The inspection took place on 30 December 2016 and was unannounced.

The service is registered to provide accommodation and personal care for up to 22 older people living with learning disabilities and dementia. There is a communal lounge, dining room, conservatory and craft room on the ground floor. Bedrooms are situated on the ground and first floor, accessed by a lift. The service is situated in the village of Eastry near Sandwich, with easy access to local shops. At the time of the inspection there were 16 people living at the service.

A registered manager was in post, however they were not present at the inspection, we spoke to the registered manager after the inspection. We were supported by the team leader during the inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

Risks to people were identified and assessed and guidance was provided for staff to follow to reduce risks to people. People received their medicines safely and on time.

Staff knew about abuse and knew what to do if they suspected abuse. Staff knew about the whistle blowing policy and the ability to take concerns outside of the service. Staff were confident that any concerns raised would be investigated to ensure people remained safe.

The provider had a recruitment policy and processes in place, these had recently been updated, the processes ensured that staff were of good character. There were consistent numbers of staff on duty. There were staff vacancies at the time of the inspection, these were covered by agency staff, who worked regularly at the service. Staff completed regular training, had one to one supervisions and annual appraisals to discuss their development.

Staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. Staff knew the importance of giving people choices and gaining their consent.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed with the local authority as being required to protect the person from harm. Some people had an authorised DoLS in place and these were reviewed regularly.

People enjoyed home cooked meals. Some people required special diets, as recommended by healthcare professionals; these meals were appetising and met people’s needs. People’s health was assessed and monitored; staff took prompt action when they noticed changes or any decline in a person’s health. Staff worked closely with health professionals and followed any guidance given to them to ensure people received safe and effective care.

People told us they were happy at the service. Staff spoke with and engaged with people in a kind and compassionate way. Staff respected people’s dignity and treated them with respect. People had been encouraged to be involved with the planning of their care, when they were able to. Staff involved relatives and advocates when planning care for people who were unable to participate. People had a detailed, descriptive plan of the support they needed.

The provider had a complaints policy and procedure. People and relatives knew how to complain, management had followed the procedure and used any complaints as a learning experience.

People’s family and friends were welcome to visit at any time. People were encouraged to visit relatives; staying with them for holidays. Staff, including an activities co-ordinator, spent time with people on a one to one basis. Staff encouraged people to be as independent as possible.

Our inspection team was made up of one inspector. We spoke with some of the people who used the service, the manager and care staff. We spent time with people who had communication difficulties and observed the interactions between people and staff during the day. We set out to answer our five key questions:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

As part of this inspection we followed up on a compliance action given at the last inspection that required improvements to be made to the building. At this inspection we found that all required improvements had been made. 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, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe because assessments had been undertaken to ensure that people received safe and appropriate care. People told us or expressed that they felt safe. Assessments had been undertaken to ensure that people received safe and appropriate care. Checks and audits were carried out to make sure the building and equipment was maintained and safe. The registered manager supervised and checked staff competency so that staff had the skills they needed and worked in a safe way.

Is the service effective?

The service was effective because specialists, including the local community physiotherapist and speech and language therapist, had been involved in people’s care and had given advice to staff. People’s health and care needs were assessed with them and/or their representatives. Specialists, including the local community physiotherapist and speech and language therapist, had been involved in people’s care and had given advice. Staff had received the training they needed and there was an ongoing training programme to make sure staff had the skills they needed to support people appropriately.

Is the service caring?

The service was caring because staff spent time with people and occupied them with activities. People were treated with respect and dignity by the staff. Staff had got to know the people using the service well and had developed ways to communicate with them.

Is the service responsive?

The service was responsive because care was consistently planned and delivered in response to people’s changing needs. People’s health and care needs were assessed with them and /or their representatives. Staff had received support and training to provide individual care. People were able to participate in meetings to discuss the running of the home and their individual preferences.

Is the service well-led?

The service was well-led because the service had an experienced registered manager who had worked in the home consistently for several years and who kept up to date with current good care practice. People using the service and staff participated in discussions in meetings about the running of the home and activities. There were systems in place to provide on-going monitoring of the home. This included checks for the environment, health and safety, fire safety and staff training needs. The staff had individual supervision and staff meetings that enabled them to share ideas and concerns.

We spoke to and spent time with some of the people living in Eastry House. Not all the people living in the home were able to talk with us about their lifestyle so we observed their interactions with the staff. People said or expressed that they were happy with the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We saw good interactions between people using the service and staff and people looked comfortable and at ease in the home.

People’s care was planned and delivered so that it met their individual needs. We found that people's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and wellbeing. People were provided with appropriate equipment that was regularly serviced and well maintained.

We saw that the home needed repairing and redecorating in parts. Some leaks from the roof had caused damage to the ceilings and walls in various parts of the home. The carpet was worn and stained in some communal areas and there were tears in the stair carpet.

There was a thorough recruitment process that included checks to make sure staff were suitable with the people using the service. People had the opportunity to meet new staff before they started working in the home. New staff were given initial training and support.

We met and spoke with some of the people using the service and everyone we spoke with said or indicated that they were happy living at Eastry House.

People told us that they felt safe and well looked after. People told us that they could express any problems to the staff who would listen and act.

People said that they thought the staff were kind and caring. One person said “I like all of the staff. I have no favourite, they are all good.”

Staffing was planned around individual needs and activities. This meant that people had the support they needed when they needed it. Personal hobbies and interests were supported.

People looked relaxed in the company of each other and staff. We saw that people took part in a range of community based activities that they enjoyed and were involved in the local and wider community. One person said “I am quite happy here. The staff are alright and I am happy with my room. I have no complaints.” Another person said “I am going out for lunch today with my family.”

A visiting relative said “I am kept well informed. I feel I can turn up at anytime; I am always made to feel welcome. I am very satisfied with the service and I know that my relative is in good hands.”

People’s health needs were supported and the service worked closely with health and social care professionals to maintain and improve people’s health and well being.

Not all the people living in the home were able to tell us about their experiences so we observed the interactions between the people living in the home and the staff.

Staff were kind and respectful to the people living in the home.

People were offered choices as part of the day to day routine in a way that they could understand.

People said they liked the home and the staff were good.

We observed people looking comfortable and at ease in the home and with staff.

People were given the opportunity to tell staff how they wanted to be supported.

People talked about what they had been doing earlier in the day and the day before. They said they liked arts and crafts. Some people talked about the day centre and how much they liked it.