Eldon Housing Association Limited

Eldon Housing Association Limited is an ‘extra care housing’ service. Extra care housing services provide personal care to people living in their own flats within housing schemes. Eldon Housing Association Limited provided personal care to people in two buildings in Croydon: Lindsay Court and Westdene. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 44 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Risks to people were not adequately assessed and plans to mitigate and manage risks were not sufficiently detailed, instructive and personalised. Medicines management was not always safe. This put people at risk of potential harm. However, we found no evidence anyone had been harmed and people and their relatives said they felt the service was safe. There were systems and process in place to protect people from abuse and improper treatment. There were enough staff to meet people’s needs and new staff were recruited safely. Infection prevention and control in both schemes was good. Staff learned lessons when something went wrong.

People’s needs and choices were assessed and their needs and preferences were met. However, their assessments and care plans did not contain sufficiently detailed and person-centred information. Despite this, staff knew people’s needs and preferences well and provided them with the right care and support. New staff received induction training and all staff completed regular training and were well supported to do their jobs. Staff supported people to eat and drink enough and maintain a balanced diet and worked with other agencies to provide people with consistent, effective and timely care. Staff supported people to be active and to live healthier lives and access healthcare services and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s assessments and care plans did not contain sufficient information about their equality, diversity and human rights or any information about any protected characteristics they may have. However, staff knew people well and understood and respected their diversity. People were well treated, and staff were friendly, kind and caring. People and their relatives were involved in their assessments, planning their care and reviews of their care and support, and were encouraged to participate in making decisions about their care. People and their relatives felt they were always treated with respect and dignity. People were supported to be as independent as possible.

People’s care and support was not recorded and planned in a personalised way and people’s individual communication needs had not been sufficiently recorded in their assessments and care plans. However, staff communicated with people in ways they could understand because they knew people’s individual ways of communication well. People were supported to maintain relationships, follow their interests and participate in activities. There was a complaint policy and procedure in place and complaints were dealt with appropriately and to people’s satisfaction. People could be provided with end-of-life care and support if required.

The provider’s quality assurance systems and processes were not always effective. The provider’s audits had not identified the issues we found during our inspection. There was a positive culture and the care and support people received was inclusive and empowering and achieved good outcomes for them. The provider, managers and staff understood their duty to communicate openly and honestly when something went wrong. The provider engaged people, their relatives, and staff in the development of the service. There were systems and processes to support continuous learning and improving care. Staff worked well in partnership with other services, organisations and agencies to provide people’s care and support.

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

Rating at last inspection

The last rating for this service was good (published 27 June 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, person-centred care and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Eldon Housing is an ‘extra care’ service. Extra care services provide personal care to older people living in their own flats within schemes. Eldon Housing provided personal care to people in three schemes: Lindsay Court and Westdene in Croydon and Joan Nightingale House in West Sussex. Some people were living with dementia and some had physical disabilities. There were 43 people receiving the regulated activity personal care at the time of our inspection.

The service had a registered manager in post. 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.

The provider had audits in place to monitor and assess the quality of service. However, although audits in relation to medicines management and infection control required improvement. In addition auditing systems to check the service was providing care in line with the MCA required improvement. Staff received training in managing medicines and the provider was planning to introduce assessments to check the competency of each staff member.

There were enough staff to care for people and people received consistency of care from staff who knew them well. Staff were recruited following robust procedures to check their suitability.

Risks relating to people’s care were reduced, such as those relating to falls and moving and handling. The provider assessed risks and put management plans in place for staff to follow. Risks relating to infection control were also reduced as staff followed suitable infection control procedures. The provider told us they would introduce robust infection control audits to check procedures always met best practice.

People were safeguarded from abuse and neglect as staff understood the signs people may be being abused and how to respond to keep people safe. Staff were confident to whistleblow if they observed poor practice. In addition the provider monitored significant events such as safeguarding and accidents and incidents to check people received the right support and to see how the service could learn and improve from the events.

People received their choice of food and drink and particularly enjoyed the food served in the restaurants on site. Staff supported people to maintain their health and to access healthcare services where this was part of their care package.

The management and staff did not always know the action to take if they suspected a person may lack capacity in relation to the care, in line with the Mental Capacity Act (MCA) 2005, such as assessing their mental capacity and making decisions in people’s best interests. In addition the provider was not always clear on the full process involved in depriving people of their liberty lawfully in an extra care setting. However, they had taken the action required of them by notifying the local authority of people who needed to be deprived of their liberty to keep them safe. The registered manager told us they would improve in relation to these areas.

Staff were supported to meet people’s needs through a programme of induction, training, supervision and appraisal.

Staff were caring and treated people with dignity and respect. People were involved in decisions about their care and were encouraged to maintain their independence as far as possible. Staff knew the people they supported and developed good relationships with them.

People’s care plans were sufficiently detailed and reliable to guide staff on caring for people. People were involved in developing their care plans.

People were provided with the opportunity to take part in group activities they were interested in. This helped reduce their risk of social isolation.

The provider investigated concerns and complaints and people had confidence in how the provider would respond to any concerns they raised.

The managers and staff understood their role and responsibilities. The provider had systems to communicate with and gather feedback from people and staff.

We visited the agency office and made a separate visit to the Association's two extra care schemes that provide domiciliary care services. One of the schemes was undergoing major refurbishment at the time of our inspection. We met with thirteen people using the service and one relative during the course of our two visits. We spoke with five members of staff, the housing manager, registered manager and a scheme manager.

All the people we spoke with were pleased with the service and said they were involved in their care and support. People felt that care staff respected their privacy and dignity and helped them to remain as independent as they could. Comments included, 'I am very happy here and I like my independence', 'The staff are very sociable and they shop for me,' and 'The girls are great and they help me with anything I need.'

People using the service complimented the staff and described them as 'wonderful staff'; 'there's not one bad one' and 'very, very kind people.'

Staff told us they liked working for Eldon Housing Association. When asked what the service did well one staff member said, 'There is good care, they always deal with any problems.' Another member of staff told us management were helpful and there was always someone to talk to if needed.

Care records provided up to date information about people's needs which meant that staff understood how to support each person and provide consistent care.

There were robust arrangements in place to protect people from the risk of abuse. People spoken with confirmed that they felt safe and had no concerns regarding the care provided.

The provider had effective quality monitoring systems and feedback from people using the service was used to improve the support they received. We found the process for staff recruitment was robust and well managed. There had been some recent changes to the staffing structure but the provider was monitoring the staffing arrangements accordingly.