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Inspection carried out on 31 October 2018

During a routine inspection

Eynesbury House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and we looked at both during this inspection. The home accommodates six people in the main house and three people in a separate annex, known as The Mews.

The inspection included two visits to the home. The first visit, on 31 October 2018 was unannounced. We arranged with the registered manager to return on 12 November 2018 to carry out our second visit. We received further information on 17 December 2018.

At our previous inspection in August 2017 we found several areas in which the home needed to improve. We rated the home as Requires Improvement overall and in all five questions. At this inspection (October and November 2018) we found that the staff team, led by a new registered manager and deputy manager, had made a number of improvements.

There was a registered manager in post who understood and carried out their responsibilities. They provided good leadership and direction for the staff team.

People felt safe and were protected as far as possible by staff who were trained to report any avoidable harm or abuse. Staff had assessed any potential risks to people and had put measures in place to reduce the risk. There were enough staff to meet people’s assessed needs and keep people safe. The provider’s recruitment process reduced the risk of them employing unsuitable staff.

Staff followed the correct procedures to prevent the spread of infection and knew how to report any accidents and incidents. Staff had undertaken training in how to give medicines safely and as they had been prescribed.

Senior staff carried out assessments of people’s needs to ensure that staff could meet those needs in the way the person preferred.

New staff received a thorough induction during which they shadowed more experienced staff. Staff undertook a range of training in topics that assisted them to do their job well. Staff supported people to shop and cook their own meals and involved other healthcare professionals to support people to maintain their health.

Staff supported people to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People liked the staff. Staff treated people with respect and showed they knew each person well. People were involved in planning their care and support. Staff respected people’s privacy and dignity and supported people to remain as independent as possible.

Support plans were personalised and gave staff detailed guidance relating to the support each person needed. People received personalised support that was responsive to their individual needs.

A complaints process was in place and the registered manager responded to complaints. The provider had a policy in place to meet people’s end-of-life care needs when the person needed this.

Staff felt supported by the registered manager and the deputy manager. Staff were clear about their role to provide people with a high-quality service, thus upholding the provider’s values. Staff liked working at this home.

The provider had a quality assurance system in place. The system included a number of ways in which people, their relatives and staff could give their views about the home and how the provider could improve it. The provider carried out audits and monitoring checks on all aspects of the service delivered by the staff.

The registered manager worked in partnership with other professionals to give people joined-up care.

Inspection carried out on 15 August 2017

During a routine inspection

Eynesbury House is registered to provide accommodation and care, without nursing, for up to nine people. On its website, the provider describes Eynesbury House as “a residential service designed to support adults with Asperger syndrome or High Functioning Autism.”

The service is situated in a residential area of Eaton Socon, within walking distance of local facilities and the town centre of St Neots. The main house has six single bedrooms. The Mews, situated next to the main house, is a separate annex for three people who are able to live more independently. It has its own entrance and accommodation includes three single bedrooms and a kitchen/lounge/dining room.

The inspection visits to the service took place on 15, 22 and 25 August 2017. On 15 and 22 August 2017 the visits were unannounced. On 25 August 2017 we met with the provider’s representatives to discuss our findings then returned to the service to complete the inspection. There were eight people living at the service when we visited.

At our previous inspection we rated the service as good in all five of the questions we ask. Since then, Brookdale Healthcare had become part of Tracscare. This meant that there were new directors of the organisation and some new systems, policies and procedures were being introduced.

Prior to this inspection a number of concerns had been raised with the Care Quality Commission (CQC). These had come from a range of sources and related mainly to staffing; staff turnover; the use of agency staff; and the ways in which some people were being supported. During the inspection we found that some of the concerns were substantiated. The service had been through a difficult patch. This was partly due to one person who had been admitted to the service who had felt they were not being supported appropriately. This person’s behaviour had led to a number of staff leaving. Additional agency staff had been employed to ensure that everyone was safe. At the same time, a second person had been admitted who was very dissatisfied with the service because they did not want to be there. There had been a lack of strong leadership and the staff no longer worked as a team.

At the time of the inspection the first person had left. The second person demonstrated that they were still dissatisfied and expressed this very vocally. Following the inspection they were given notice to leave. We therefore found that there were very mixed views about the service, from people who lived at the service, their relatives and members of staff. However, a new manager had been appointed and staff were hopeful that the changes in the atmosphere they had begun to feel would develop into improvements in the service.

Although we saw some kindness and caring, we also saw that staff did not interact with people or engage them in conversation. Staff did not always treat people with respect, ensure people’s privacy and dignity were maintained or support people to be independent.

There were not always sufficient staff on duty to make sure that people’s needs were met in a timely manner. Staff had received an induction and had undertaken training in topics relevant to their role although this was not always up to date. Staff had been recruited in a way that made sure that only staff suitable to work in this care service were employed.

This service requires a registered manager as a condition of its registration. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run. At the time of this inspection there was a registered manager in post. However, they had been on maternity leave and on their return had been promoted to area manager. A team leader had been the acting manager in their absence. A new man

Inspection carried out on 14 and 21 July 2015

During a routine inspection

Eynesbury House is registered to provide accommodation and non-nursing care for up to nine people. On the day of the inspection there were seven people living at the home. Short and long stays were offered.

The home is a converted and extended period property. It is located in a residential area of Eynesbury, on a site with two other care services. The main house has accommodation for six people on two floors, with a kitchen, lounge, dining room, laundry and offices on the ground floor. The extension has a separate entrance and can accommodate three people. An open-plan kitchen/dining/sitting room means that these three people can be offered more independent living.

This inspection took place on 14 and 21 July 2015 and was unannounced. The last inspection of this home was on 30 September 2013. At that time we found that the provider was meeting the requirements of the regulations that we had assessed against.

At the time of this inspection on 14 and 21 July 2015 there was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

People were happy at Eynesbury House and were complimentary about the staff and the management team.

The service was safe because there were enough staff to support people in the way they wanted to be supported. Staff had been trained to recognise and report incidents of harm and any potential risks to people were managed so that the risks were minimised. All the required pre-employment checks had been carried out before staff started work. People were given their medicines safely.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), which apply to care services. People’s capacity to make decisions for themselves had been assessed, which meant that people’s rights in this area were protected.

People were encouraged to cook their own meals and to eat healthy food. They were supported to make choices in all aspects of their daily lives and their decisions were respected by the staff. People were supported to access a range of healthcare professionals so that their health was maintained.

Relationships between people who lived at Eynesbury House and the staff were good and staff showed they cared about the people they were supporting. Staff treated people well and respected their privacy. People were encouraged to be as independent as possible.

People were involved in the planning and reviewing of their care. Detailed, personalised information was available to staff so that each person received the support they needed in the way they preferred. A range of activities and outings were offered to people and there were links with the local community.

The home was managed well. People, their relatives and the staff were encouraged to give their views about the home and put forward their ideas for improvements. People knew how to complain and felt comfortable with raising any issues with the management team. An effective system was in place to monitor and audit the quality of the service being provided.

Inspection carried out on 30 September 2013

During a routine inspection

During this inspection we spoke with four people who used the service and three members of staff. People who used the service told us that were very happy with the care they received and that they felt safe. One person stated that: �I get all the help I need and staff are nice and we get on well�.

We found that staff were supervised and trained appropriately to carry out their role effectively. Medication storage and records were well maintained.

We found that consent had been recorded within people�s care plans and that people's care and support needs were well documented.

We found there were appropriate procedures in place for protecting people from abuse. Staff we spoke were clear on how to listen and act on any concerns that they witnessed or were told.

We found that appropriate numbers of trained staff were available to support people in meeting their care and support needs.

Inspection carried out on 7 November 2012

During a routine inspection

During our inspection we spoke with two people who lived at the home and they both said that they were happy living there and that the staff provided them with good support. People were supported to maintain their independence and to take part in a range of activities in the local community.

There were clear records in place relating to the assessment of risks for individual people and care plans which provided detailed guidance to staff about how to meet people's needs. Staff had a good understanding of people's needs and were enthusiastic about supporting people to achieve their goals.

Inspection carried out on 21 December 2011

During a routine inspection

People we spoke with were positive about the care and support they received. They said that they met regularly with their key worker to discuss daily and weekly activities and to review care and support needs. People were satisfied with their bedrooms which they had been able to personalise with their own belongings.

We were told by people using the service that they were able to raise issues or concerns with staff whenever they wished and that the regular 'House Meetings' also provided them with a forum to discuss issues affecting their lives.