• Care Home
  • Care home

Archived: Eleanor House

Overall: Inadequate read more about inspection ratings

19 Eleanor Street, Grimsby, Lincolnshire, DN32 9DT (01472) 359330

Provided and run by:
Kalbro Investments Limited

All Inspections

6 and 7 July 2015

During an inspection looking at part of the service

We inspected Eleanor House on 6 and 7 July 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Eleanor House is registered to provide accommodation and personal care with nursing for 17 adults who may be living with mental health or dementia related conditions. Accommodation is located on the ground and first floors, with both shared and single rooms. There is lift and stair access to the first floor. The service is situated close to local amenities.

The manager of the service became the registered manager on 13 May 2015. 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.

We carried out an unannounced comprehensive inspection of this service on 8 and 9 January 2015. During this inspection we found the registered provider was in breach of regulations 9, 10, 11, 15, 17, 18, 22 and 23 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2010. These relate to Regulations 12, 17, 13, 15, 10, 11 and 18 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. This meant that the registered provider was not meeting the regulations relating to safeguarding people who used the service from abuse; ensuring staff respected people who used the service and involved them in their development of their care and treatment; ensuring treatment or support was delivered in line with people’s needs; ensuring consent from people or appropriately appointed persons was obtained; ensuring sufficient numbers of qualified, experienced and skilled staff were in place; ensuring staff received adequate training and support and assessing and monitoring the quality of service provision.

We also found a breach of regulation 18 of the Care Quality Commission [Registration] Regulations 2009 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2010. This meant the provider had failed to notify us of incidents occurring in the home.

We undertook a focused inspection on 6 and 7 July 2015 to check whether the service was now meeting legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Eleanor House on our website at www.cqc.org.uk.

During this inspection we found that since the inspection in January 2015 the registered provider had implemented a range of audits and checks; however we found these were ineffective and failed to highlight shortfalls within the service.

We found that the registered provider had continued to fail to take appropriate action to recruit additional staff to ensure there were sufficient numbers deployed within the service.

We saw that the registered provider had taken action to ensure staff had received training about the Mental Capacity Act [MCA] 2005. However, we found that where people lacked capacity staff continued to fail to adhere to the MCA Code of Practice. Staff did not understand the principle that people needed to be able to make decisions including unwise choices. Staff did not explore the strengths people who used the service had and therefore were not supporting individuals to make decisions. Also staff failed to ensure, when appropriate, that ‘best interest’ decisions were made. Staff had not always had regard for the professional code of conduct in relation to the MCA when administering covert medicines.

We found that the registered provider had developed people’s care records but more work was required on these to ensure they provided staff with accurate information to enable to them keep people safe.

We found that the registered provider had taken action to ensure staff knew how to report safeguarding concerns. Staff had received training to ensure they knew how to manage the behaviours that may challenge the service. However, more progress and evidence of sustained improvements was required. We found that the registered provider remained non-compliant with this regulation.

We saw that the registered provider had taken some action to ensure people were provided with an environment that was safe. However, more work was required on the electrical wiring of the building to ensure the registered provider became compliant with this regulation.

During our focused inspection we saw that the registered provider had taken action to enable people’s involvement in decisions and promotion of their wellbeing. However, more progress and evidence of sustained improvements was required to ensure the registered provider became compliant with this regulation.

We found the registered provider had taken action to ensure staff had the right skills to carry out their roles. However, more progress and evidence of sustained improvements was required to ensure the registered provider became compliant with this regulation.

Since the inspection in January 2015 the registered provider had taken action to ensure notifications about significant incidents were reported correctly. However, more progress and evidence of sustained improvements was required to ensure the registered provider became compliant with this regulation.

We have judged these latest findings demonstrate the breaches of regulations continue to have a major impact on the people who used the service. This is being followed up and we will report on our action when it is complete. As a result of the continued non-compliance we are considering our regulatory response.

The registered provider has given us written assurance they will not admit any further people to the service until we are satisfied appropriate arrangements are in place to ensure people’s health, safety and welfare are protected and the registered provider is compliant with all of the relevant regulations.

08 and 09 January 2015

During a routine inspection

This inspection took place over two days on 8 and 9 January 2015 and was unannounced.

Eleanor House is registered to provide accommodation and personal care with nursing for 17 adults who may have mental health or dementia related conditions. Accommodation is located on the ground and first floors, with both shared and single rooms. There is lift and stair access to the first floor. The service is situated close to local amenities.

There had not been a registered manager at this location since 5 November 2013. 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. A new acting manager had been appointed following our visit in August 2014. Whilst we found they had plans for improving the service, we found they had not yet implemented the requirements that were needed that would ensure safe and effective care was delivered.

At our last inspection on 21 August 2014 we found the registered provider was failing to have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. We served a Warning Notice on the registered provider telling them where they were failing and requiring them to address the issues before 7 November 2014. We also asked the registered provider to make improvements to assessment and planning of care, safeguarding people who used the service from harm, maintenance of the building, staff training and development to ensure the service was compliant with regulations associated with the Health and Social Care Act 2008.

The registered provider sent us an action plan telling us the improvements they were making. During this inspection we looked to see if these improvements had been made. We found a number of continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The registered provider had not responded effectively and promptly to our concerns; very little improvement had been made to ensure people received care that was safe, effective and protected them from harm.

We found people’s safety was being compromised and they were at serious risk of harm because care was not being assessed and planned in a way which met their changing needs. An action plan had not been implemented to address the preliminary findings of an on-going safeguarding investigation. Incidents involving the management of behaviour that may challenge the service and others had not been appropriately reported and staff were unclear about their responsibilities about this. Recruitment systems were not safe. There was no system in place to assess staffing levels required to meet people’s changing needs. There were insufficient numbers of staff to enable people to have access to appropriate community activities

Staff did not have the knowledge and skills they needed to carry out their role and responsibilities effectively. They were not clear about care support to prevent people sustaining pressure damage; they were also not clear about the management of a specialist feeding tube (PEG) for a person who used the service.

The human rights of people who may lack capacity to take particular decisions were not protected. Staff understanding about the use and principles of the Mental Capacity Act (MCA) 2005 was unclear. Staff were using physical interventions which had not been formally agreed which meant they could be restraining people unnecessarily and was outside the law. Staff had not received training about safe use of physical interventions.

There was no evidence of capacity assessments and best interest meetings to support consent for people who did not have capacity to make informed decisions.

Areas of the building and furnishings required renewal and repair to ensure people’s safety and the appropriate standard of décor and comfort was maintained.

People we spoke with were positive about the care they received, however this was not supported by our observations and feedback from health professionals.

We were concerned some people living at the home were isolated because they did not leave their rooms regularly or at all, and there were not enough opportunities for people to engage in hobbies, social interests or activities either as a group or on an individual basis.

The culture of the service was not open and transparent with professionals who were trying to support the service, such as the local adult safeguarding team and there was a lack of reliable information to show the service was being run in the best interests of those living there.

Inspectors found that improvements required as a result of a previous inspection had not been made, and we also identified further concerns. As a result CQC is considering all options available to them in relation to protecting people who use the service.

Breaches were found in regulations 9, 10, 11, 15, 17, 18, 22 and 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. There was also a breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We have deemed these posed a potential significant impact on people who used the service. This is being followed up and we will report on any action when it is completed. 

21 August 2014

During a routine inspection

This inspection was carried out by two social care inspectors following a concern that had been raised with the local authority that people who used the service may not be appropriately safeguarded from harm.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There was evidence the premises had not been safely maintained, which meant people's safety, health or well-being was placed at risk of potential harm. There was an inconsistent approach to planning and reviewing people's support, which meant that care and treatment may not be delivered appropriately.

Whilst we observed staff worked as a team, we saw that staff had not received regular supervision and appraisals of their work, which meant they may not have the competencies needed to safely carry out their roles

Is the service effective?

There was evidence staff training and development was in need of further development to ensure staff had the right skills to safely carry out their work. Information in people's care plans was insufficiently developed regarding their capacity to make informed decisions that was in line with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards, to ensure people had consented to the way their support was provided and enable their human rights to be protected.

Is the service caring?

We observed care staff interacting positively with people who used the service to ensure their wishes and needs were respected. One person told us they liked to be as independent as possible and that staff provided assistance when this was required. They told us staff were, 'Alright'they help me with getting dressed and medical attention when I need it.'

Is the service responsive?

We saw information in people's care plans was not always kept up to date, which meant people who used the service may be at risk of inappropriate or unsafe care and treatment being provided.

We were told that incidents and accidents were not routinely analysed to enable the service to learn from past events and ensure potential risks to people were safely managed.

Is the service well led?

A registered manager had not been in post during the past year and there was evidence further leadership and direction was needed, to ensure the staff were clear about their professional roles and responsibilities.

We found administrative systems were limited and that information was not always immediately available or was hard to find. We found that quality assurance systems were not systematically maintained. There was limited evidence that audits of the service were carried out, to ensure potential risks to people who used the service were managed safely.

We found informal consultation with people who used the service took place via regular two weekly meetings to ensure they were able to contribute ideas and suggestions for improving the home. One person told us they had made a request for kippers to be provided and we saw had been acted on and included on the menu.

19 April 2013

During a routine inspection

People comments about the service were mainly positive. People told us they were respected and their dignity was upheld. Other comments included: 'They do respect my dignity; it is my choice of room and I do like it,' and 'The care and food is good; there are two of us in chairs. Staff do help me to dress in the morning, but I prefer to do it myself in the evening, and do so.'

People's comments about their activities included: 'I clean and I have been going out every day,' 'I do the laundry and I vacuum; I go to a day centre three days a week and the other days are usually my days out,' 'I do go to the supermarket,' and 'I like to listen to music and to watch TV.' We found that staff supported people with what they wanted to do.

We spoke with people who used the service who confirmed that they had given their consent for the care and treatment they received. People we spoke with said they felt safe in the service.

People spoke positively about the staff that worked with them. Their comments included: 'The staff are pleasant,' and 'The staff are all right and they are supported by the organisation.' A visiting healthcare professional told us, 'The carers normally help; staff are very friendly and have done an excellent job.'

The provider used surveys to obtain the views of people and meetings for residents and their relatives were held regularly. Arrangements for quality assuring the service included visits by the provider and regular management audits.

14 December 2012

During a routine inspection

We visited Eleanor House to carry out an inspection in December 2012. We spoke with people who lived in the service and they told us they were happy living there. One person told us "I like it here, it is my home". We looked at care files and found them to be detailed, person centred and reviewed regularly. Extensive assessments and plans were written with people and these covered a wide range of areas.

The service did not use consent forms or have a consent policy in place. However people living in the service confirmed that they were regularly asked before any care or treatment was carried out.

We looked at the environment and infection control policies and procedures used within the service. We found the service to be mostly clean and well maintained and the schedules for cleaning to be robust.

We saw that the service carried the appropriate checks before employment of staff commenced. We looked at staffing levels within the service and found these to be appropriate.

We also looked at the quality assurance systems that the service used and found these to be extensive, up to date and followed up with action from management and the staff. People were invited to be involved in the development of the service and had opportunities to raise any issues if needed.

10 October 2011

During an inspection looking at part of the service

At our last inspection in July 2011 we spoke to some people who use the service.

People told us that they liked living in the home and when we asked them if they felt safe there they told us that they did. One person told us 'This place is much better than the last place I was in'. They described staff as 'ok' and 'kind' and confirmed that they helped them when they need it. Once person was very complimentary about a particular member of staff describing them as 'Really supportive' and 'Will do anything to help you'.

We asked people if they felt that they were involved and were given choices in planning their care and they indicated that they felt involved and were able to make their own decisions.

People told us that they enjoyed the food and they had enough to eat and drink. One person we spoke to is a vegetarian and told us that the vegetarian diet option was 'Really good, plenty of choice'.

We asked people if they were able to control their own money and they told us they were. One person told us that 'I often go into town and I can spend my money on what I like'.

Some people we spoke to described the types of activities they enjoyed being involved in such as bingo and karaoke.

We asked people if they felt they could raise any concerns or worries they may have and they indicated that they felt they could talk to staff to raise any concerns they may have.

18 July 2011

During a routine inspection

As part of our assessment we spoke to some people who use the service. People told us that they liked living in the home and when we asked them if they felt safe there they told us that they did. One person told us 'this place is much better than the last place I was in'. They described staff as 'ok' and 'kind' and confirmed that they helped them when they need it. Once person was very complimentary about a particular member of staff describing them as 'really supportive' and 'will do anything to help you'.

We asked people if they felt that they were involved and were given choices in planning their care and they indicated that they felt involved and were able to make their own decisions.

People told us that they enjoyed the food and they had enough to eat and drink. One person we spoke to is a vegetarian and told us that the vegetarian diet option was 'really good, plenty of choice'.

We asked people if they were able to control their own money and they told us they were. One person told us that 'I often go into town and I can spend my money on what I like'.

Some people we spoke to described the types of activities they enjoyed being involved in such as bingo and karaoke.

We asked people if they felt they could raise any concerns or worries they may have and they indicated that they felt they could talk to staff to raise any concerns they may have.