase of additional hoists and slings, deployment of staff to cover all areas of the home throughout the day and night and better systems to ensure care plans reflect people's needs and where best interest decisions are needed, setting out how this decision has been made to fully protect people's rights.

We received some information of concern about one person who had lived at the home, but the concerns raised may have impacted on other people's care and support. We decided to carry out an unannounced inspection to look at the key areas of concern raised. We spent time talking to people who lived at the home. We spoke in detail to six people who were able to give an informed view of their experiences of care and support. We also spent time observing how care was being delivered in different parts of the home over the lunch time period and during the afternoon.

People we spoke with gave an overall positive view about the care and support they received. One person told us ''I have lived here for over nine years now. There is nothing they could improve on. All the staff are wonderful and they will all go the extra mile to make sure we are well looked after.'' Another person commented ''We are very well looked after. Staff are all very good, even the young ones. When they are busy, you sometimes have to wait a bit longer, but mostly they come quickly if you need them.'' We heard from one visiting relative, how they were kept fully informed of any changing needs and they told us ''I am very happy with the care here. I know my relative is being very well cared for.''

We spoke with nine staff and heard how staff rotas were planned ahead and any gaps due to sickness or leave were covered by existing staff. We saw there were sufficient staff for the current number and needs of people living at the home. Following the inspection we spoke with two professionals who visited the service and with the commissioning team. No concerns were raised about the care and support being delivered to people. One professional told us ''We have recently reviewed someone whose family have a lot of anxieties about the care provided. The manager had gone out of her way to ensure this family have the relevant information and details to feel assured their views were listened to.''

We looked at how the service had dealt with complaints and saw they kept detailed records about this. We saw the service had looked at ways they could make sure people living at the home and their relatives could express their views, either via a formal review process, complaints or in an informal way by talking with staff. We checked the number and sort of accidents and incidents that had occurred in the last 12 months. They had been fully documented and actions put in place to reduce the risk of a further accident occurring.