Nurtrio

About the service

The Eleanor Centre provides care and support through a domiciliary care service and a supported living service to people who live in their own homes. The service provides support to people with a learning disability or autism spectrum disorder, older people, people living with dementia, and mental health needs. It also supports people with a physical disability, sensory impairment, and younger adults. At the time of our inspection there were 84 people in receipt of domiciliary care and 48 people in supported living receiving a service from this provider.

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

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff did not understand and demonstrate a good working knowledge of the Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005. Information about risks was not always up to date and safety concerns were not consistently identified or addressed quickly enough. There was not always enough staff to support people. The service was not always clear in its responsibilities and role in relation to medicines. National guidelines were not always followed, this also applied to non-prescribed medicines. Recruitment systems were robust and ensured the right people were recruited. People were supported by staff to pursue their interests, had a choice about their living environment and were able to personalise their rooms.

Right Care:

People’s care treatment and support plans did not always reflect their range of needs. However, we observed positive interactions between people and staff and people were treated with dignity and respect. Staff had received safeguarding training and knew how to keep people safe, however, further training to support staff to manage people in the least restrictive way was required. People were supported to attend regular health checks and systems and processes were in place to ensure continuity of care. People could make choices and were supported by staff. People told us they were supported to plan menus’ and could have snacks when they wanted.

Right Culture:

The service did not have well developed statements of its vision and values. Support from managers was inconsistent and staff and managers did not share an understanding of the risks and issues facing the service. Staff did not have regular opportunities to discuss best practice in a learning and supportive environment and there is limited evidence of learning, reflective practice, and service improvement. Staff supervision and support systems were not consistent and did not meet their needs. Lessons were not always learned and shared with staff. People and those important to them were not always involved in the planning of care or decisions about their care and treatment. People, their families and staff received regular updates about the service and questionnaires to support further improvements.

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

Rating at last inspection

The last rating for the service under the previous provider was good, published on 30 January 2019.

Why we inspected

The inspection was prompted in part due to concerns received about risk, staffing and culture. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Eleanor Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the need for consent, safe care and treatment, good governance, and staffing. We have made a recommendation the provider ensures staff have received the appropriate training to care for people safely and in a way the person would want.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

People’s experience of using this service: -

The way staff responded to people’s individual needs had been very good. The support staff had provided had been flexible and tireless, which had enhanced the quality of specific people’s lives. This had enabled people to live more independently, access community facilities, to be more included in society and to be prepared for nursing interventions. There was a strong sense of staff empowering people to make their own decisions and including them when important decisions were made such as staff recruitment. Staff supported people to develop coping mechanisms to manage their mental health needs, had taught people cooking skills in order to be independent and liaised with professionals on the use of assistive technology. In discussions, staff described the ethos of using all means possible to support and reassure people when they had anxious or distressed behaviours to avoid the use of medicines to calm people. The care plans had comprehensive information for staff in how to meet people’s needs.

People were protected from abuse and avoidable harm. Staff had completed training in how to safeguard people and risk assessments were completed to identify potential hazards. These measures provided staff with knowledge about what constituted abuse and the action to take should they have concerns. The risk assessments helped staff to minimise risk whilst ensuring people still made their own decisions and risk-taking was manageable and as safe as possible.

Staff supported people to access a range of health care professionals when required and ensured they received their medicines as prescribed. Staff liaised with health professionals as part of planning and delivering care and support.

People had support to meet their nutritional needs when this was part of their support plan. Staff assisted people to plan menus, shop for ingredients and prepare meals of their choice.

Staff had developed good relationships with people and treated them with dignity and respect; they encouraged people to be as independent as possible. Information was made accessible to people in different formats, for example easy read versions, symbol cards and staff training in sign language.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had received training in mental capacity legislation and understood their responsibilities. They knew how to gain consent before delivering care tasks and ensured people could make their own decisions and choices.

Staff were recruited safely and there were sufficient numbers to support people safely. Those people who required one to one support had this planned and provided; this was confirmed in discussions with staff.

Staff had access to training, induction, supervision and support. All staff spoken with described management support as accessible and training as relevant to their role. Staff were provided with personal protective equipment to help minimise the spread of infection; staff had completed training in infection prevention and control.

There was a quality monitoring system which ensured checks and audits were carried out, people’s views were obtained and listened to and shortfalls were addressed. Accidents and incidents were analysed so that lessons could be learned. Senior management and the Board of Trustees had oversight of the service and completed regular checks.

The culture of the service was open and people felt able to raise concerns.

A full description of our findings can be found in the sections below.

Rating at last inspection: Good (published 6 July 2016).

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

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

The service had a registered manager in post as required by a condition of registration. 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 registered provider is reviewing the registered manager post so the person may change in the near future.

We undertook this inspection on the 3 June 2016. We gave the service 24 hours’ notice as we wanted to be sure there was someone available at the main office to speak with us.

We found the service was well-managed and had good systems in place to recruit staff safely and to ensure there was sufficient available to meet people’s needs. Employment checks had been carried out so people could be sure those staff supporting them were suitable to work in care settings.

Staff knew how to safeguard people from the risk of abuse and harm. We saw staff had policies and procedures to guide them and undertook safeguarding training so they could recognise abuse and know how to report it. Staff completed risk assessments to enable them to identify any areas of concern and plan interventions to minimise risk whilst at the same time supporting people to make choices about aspects of their lives.

We found the registered provider and staff team acted within the law in relation to supporting people who lacked capacity to make major decisions for themselves. They consulted with people and took advice from health and social care professionals about best interest decisions. We saw staff provided information to people who used the service which helped them to make choices about aspects of their lives.

We found staff supported people to maintain their health by monitoring their needs and assisting them to access community health professionals when required.

Staff supported people to prepare meals and to have a well-balanced diet and fluid intake. They helped people to shop and plan the weekly menu so choices were varied. Staff monitored people’s nutritional intake and weight and took action when there were any concerns.

The support staff provided helped to maintain people’s independent living skills which included personal support, housekeeping and their tenancy requirements. We observed positive interactions between staff and the people they supported; staff were kind and patient and gave people time to respond to questions and requests. Relatives had very positive comments about the staff team and felt they supported their family members to have a good quality of life.

We saw staff supported people to access community facilities so they could feel included in society. They also assisted people to participate in activities within the service to help them pursue individual interests and to interact with other tenants. Staff supported people to maintain relationships with their relatives.

We saw staff completed training so they had the skills required to support people. Staff were supervised and had appraisal to help with their development. New staff completed an induction and were supported by more experienced staff until they felt ready to assist people alone.

The service had a quality monitoring system in place. This consisted of audits, observations of practice, assessments of record keeping and visits to people to check if there were any areas to improve. The service included people and their relatives in this process so they were able to express their views. There was a complaints policy and procedure and people felt able to raise concerns in the belief they would be addressed.