Care home management support provider Fulcrum tells CHP how it helped transform Eastcotts Nursing Home in Haverhill, Suffolk from an Inadequate in all areas to a Good in all areas service.
Eastcotts Nursing is registered for 59 service users. It specialises in providing residential services for older people and provides nursing and dementia care.
Regulation breaches produce Inadequate rating
Eastcotts was inspected by the CQC in early April 2019. During the CQC feedback session after the inspection, the provider, Indra Rajeevan – known as Raj – realised that the home was failing in terms of compliance and so was not in a good position. He immediately engaged Fulcrum.
The CQC published its report in July 2019 and rated all areas as Inadequate. Eastcotts was put into special measures. The CQC had identified breaches of seven regulations and took enforcement action to impose conditions on registration.
Fulcrum was tasked with addressing the significant concerns: resolving the poor care practices, improving recruitment practices, making the quality assurance systems more effective and assisting and mentoring a newly recruited manager.
Addressing the concerns
Experienced Fulcrum consultant, Trisha Kelly, began making regular visits to Eastcotts. Initially, she undertook compliance audits, especially concentrating on assessing care plans and medications. The feedback from the audits, along with the CQC’s report, allowed her to devise an action plan to address the home’s shortcomings.
There were no quality governance systems in place, so Trisha started from scratch. She carried out a thorough review of the care home’s documentation, evaluating risk assessments and mental capacity assessments. The outcomes were also added to the action plan.
With help from Trisha, the home’s new manager began to implement the action plan. Progress was reviewed regularly, to ensure that the identified areas were being completed.
To improve practices at the home, Trisha put in place new systems and processes. These included a falls tracker and best practice files. She also implemented Personal Emergency Evacuation Plans (PEEPS) for residents that identified risks and impairments that might impede individuals evacuating the home in an emergency. And an electronic auditing system was introduced, which scheduled audits of various systems and plans at certain times each month.
Trisha instituted flash meetings, daily meetings with key staff and heads of departments, like nurses, the manager, the housekeeper, the chef, and so on. These meetings addressed clinical and staff issues and improved the effectiveness of communication across the home.
A key initiative that Trisha introduced was the implementation of a detailed handover document. Her template detailed what needed to be recorded by staff in a 24-hour period to enable a valuable and effective handover to the next shift, or as a record for a staff member to check for any updates while they had been on leave.
A number of trackers were instituted at the home, ensuring that changes and improvements could be assessed on an ongoing basis. This included a Deprivation of Liberty Safeguards (DoLS) tracker to monitor DoLS applications and outcomes.
Trisha instituted champions roles and files and ingrained the champions approach at Eastcotts by holding supervisions with the staff to introduce them to the practice. The skills and knowledge needed to provide care for residents with diverse or complex needs is broad. Trisha created champions for certain areas of care and explained to staff the importance of doing this so that in-depth skills and knowledge were spread across the team.
To involve staff more in the care of the residents, Trisha helped initiate the appointment of champions for different areas, including falls, tissue viability, infection control and so on.
Finally, Trisha instituted a system of staff competency assessments that were used to evaluate staff capabilities and determine their training and development needs.
Remarkable ratings improvement from Inadequate to Good
Eastcotts was inspected by the CQC again at the end of October 2019. It attained a two-step improvement in all ratings, gaining a Good rating. Going from red across the board to green in all areas is a remarkable achievement and reflects on the hard work put in by Trisha, Raj, the manager and all the Eastcotts staff.
The Eastcotts senior nurses, team leaders, and the new manager, Marie Smale, all worked hard to implement the changes made by Fulcrum. Marie was a key driver of this collective effort and her influence in the transformation was recognised in the CQC’s report, which said: “Staff felt very well supported by the registered manager. The registered manager and provider completed regular audits and checks, which ensured levels of quality and safety were maintained at the home. The registered manager understood and met their regulatory responsibilities.”
Others noted: “The manager has tightened things up” and the CQC added: “At this inspection we found a number of improvements had been made by the provider and registered manager.”
The CQC also noted Fulcrum’s contributions, reporting, “The consultancy company initially employed by the provider to commence the immediate improvements needed after our last inspection continued to be employed to undertake their own checks on the quality of the care provided and to make sure necessary improvements were being made.”
The feedback from the April CQC inspection and the resulting Inadequate rating was a real upset for Eastcotts. “We couldn’t afford for the reputation of the home to be damaged by this, so we needed to act quickly,” said Raj. “But with Fulcrum’s help, we’ve achieved a Good rating again and we couldn’t be more delighted.
“Trisha’s knowledge and experience have been indispensable. We’re back to where we should be and Eastcotts is being managed and run by a first-rate and very capable team. The home is thriving, the staff are happy and we are providing the excellent levels of care that our residents deserve.”
Fulcrum continues to work with Eastcotts and the home is now striving to achieve its first Outstanding rating.