We carried out a review of the data available to us about Elliott House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Elliott House, you can give feedback on this service.
Elliott House is a residential care home providing personal care to up to nine people who live with a learning disability, autism and/or associated health needs. At the time of inspection, there were eight people living in the home.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
People’s experience of using this service and what we found
Based on our review of safe, effective and well-led the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The service was maximising people’s choice, control and independence. The care was person-centred and promoted people’s dignity, privacy and human rights. The values and attitudes of the registered manager and staff ensured that people using the service lead confident, inclusive and empowered lives.
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.
Right Support
The registered manager considered people’s needs when deciding on staffing levels. There were enough staff to support people to go out to undertake activities and enjoy hobbies, as well as support people with their needs in the home.
People were supported to eat and drink enough and to make their own meals if they chose to. People were able to eat together at the same time but could also eat alone if they wished.
Right Care
Risk assessments were in place regarding risks to people’s health and safety. For example, risks were considered for people to undertake specific activities outside of the home. Systems were in place which ensured safety checks and maintenance were completed.
People were supported to access healthcare professionals, for example, their GP. People received their medicines as prescribed.
People’s needs were assessed before the provider offered people a service. The provider had a training programme in place which covered a range of topics, relevant to people’s needs.
Right Culture
The new registered manager and provider had responded positively to the concerns we raised in our previous report. Action had been taken immediately and the ethos and culture of the service had changed for the better. Therefore, outcomes for people had improved and this was evident during our visit. The use of restrictive practices had been reviewed and people were no longer restricted in what they could do. Staff had received training in safeguarding and were aware of what to do if they were to witness or suspect abuse.
Staff were responsive to people’s requests and people could choose how they spent their time. People enjoyed various home-based activities and regularly went out to local places such as cafes.
The culture in the home was positive, inclusive and empowering. People and their relatives were consulted and included in decisions made about daily life at the home. The registered manager had systems in place to ensure there was continuous learning in the home.
For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
At our last inspection this service was rated requires improvement (published 11 June 2021). We found breaches of the regulations in relation to safeguarding, restrictive practices and governance. The provider met with us and provided an action plan after the last inspection to tell us what they would do and by when to improve.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We undertook this focused inspection to check if the provider had made improvements and if they were now meeting the legal requirements. This report only covers our findings in relation to the key questions Safe, Effective and Well-led.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elliott House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Elliott House is a residential care home providing personal care to up to nine people who live with a learning disability, autism and/or associated health needs, who may experience behaviours that challenge staff. At the time of inspection, there were eight people living in the home.
People’s experience of using this service and what we found
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.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right support:
• The environment was suitable for people to live a life like any other citizen. The service is located in a residential area with access to local facilities.
Right care:
• There were some daily practices which were applied to every person, which meant their care and support was not always person-centred.
Right culture:
• Risks were not always in accordance with best interest and least restrictive principles. Restrictive practices were not challenged and it was not clear how people’s skills were being built upon to further improve their choice, control and independence.
The provider had policies and procedures in place designed to protect people from the risk of harm and abuse, however, the procedures had not been followed correctly. The home had restrictive practices in place and care was not always person-centred.
Systems were in place which ensured safety checks and maintenance were completed on water, gas and electric installations. However, action had not been taken to reduce the temperature of the hot water and a waste bin placed under a fire extinguisher was replaced in the same position after we had advised the registered manager and it had been removed.
The provider had systems in place to monitor the quality of the service but these systems did not identify the concerns we found during the inspection.
The provider followed a recruitment procedure which ensured pre-employment checks were in place before new staff started work at the home and there was a staff training programme in place.
People were supported with their specific dietary requirements, for example, pureed food was provided for those who needed it. People received their medicines as prescribed. People were supported to access healthcare services, for example, seeing the GP and having annual healthcare checks.
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 8 January 2019).
Why we inspected
The inspection was prompted in part due to concerns received about safeguarding. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led.
We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elliott House on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.
We have identified breaches of three regulations in relation to keeping people safe, restrictive and blanket practices and governance.
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 and meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
At the time of the inspection eight people were living at the home. The service is a residential home that has been developed and adapted in line with the values that underpin the Care Quality Commission's 'Registering the Right Support' and other best guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can lead as ordinary life as any citizen.
The home had a registered manager. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.
This comprehensive inspection took place on 27 and 28 November 2018. The inspection was unannounced, which meant the staff and provider did not know we would be visiting.
At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good. There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
At our last inspection in March 2016 we found the provider was required to improve the recording of the administration of people’s prescribed medicines and staff recruitment processes. At this inspection we found the provider had made the required improvements to accurately record medicine administration and staff recruitment procedures.
People were protected from avoidable harm, neglect, abuse and discrimination by staff who understood their responsibilities to safeguard people. Risks to people had been assessed and plans minimised potential risks, whilst promoting people’s independence. There were sufficient suitable staff deployed to support people safely who been enabled to develop and maintain the necessary skills to meet people’s needs. There was a positive attitude to learning from incidents and near misses.
People's care and support were delivered in accordance with detailed assessments and care plans, which were reviewed regularly. People were supported to eat a healthy balanced diet. 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. The registered manager had developed effective partnerships with relevant professionals and quickly referred people to external services such as GPs, neurologists, dieticians, opticians and dentists, when required to maintain their health.
Staff supported people to maintain high standards of cleanliness and hygiene in the home, which reduced the risk of infection. Staff followed required standards of food safety and hygiene, when preparing or handling food.
There were positive, caring relationships between people and the staff who supported them. The provider supported people to be actively involved in decisions about their care and support. The service people received had a very positive impact on their dignity, independence, self-esteem and confidence.
People were supported by regular staff who were kind and caring, which had a positive impact on their mental wellbeing. Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights.
People were supported to take part in activities that they enjoyed and to maintain relationships with their families and those that mattered to them. This helped to protect them from the risk of social isolation.
The registered manager sought the views of people and their relatives and used these to drive improvements in the home. People and relatives were confident that the staff would listen to them if they had any concerns and would take the necessary action to deal with them.
The service was well led. The vision, values and culture of the service were understood and delivered by staff whilst they supported people. The safety and quality of support people received was effectively monitored and identified shortfalls were acted upon to drive continuous improvement in the service.
Further information is in the detailed findings below.
The service provides accommodation and support for up to nine people who have learning disabilities or autism. Elliott House aims to support people to lead a full and active life within their local community and continue with life-long learning and personal development. The service is a converted house, within a residential area, which has been furnished to meet individual needs. At the time of our inspection nine people were using the service.
The service had a registered manager in place. 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 service is required by a condition of its registration to have a registered manager.
There were enough staff to keep people safe and support people to do the things they liked. The provider had recruitment process in place to identify applicants’ who were suitable to work with people. However, the registered manager had not always followed this process through to completion to ensure a full employment history would be available for all staff. They took action following our inspection to rectify this and we will be looking at this again at our next inspection to ensure these improvements have been sustained.
Staff understood how to keep people safe from abuse. People’s safety risks were identified, managed and reviewed and staff understood how to keep people safe at home and in the community. Systems were in place to protect people from the risks associated with medicines. We found three medicine recording errors. The service had identified this as an area of improvement prior to our inspection and was taking action to ensure medicine records would always be accurate.
People living at Elliott House received care and support from knowledgeable and experienced staff. Many of the staff had supported people living at the service for some years and demonstrated an in-depth knowledge of people’s needs and aspirations. Staff were supported to undertake training to support them in their role, including nationally recognised qualifications. They received regular supervision and appraisal to support them to develop their understanding of good practice and to fulfil their roles effectively.
Staff sought people’s consent before they provided their care and support. Where some people were unable to make certain decisions about their care the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed. Where people had restrictions placed upon them to keep them safe, the staff continued to ensure people’s care preferences were respected and met in the least restrictive way.
People were supported to have their health needs met by health and social care professionals including their GP and dentist. People were offered a healthy balanced diet and when people required support to eat and drink this was provided in line with professional’s guidance. People received the support they needed to manage their epilepsy.
For those people who needed support to manage their behaviour, behaviour support plans had been drawn up by the provider’s assistant psychologist. Staff had received training in positive behaviour support, understood the triggers for people’s behaviours and ensured people were sufficiently occupied during the day. When restraint was used to keep people safe in line with their behaviour support plans, these incidents were recorded and reviewed by the registered manager to ensure they were appropriate and proportionate.
Staff supported people to identify their individual wishes and needs by using their individual methods of communication. People were encouraged to make their own decisions and to be as independent as they were able to be.
Relatives told us people were happy and content in the home. We observed people appeared relaxed and calm in the company of staff who they readily approached for support when required.
Relatives told us they had no reason to complain but knew how to do so if required and that the staff always took immediate action if they had any concerns. The registered manager listened to people’s comments and implemented identified learning from incidents and accidents.
The senior staff provided clear and direct leadership and effectively operated systems to assure the quality of the home and drive improvements.
Relatives told us the home 'exceeded their expectations' and they were 'delighted' with the care people received. They told us the staff were skilled and they knew the best ways to provide care and support for their relative. We saw evidence that people were engaged in many activities of their choosing.
Staff told us they felt well trained and supported to provide a good service for people. Their records evidenced an extensive training programme. Staff received regular supervision and annual appraisals which meant the provider had ensured they were well trained and supported to provide safe and appropriate care and support.
Before people moved in to the service, the provider worked with them to make sure they were happy to live there. The staff checked that people were happy to receive support they offered to them, as far as people were able to communicate this. Where restrictions were in place, this was assessed as being necessary to protect people.
People's support plans reflected their needs and the provider made sure that plans were up to date. Staff followed people's support plans to provide appropriate care and support to people.
Where people's behaviours were challenging and potentially harmful for others, the provider worked with other professionals to minimise the impact this had on people using the service.
The provider regularly reviewed the quality of the service to ensure that enough well trained staff were available to meet people's needs and so that improvements could be made to the service provided.