About the service: Eastside House is a residential care home that provides accommodation and personal care to older people, some of whom were living with dementia. At the time of the inspection there were 14 people living at the home.

People’s experience of using this service: Where risk assessments were in place, these gave information and guidance to care staff on how to ensure people were kept safe from harm and to minimise risks. However, we found that where people had specific risks associated with their health and medical needs these had not been identified or risk assessed.

The service was not working in line with the principles of the Mental Capacity Act 2005 (MCA).

Mental capacity assessments and best interests decisions had not been completed for people who had been assessed as lacking capacity.

Where people had been noted as lacking mental capacity and subjected to restrictions that could have amounted to a deprivation of liberty, Deprivation of Liberty Safeguards authorisations had not been applied for to ensure that people were being deprived of their liberty lawfully.

Care plans and associated records were not always current and reflective of people’s needs and preferences. Although reviews of people’s care had taken place, the care plans had not always been updated to reflect any significant changes.

People could access all areas of the home as they pleased and engaged in activities of their choice and preference. However, this could be further improved on to ensure people engaged in a variety of activities and outings to further enhance their well-being.

Management oversight processes were in place to check aspects of the service provision but these were not always effective because they had not identified any of the issues we found as part of this inspection process.

People were very happy living at Eastside House and told us that care staff were kind and caring. People knew the care staff well and had established positive relationships with them.

We observed that care staff also knew people well and delivered care according to their needs and preferences.

Relatives were complimentary of the care and support that their loved one received and found care staff to be attentive to their needs.

People were observed to enjoy the meals provided at the home. People were offered choice and we saw people had access to drinks and snacks throughout the day.

Medicines management and administration was safe. People received their medicines on time and as prescribed.

Recruitment processes followed by the service ensured that only those staff assessed as safe to work with vulnerable adults were recruited. Sufficient numbers of staff were available to support people safely.

People and their relatives knew who to speak with if they had any complaints or concerns and were generally confident that their concerns would be appropriately addressed.

Rating at last inspection: At the last inspection the service was rated good (report published October 2016). However, at this inspection we found areas of concern that required attention and improvement. The service has now been rated requires improvement.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We found four regulatory breaches during this inspection. We will ask the provider to submit an action plan detailing the steps they intend to take to ensure the required improvements are implemented. We will also continue to monitor the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

This inspection took place on 25 August and 14 September 2016 and was unannounced. The service met all of the regulations we inspected against at our last inspection in January 2014.

Eastside House is a care home for up to sixteen people that specialises in the care and support of older people and people living with dementia. There were three vacancies when we inspected.

There was a registered manager in post at the service. A registered manager is a person who has registered with the 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.

People and their representatives provided good overall feedback about the service. There was particular praise for how people’s health needs were addressed. The service supported people well with healthcare matters and acted on the advice of healthcare professionals. There was evidence of effectively addressing some aspects of concern around some people’s health.

People were treated in a respectful and individualised manner that recognised their needs and preferences. For example, people’s support needs around nutrition and hydration were recognised and addressed. Attention was paid to people’s safety, and the service took action when safety issues were identified.

There was a calm and friendly atmosphere at the service. There were enough staff working at the service to keep people safe and uphold good standards of cleanliness. The registered manager and the owner worked closely with staff and people using the service to help ensure appropriate standards of care and support were provided. The service encouraged concerns to be raised informally and responded to them.

The service encouraged people to keep in contact with friends and family, and to have visitors. People’s cultural backgrounds were considered as part of the care provided.

There was sufficient ongoing training and support of staff to equip them with the skills needed for their roles, particularly due to the owner’s investment in ongoing training for all staff in a national care qualification.

We made two recommendations in this report based on minor concerns identified during the inspection. We recommended that the registered people look into specialist training on safer recruitment of staff, as written references were not consistently in place for new staff before they started working at the service. We also recommended that specialist activity guidance be sought, particularly with a dementia focus, to broaden staff awareness and skills on how different people using the service may engage.

At our last inspection of this care home, the provider was not compliant with two standards. We had found that arrangements for the recording, safe administration and disposal of medicines were not appropriate, and an accurate record in respect of each person was not always maintained. The provider sent us an action plan addressing our concerns.

At this inspection we found that improvements had been made. There were now records to account for all medicines coming into the service and those being returned to the pharmacist. Medicines management systems ensured that there was enough of each person’s medicine without excess stock accumulating. Checks of records against remaining stock found no overall discrepancies. We found that people were protected against the risks associated with medicines because the provider now had appropriate arrangements in place to manage medicines.

We also found that people’s care plans were now being kept up-to-date and included relevant information such as about their mobility and dementia care needs. Where someone needed their fluid intake monitored, this was up-to-date and without significant gaps. People were protected from the risks of unsafe or inappropriate care because accurate records were maintained.

We did not speak with people who use the service on this occasion. We spoke with a visiting healthcare professional who told us, “you’re not going to get better than this home.”

We spoke with nine people who use the service and five visitors including relatives and a healthcare professional. People praised the service and the care provided. Comments included, “all the staff are compassionate and patient” and “they’re knowledgeable, attentive and professional.” Relatives told us they had chosen this service after visiting a range of care homes. “We’re glad we made that decision,” one relative said.

Feedback and observations indicated that staff and the management team knew people as individuals, and responded to people’s care needs. We found that the service liaised well with health professionals. Care was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found that people were protected from the risks of inadequate nutrition and dehydration. They were cared for in a clean, hygienic environment, and were protected from the risk of infection.

However, we found that people were not always protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements for the recording, safe administration and disposal of medicines were not in place.

We also found that people were not always protected against the risks of unsafe or inappropriate care arising from a lack of proper information about them. Accurate records in respect of each person, including up-to-date care plans and fluid monitoring charts, were not always maintained.

We spoke with ten people who use the service and three visitors. People were positive about the service and the care provided. Comments included, “it’s an extraordinary place. I thoroughly recommend it”, and “this is the best home in the area.”

“The staff are wonderful,” one person told us. We observed that staff interacted warmly and inclusively with people who use the service. They worked as a team and attended to people in an unhurried and pleasant manner. They were appropriately trained and supported. We noted also that the environment was safely maintained.

There were systems in place aimed at ensuring people experienced care and support that met their needs. However, we found there was a failure to review and update falls risk assessments after people had had falls. This may have failed to protect people against inappropriate or unsafe care.

There has been no registered manager working at the service since March 2012. This is a breach of the provider's registration conditions. We are writing separately to the provider about this.

We spent most of our visit talking with and observing people using the service. People told us they were satisfied with their care. They said they were treated with respect and were involved in decisions about their care and treatment. People told us they could talk to staff and they had support from their relatives or friends. They told us they could choose what, where and when to have their meals. We saw care workers responding to people's requests by serving meals at places of their choice. Some people told us that they were not consulted in advance about their preferences of meals. However, they said the home always provided them with meals that met their cultural and dietary preferences. The following were some of people’s comments:

"The home helps me decide what I want".

"The home is brilliant".

People told us staff listened to them. They said the home was pleasant and comfortable. Observations indicated that people were comfortable and presentable. We saw people using appropriate equipment that ensured their safety and assisted them to be as independent as possible. People told us they were visited by families, friends, and others such as a hairdresser and health professionals. We saw people watching television, reading newspapers or interacting with each other and staff. The following were some of people's comments:

"All the staff here are willing to help."

"Sometimes we have people who come here to entertain us. This is nice".

"I am quite happy here".

People told us they felt safe living in the home. They told us they knew who to speak to if they had a concern. People told us the manager and the owner were both approachable and they could speak to them if they had any worries. From observations it was evident people were able to talk to and be listened to by staff. People told us staff responded to their queries quickly. When a call bell in a bedroom was pressed by a person using the service, a staff member answered the bell within less than a minute. This gave people confidence that they were safe.

We observed staff talking to people and asking them if they wanted anything or if they were satisfied with their meals. People told us they could talk to the manager and owner of the home.

Relatives and visitors told us they were satisfied with the care and support available at the home. They said they could visit people and staff at any time of the day. The following were some of people's comments:

"The home is highly regarded".

"The staff are excellent. I give them full marks".