Archived: Eltham House

Eltham House is a residential care home providing personal care and accommodation to people with learning disabilities or autistic spectrum disorder. Accommodation is provided in an adapted domestic style property, registered to support up to six people. On the day of our inspection six people lived at the home.

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

The management of individual risk assessments had improved and were well managed. However,

environmental risks were not always identified or assessed. People

felt safe living at Eltham House and staff understood their responsibilities to keep people safe. Staff were recruited safety and medicines were well managed and administered.

Some checks on the environment were not always effective, as they failed to identify the issues we found. People and relatives were encouraged to share their views of the service, staff felt supported and told us the service was well led. The registered manager was committed to addressing shortfalls identified during the inspection visit to improve the safety of the environment.

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.

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 able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People had choice and were supported to be as independent as possible. The care people received was person-centred and people’s rights to privacy, dignity and respect were upheld.

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

The last rating for this service and update was requires improvement (last report published 3 April 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show 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 the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. Although we found improvements had been made the overall rating for the service has remained the same, as some processes and systems that have been introduced need time to become more established and provide assurances of improvement.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Eltham House is a residential care home providing personal care and accommodation for younger people with learning disabilities or autism. The service was a domestic style property registered to support up to six people. Six people were using the service during our visit.

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

The service has been developed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

Some outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People had opportunities to become more independent. People were supported to maintain relationships that were important to them and had opportunities to develop friendships and meet new people in their local community. People had access local facilities in line with their cultural preferences.

People were supported to have 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.

Risk management required improvement. Some known risks had not been assessed, and guidance was not always in place for staff to help them provide safe care. Quality audits and checks were not consistently effective and had failed to identify the issues we found. The provider had failed to meet their regulatory responsibility to inform us when Deprivation of Liberty Safeguards (DoLS) had been authorised by the supervisory body.

The management team took responsive action during and following our inspection visit in response to our inspection findings.

People received their medicines when they needed them, but the storage of medicines was not consistently safe. Staff were trained in administering medicines and their competence to do this safely was assessed regularly by their managers.

People felt safe living at Eltham House and safeguarding procedures were in place to protect people. Staff were recruited safely, and enough staff were on duty during our visit to maintain people’s safety. However, staff felt if more of them were on duty during the day time they could be more responsive to people’s needs. The registered manager was aware of this and was taking action to improve outcomes for people.

Staff were kind and caring. They enjoyed their jobs and spoke fondly about the people they cared for. The atmosphere was relaxed and interactions between people and staff were positive. Staff received training to help them understand the principles of the Equality Act and the management team demonstrated commitment to achieving equality.

People had access to health professionals when needed. The staff team worked with other organisations including the local authority to support care provision and service development. People were encouraged to eat a nutritionally balanced diet to maintain their health. Staff knew what people liked to eat and drink and people’s dietary requirements were catered for.

People were happy with the care and support they received. People and their relatives were involved in planning and reviewing care. Staff knew people well, but care records did not always contain accurate and up to date information to help staff provide responsive care.

People’s right to privacy was respected. People's communication needs had been assessed and staff communicated with people well. Staff understood their responsibility to support people to share any concerns and the provider's complaints procedure was on display within the home.

The environment continued to meet people’s needs and was clean and tidy during our visit. Staff felt supported and told us the service was well led. Feedback from people and their relatives was welcomed and listened to.

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 12 December 2017)

Why we inspected

The inspection was prompted in part due to concerns received about the quality of care people received. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern.

Enforcement

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report. We identified breaches in relation to the safety and governance of the service at this inspection. You can see what action we have asked the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home was last inspected in January 2017. At that inspection we found two breaches in the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014.

These breaches were in relation to the care and support people received. The provider did not ensure risks to people’s safety and well-being were assessed. Where risk had been assessed management plans were not up to date. This meant staff did not have the information they needed to keep people and themselves safe, including in an emergency. The provider did not have effective systems and process in place to monitor and improve the quality and safety of the service people received.

The home was rated as Requires Improvement. We asked the provider to tell us how improvements were going to be made. In response the provider sent us an action plan which detailed the actions they were taking to improve the service.

At this inspection on 31 October 2017 we checked to see if the actions identified by the provider had been taken and if they were effective. We found sufficient action had been taken in response to the breaches in Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the provider was no longer in breach of the Regulations.

There was a registered manager in post at the time of our inspection. A requirement of the service's registration is that they have a registered manager. 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 and associated Regulations about how the service is run. The registered manager is also the provider for this service and is referred to as the provider throughout this report.

Risks to people’s safety were identified and assessed. However, further improvement was needed to ensure records relating to the support people required in the event of a fire, or other emergency were clear and to ensure all staff knew where these records were kept. People told us they felt safe living at Eltham House and staff were happy working at the home. Staff understood how to protect people from abuse and their responsibilities to raise any concerns.

People’s care plans contained up to date information which provided staff with the guidance they needed to provide personalised care. Staff demonstrated a good understanding of the needs and preferences of the people they supported. People and some relatives were included in planning how they were cared for and supported.

There were systems in place to monitor the quality and safety of the care and support people received, and the provider regularly sought feedback from people and their relatives and other visitors. The provider used this feedback to make improvements to the service provided.

Staff were recruited safely and there were enough staff to support people at the times they needed. People received their care and support from staff who they knew and people were supported to take part in meaningful activities.

Staff completed an induction when they started working at the home and had their work practices regularly checked by a member of the management team. Staff completed training the provider considered essential to meet people’s needs safely and effectively. People received their medicines as prescribed from trained staff.

The management team and staff understood the principles of the Mental Capacity Act (MCA) and their responsibilities under the Act. Staff gained peoples consent before they provided support to people.

People were encouraged to make choices about their daily lives, including what they would like to eat and drink. People received a choice of nutritional meals that met their individual needs. Staff supported people to maintain their health and well-being and ensured people had access to health care service when needed.

Staff respected people’s privacy and dignity and supported people to maintain their independence. People who lived at the home were encouraged to maintain links with friends and family who could visit the home at any time. People and relatives knew how to make a complaint and complaints were managed in line with the provider’s procedure.

The home was last inspected on 7 March 2016, when we found the provider was compliant with the fundamental standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, the home was awarded an overall rating of ‘requires improvement’. This was because care records and risks assessments had not been updated when people’s needs changed, and risk management plans were not always followed by staff. Medicines were not consistently managed in line with the provider’s medicines management policy. Systems to monitor and improve the quality and safety of the service had not identified where improvement was needed to mitigate the risk to people’s health and safety.

There was a registered manager in post at the time of our inspection. A requirement of the service's registration is that they have a registered manager. 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 and associated Regulations about how the service is run.

At this inspection on 4 January 2017, we checked to see if improvements had been made. We found some actions had been taken, but there were still areas where improvement was needed.

Risk assessments had not been updated when people’s needs had changed and did not give staff the information they needed to minimise risks associated with people’s care and support needs. Measures were not in place to enable staff to support people safely in the event of a fire, or other emergency at night.

Most care plans did not support staff to provide personalised care consistently as they had not been reviewed and information in them was not always accurate. However, where up to date information was lacking, staff demonstrated a good understanding of the needs and preferences of the people they supported.

The provider had not taken steps to ensure the systems used to monitor and check the quality and safety of service provided were consistently effective and supported the service to improve.

People and their relatives told us they felt safe living at the home and staff treated them well. Staff knew how to safeguard people, and were clear about their responsibilities to report safety concerns to the manager. All necessary checks had been completed before new staff started work at the home to make sure, as far as possible; they were safe to work with the people who lived there.

Staff respected people’s privacy and dignity and supported people to maintain their independence. People who lived at the home were encouraged to maintain links with friends and family who could visit the home at any time.

Staff were available at the times people needed them and had received training so that people’s care and support needs were met. Staffing levels enabled people to have the support they needed to take part in interests and hobbies that met their individual needs and wishes.

People were encouraged to eat a varied diet that took account of their preferences and specific dietary requirements. People were supported to attend health care appointments with health care professionals when they needed to, and received healthcare that supported them to maintain their wellbeing. Medicines were managed and administered safely.

People were encouraged to make choices about their daily lives and were involved in decisions about their care. People and relatives knew how to make a complaint and complaints were managed in line with the provider’s procedure. People and others were given the opportunity to share their views about the service and how it was run.

The provider understood their responsibilities under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom. Staff understood the principles of the Mental Capacity Act (MCA), and care workers gained people’s consent before they provided personal care. People told us they were encouraged to make choices about their daily lives.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full report.

Eltham House provides care and support for up to six people with physical disabilities, learning disabilities, or autism spectrum disorders. The home is located in Cheylesmore, Coventry in the West Midlands. There were five people using the service when we visited. Each person had their own bedroom and there was a shared lounge, conservatory and kitchen diner at the home.

There was a registered manager in post at the time of our inspection. A requirement of the service's registration is that they have a registered manager. 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 and associated Regulations about how the service is run. We refer to the registered manager as the manager in the body of this report.

People and their relatives told us they felt safe living at the home and staff treated them well. Staff knew how to safeguard people and were clear about their responsibilities to report concerns to the manager. All necessary checks had been completed before new staff started work at the home to make sure, as far as possible; they were safe to work with the people who lived there.

Risks associated with the delivery of care and support for people who lived at the home had been assessed. However, risk management plans and risk assessments had not always been updated when people’s care or support needs changed, and were not always followed by staff. This meant the risks associated with people's care were not always monitored and managed, so that risks to people were minimised. Systems to ensure medicines were managed safely were not consistently effective. Staff had not followed the provider’s policy and procedure to ensure the safe management and administration of controlled medicines.

There were enough staff employed at the home to care for people safely and effectively. New staff completed an induction programme when they started work to ensure they had the skills they needed to support people effectively. Staff received training and had regular meetings with the manager in which their performance and development was discussed.

People were supported in line with the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The provider had made applications to the local authority in accordance with DoLS and the MCA, and at the time of our inspection was awaiting the outcome of those applications.

People were encouraged to eat a varied diet that took account of their preferences and specific dietary requirements. People had access to a range of healthcare professionals. However, the advice of health care professionals was not consistently recorded on care records, or followed by staff to ensure people received the care they needed when their health changed.

Staff treated people with respect and dignity, and enabled people to maintain their privacy and independence. People who lived at the home were encouraged to maintain links with friends and family who could visit the home at any time.

People were supported in a range of activities, both inside and outside the home. Staff were caring and encouraged people to be involved in decisions about their life and their support needs. People were supported to make decisions about their environment and choose how their room was decorated.

People’s care records were not always reflective of their care and support needs therefore did not provide staff with up to date information about how people should be cared for and supported. However, staff had a good understanding of the needs and preferences of the people they supported. People and their relatives thought staff were caring and responsive to people’s needs.

People knew how to make a complaint if they needed to. Complaints received were fully investigated and analysed so that the provider could learn from them. People who used the service and their relatives were given the opportunity to share their views about how the service was run.

There were systems in place to check and monitor the quality and safety of the service people received. However, checks did not always identify where the home needed to make improvements to mitigate the risks to people’s health and safety.

Two members of staff were on duty providing personal care to four people throughout our visit, in addition to the manager and the assistant manager. The staff numbers allowed for individual attention for people and supported people to take part in activities inside and outside the home.

We saw people appeared to be enjoying different tasks and their daily routine. Everyone who used the service were happy to be introduced to us. Some people spent time chatting to us. Other people were happy to show us around their rooms and the communal areas. People indicated to us they enjoyed living at the home. One person said, "I like it here."

We were shown copies of customer satisfaction survey forms which had been completed recently. People were positive about the service. One person who lived there had written, "I like living here, it makes me happy."

We saw a system was in place to record and report any issues that could be considered as safeguarding. We saw contact numbers were displayed for the local authority and the CQC. The manager was clear about what to do when reporting safeguarding concerns.

We saw people appeared to be enjoying different tasks and their daily routine. Everyone who used the service were happy to be introduced to us. Some people spent time chatting to us. Other people were happy for us to be shown around their rooms and the communal areas.

People who lived at the home all had very different strengths and needs. We saw people being supported in ways that suited their individual needs. Staff we spoke with showed good knowledge of the skills and abilities of each person who lived at the home. We observed staff had a good rapport with people who used services.

We asked people if they were treated with consideration and respect. People told us they were treated with consideration and respect. One person told us 'I can choose my activities and the meals that I want.'

People told us they enjoyed living at the home. One person said 'I like it here.' Another person told us "I've been here a long time."