We carried out a review of the data available to us about Eastleigh 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 Eastleigh House, you can give feedback on this service.
Eastleigh 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 both were looked at during this inspection.
Eastleigh House accommodates a maximum of 10 people who have a learning disability, autism and complex needs, in one adapted building. There were nine people living at the home at the time of the inspection.
People’s experience of using this service and what we found
People’s individual risks were identified, and extensive risk assessment reviews had been carried out to identify ways to keep people safe. For example, risk assessments for choking and behaviour management were clear and detailed the support people needed to mitigate risk. Risk management considered people’s physical and mental health needs and showed measures to manage risk were as least restrictive as possible. The service worked with other agencies to provide consistent, effective and timely individualised care and support.
The organisation had a dedicated positive behaviour support service to support people and staff to ensure proactive strategies were adopted in order for people to lead fulfilled lives. As a result, people had positive behaviour support plans in place for staff to follow if an incident occurred. A positive behaviour support plan is a document created to help understand and manage behaviour in adults who have learning disabilities and or autism and display behaviour that others find challenging.
Staff responded appropriately to people’s needs and interacted respectfully to ensure their human rights were upheld and respected. Interactions between people and staff were relaxed and friendly and people seemed happy. Positive feedback was received from relatives. One relative commented: “[Person's name] is looked after amazingly. Eastleigh House is the best place he has ever been. The staff do not only care for the residents, they love them. The relationships [person's name] has with staff is wonderful.”
The home was clean, and we were assured that staff were following COVID-19 national guidelines. There were policies and procedures to ensure the risks of infection was minimised with particular focus on COVID-19.
People's legal rights were protected because staff knew how to support people if they did not have the mental capacity to make decisions for themselves. People’s capacity to make decisions about their care and support was assessed on an on-going basis in line with the Mental Capacity Act 2005.
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.
Right support:
• Model of care and setting maximises people’s choice, control and independence
Right care:
• Care is person-centred and promotes people’s dignity, privacy and human rights
Right culture:
• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives
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 15 January 2020).
Why we inspected
We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about whether people were receiving safe care and treatment, specifically, how the service safeguarded people from abuse, how risks were managed, how lessons were learnt when things go wrong, how care was delivered in line with the Mental Capacity Act (MCA) and how the service works with other agencies to provide consistent, effective and timely care. A decision was made for us to inspect and examine those risks. The overall rating for the service has not changed following this targeted inspection and remains Good.
CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Eastleigh 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.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that 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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service was a large home, bigger than most domestic style properties. It was registered for the support of up to ten people. Nine people were using the service. This is larger than current best practice guidance. However,. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.
People’s experience of using this service and what we found
Significant improvements had been made in all aspects of the management of the service since the last inspection. The provider and management team were working to ensure the improvements were embedded. This included the development of an open, transparent and positive culture, where staff felt valued and supported. There was a comprehensive quality assurance programme. Clear processes were now in place to ensure effective monitoring and accountability.
Environmental improvements had been made and were continuing. The laundry was now hygienic and promoted the prevention of infection. A comprehensive refurbishment of communal areas was underway.
We observed people were supported by sufficient numbers of suitably trained and competent staff. A retention plan was in place to address concerns around a high staff turnover and high rates of sickness. This ensured the right staff were recruited and they received the support they needed to carry out their role. Recruitment and retention were improving, and there was now a stable core team of staff who knew the people they supported well.
Staff had received training which gave them the knowledge, confidence and skills to support people safely and effectively. A visiting therapist commented on the difference this had made to the safety of the service, saying, “Now the staff seem fully engaged and the fear has completely gone. The service users seem a lot happier. I see them smiling and that speaks volumes.”
Staff were recruited safely, and safeguarding processes were in place to help protect people from abuse. Risks associated with people's care had been assessed and guidance was in place for staff to follow. Care plans were detailed, person centred and reviewed regularly with people and their relatives where appropriate. The format had been revised, and staff told us they were now much easier to read. There were systems in place to ensure information about any changes in people’s needs was shared promptly across the staff team.
People received their medicines safely, and in the way prescribed for them. The provider had good systems to manage safeguarding concerns, accidents, infection control and environmental safety.
The provider had introduced a ‘positive culture pledge’, which pledged to provide compassionate care with dignity, respect and kindness. All interactions we saw were in line with this pledge. Staff promoted people’s privacy and dignity, enabling them to make choices and have as much control and independence as possible. There had been a focus on supporting people to develop their communication, so they had a voice. This had a positive impact on the people using the service in terms of decreased levels of anxiety and distress, and more control over their lives.
People were supported to engage in a wide range of activities both within the home and the local community, which maximised their quality of life.
Staff worked effectively with external health and social care professionals to meet people’s healthcare and nutritional needs.
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.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The 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's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
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 Requires Improvement (published 14 November 2018).
Why we inspected
This was a planned inspection based on the previous rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Eastleigh House on our website at www.cqc.org.uk.
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.
Eastleigh House accommodates a maximum of 10 people who have a learning disability, Autism and complex needs, in one adapted building. There were nine people resident at the time of the inspection, with ages ranging from mid 20’s to mid 50’s.
The care service had not been developed and designed in line with the values that underpin Registering the Right Support and other best practice guidance, as it was registered prior to this guidance. These values include choice, promotion of independence and inclusion, so that people with learning disabilities and autism can live as ordinary a life as any citizen. A statement from the provider organisation about Registering the Right Support included, ‘The staff team will support and enable people to maximise their potential for independence, supporting them to develop daily living skills and achieve fulfilling lifestyles.’
The service had 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 2008 and associated Regulations about how the service is run.
The inspection took place on 27 September 2018. It was announced so that people using the service could be helped to understand the reason for the visit.
At the last comprehensive inspection in February 2016 the service was rated Good overall, because we found no concerns. At this inspection we found the evidence could no longer support that rating and now the overall rating is Requires Improvement.
Hygienic practice was compromised because a partly adapted cellar was used as the laundry. Surfaces were not readily cleanable and would harbour dust. Neither did risk management ensure an effective cleaning regime in the cellar/laundry. We have made a recommendation.
There was a breakdown in the staff, management relationship. Staff said they felt undervalued and not listened to. Whilst they had the opportunity to make their feelings clear through an independently commissioned, and confidential staff survey in March 2018, staff said they did not trust that the survey was independent. No action plan was produced following the survey results but a ‘Listening group’ so as to hear first hand staff views, was held in September 2018, the arrangement having fallen through on two previous occasions. This was only attended by staff on duty at the time. Some staff told us they valued their time off and did not feel prepared to use it returning to their work place.
The provider representative was unaware of negative staff feelings, and lack of staff trust. They said the registered manager had their full support, but the concerns raised by staff were of deep concern, unacceptable to the organisation, and would be addressed as a priority.
Current staffing arrangements were inconsistent due to high levels of staff sickness and the need to replace staff who had left. This had the potential to increase risk. The provider and service management had identified sickness as a problem to be addressed. To this end they were about to try a revised staff rota and new staff were being recruited. The registered manager worked to maintain safety by filling staffing gaps, through asking staff to work extra hours, using agency staffing, and personally helping provide necessary care.
People using the service were unable to tell us their experience of living at Eastleigh House but their family members spoke very highly of the care provided and the registered manager. One said, “I can talk to the (registered manager) about anything. I can ring her any time and she will always listen.”
Our observation showed that people were relaxed and confident in staff’s company. Records, and family and professional feedback, showed that people received the care and support they needed. In particular, staff understanding of people’s communication and interpretation of their needs and emotional state meant people’s behaviours were expertly interpreted. One person’s family member said, “They look after (the person) well. I don’t worry when I leave them. They seem quite happy.” Staff’s ability to communicate with people effectively meant their views were sought and choices taken into account.
People’s health care needs were understood and met. Where people benefitted from external professional input into their health needs, this was in place.
People’s family members said they felt the service was safe. Recruitment, medicine management, financial management and the approach to the safeguarding of people using the service, promoted people’s safety. The premises were kept in a safe state, with plans in place for improvement.
People’s legal rights were understood and protected. Where restrictive practice was used, the minimum to keep a person safe and promote their dignity and well-being was applied. This had been agreed through best interests meetings and legal authorisation.
There was a clear culture of compassionate care and support. The service was said to work to the six C’s: care, compassion, competence, communication, courage and commitment, and this was evident.
Staff were well trained, competent in their work and praised the training arrangements.
Support plans and records were detailed, comprehensive and of a high standard, thus helping to promote the high standards of care and support staff delivered.
People’s family members felt that any complaint would be properly dealt with.
People’s nutritional needs were taken into account and they received a variety of balanced meals and drinks.
Attention was given to providing people with activities of interest to them, and from which they might learn skills. The premises included an activities room and a second, safe, kitchen.
There were comprehensive systems in place to monitor events at the service, both at provider and service level, and a clear organisational structure.
This inspection was unannounced and took place on 1 February 2016. At our previous inspection in November 2013 the home was meeting the regulations at that time.
Eastleigh House provides accommodation for up to 10 people with learning disabilities and autistic spectrum conditions. There were nine people living at the home at the time of our inspection.
The home had 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 2008 and associated Regulations about how the service is run.
The people living at Eastleigh House were unable to tell us whether they felt safe at the home. We spent time with people observing their interactions with staff. People were spoken to with kindness, patience and humour. We saw people smiling, accepting physical contact from staff and accompanying staff around the home for various activities. This indicated people felt safe in the staff’s company. Staff knew what action to take should they have any concerns over a person’s welfare and they were confident the registered manager would take action if they raised concerns. Staff were provided with information about the “speak out safely” campaign which actively encouraged staff to raise the alarm when they saw poor practice. The health and social care professionals we spoke with confirmed the registered manager and staff provided a safe and supportive home for people.
Risks to people’s health, safety and welfare were assessed and management plans were in place to reduce these risks. Staff were guided about what actions to take should a person become anxious or display behaviour that my place themselves or others at risk. Staff had completed training in managing behaviours that may be aggressive towards others and were confident with distraction and breakaway techniques, as well as using a physical intervention if that was necessary.
Staff were knowledgeable about people’s support needs as well as their preferences and what made a ‘good day’ for them. Each person had a care file that provided staff with very clear information about people’s care and support needs. A ‘communication dictionary’ described how people communicated their needs through words, sounds, signs or objects of reference. Each person had a key worker who supported them to develop their everyday living skills as well as new interests. The key worker developed a profile of the person to describe them as a person with likes, dislikes, personalities and preferences for staff to look beyond their disability. Care files held records of family involvement in care planning and monthly reviews as well as when the home had contacted them about significant events. Advocacy services were accessed for those people who had no family support. The health and social care professionals we spoke with told us people’s needs were well known and understood by staff.
People were encouraged to be involved in a variety of activities both in and out of the home. Each person had an individual plan for the week which included activities such as cooking, painting, going for walks or out to the local café.
People were supported to maintain a healthy diet. Many of the people living at the home were unable to express their meal choices verbally. Staff offered people a choice of two meals to enable them to choose which one they would like to eat.
People medicines were managed safely and people received their medicines as prescribed. People had access to medical care and advice through the GP service or community learning disability services. Some people were also receiving specialist support from the local hospital for more complex health care conditions.
People were supported by sufficient staff on duty to meet their care and support needs, maintain their safety and provide them with meaningful activity. Safe recruitment processes were in place to reduce the risk of employing a person who may be a risk to vulnerable adults. Staff were provided with the training they needed to understand people’s physical and mental health needs. The provider’s in-house training ‘Foundations for Growth’, with over 40 modules supported the externally accredited training staff received. New staff completed an induction programme where they undertook essential training and worked alongside an experienced member of staff. They were also enrolled to undertake the Care Certificate.
The home was adhering to the principles of the Mental Capacity Act 2005, in that people’s capacity to consent to their care and treatment was assessed and best interest decisions made on their behalf when they were unable to consent. Where it was necessary to deprive people of their liberty to keep them safe or to manage a potentially aggressive situation, authorisation had been obtained for the local authority’s supervisory body. Staff were observant for signs people may have concerns or not be happy as many of the people living at the home would not be able to express this.
The registered manager and staff team demonstrated their commitment to providing high quality, personalised support to people. They had effective systems in place to assess people’s needs, recruit and train dedicated staff and to monitor the quality of the support services they provided. Staff told us the home was well managed and they enjoyed working at Eastleigh House. The provider had signed up to quality improvement initiatives and kept up to date with current good practice.
Care records were person centred, clear to read and described how people made decisions in their daily lives. People's wishes and goals were at the centre of their plans.
Staff were knowledgeable about how people communicated their wishes and wants. We saw that staff listened to people and spent time checking people's facial expressions and body language. Staff were respectful and supported people patiently. People were relaxed around staff.
The service had policies and procedures in place that kept people safe. Staff were knowledgeable and confident about their safeguarding responsibilities and how they would respond to any concerns that may arise.
There were processes in place to monitor the quality of service being provided, and we saw that the opinions of people's families were obtained through questionnaires.
Nine people were living at the home and receiving care. Due to the complexity of their needs we were not able to ask them about their view on the changes. However we were able to observe their behaviour. All the people we saw appeared at ease and comfortable with the staff. People enjoyed spending time in the communal areas. We spoke with four staff and one visiting healthcare professional.
We followed up on the improvements required at this inspection and found that the provider had taken the necessary action. We looked at three care plans and saw that all had been reviewed on a regular basis. Feedback from staff and records showed that people were taking in part in meaningful activities. Restraint was not in use and staff had received training on how to manage behaviour that challenged the service.
Staff were up to date with training. A major refurbishment programme was near completion and staff were confident about continued improvement at the home. One member of staff said 'I can see where we're going to be.' Another said 'There's so much more structure since the new manager's been here. She's on it. She's there.'
A relative said that staff kept them very well informed and they were always made to feel very welcome. They felt that the environment was good as it was large and spacious and their relative needed lots of room to pace around. They added that they had never had reason for concern.
A relative felt that staff had a good understanding of needs and responded promptly to any changes in health. She said she was always invited to meetings and if not able to attend was kept informed.
We were able to speak to a visiting healthcare professional from a mental health trust. When asked about their experience of the home they said they 'never had a problem' and that the home was 'transparent' in its approach to care, would 'always ring' if concerned and would 'follow up' on advice given. The staff were described as 'good' and when asked if there were enough staff to meet people's needs the nurse replied 'there always seems to be'.
We were told by the manager that a major refurbishment had been planned for January 2012. At our inspection in early April 2012 work had not started.