Eleanor Nursing and Social Care Ltd - Dorchester Office

Updated 11 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection team was one inspector and Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service

Service and service type

This service is a domiciliary care agency. It currently provides personal care to people living in their own homes.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post. A new manager had been appointed and started in the week before our inspection visit.

Notice of inspection

We gave the service notice of the inspection visit. This was because it is a small service and we needed to be sure that the provider or manager would be in the office to support the inspection.

Inspection activity started on 30 November 2022 and ended on 22 December 2022. We visited the location’s office on 14 December 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

During the inspection

We spoke with 1 person who used the service and 7 relatives. We spoke with the area manager, the manager and 5 members of the staff team. We also spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We visited the office and looked at records related to 5 people’s care, and the oversight and management of the service. This included training records, internal oversight tools and audits.

Updated 11 February 2023

About the service

Eleanor Nursing and Social Care Ltd - Dorchester Office provides personal care to people living in their own homes. Not everyone supported by the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection the service was providing personal care to 28 people.

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

People and staff had experienced a major upheaval when a large number of staff, including the registered manager and staff responsible for coordinating people’s care, left the organisation. Following this significant event some visits were missed and people had felt uncertain about their care and support. The provider worked with the local authority to manage this crisis situation and reduce the risks to people and staff. The provider ensured that CQC were kept informed about the actions they were taking and the impact these actions were having.

Prior to the registered manager leaving, the provider organisation had not appointed to the role that provided close oversight and support to the service. Whilst audits and oversight, required by the provider, had been carried out, the service had not fully moved to a new electronic system adopted by the provider organisation for care planning and scheduling of care visits. This added complexity to the situation for the new management team as information was not always available to staff electronically.

People had varying confidence about their care and support and the impacts of the staff departures. An additional missed visit was identified during our calls. The senior team made a change to the oversight system that enabled them to identify delays in staff arriving to provide scheduled care and support.

People told us they felt safe with staff who usually provided their care. The impact of recent changes was evident in their comments. Staff had received safeguarding training and there were robust systems in place to manage safeguarding concerns.

Staff understood the risks people faced and supported them in ways that reduced these risks. New risks were identified, and plans put in place to reduce their impact. Care documentation did not always reflect risks appropriately and detail the information staff held. This was addressed during our inspection and a robust plan implemented to ensure risks were described accurately in care documentation.

There were enough safely recruited and trained staff to meet people’s needs. The managers were actively recruiting to ensure a stable staff team.

People received their medicines safely and systems were in place to ensure medicines administration was monitored and staff competency was ensured. The senior team checked that all medicines were reflected on the electronic care records during our inspection. This ensured all medicines administered by staff were checked during audits.

Staff were confident in their understanding of infection control measures. People told us staff wore PPE appropriately.

There were systems in place to ensure any restriction of people’s liberty was identified and managed appropriately.

Staff and people reflected that they were aware of improvements in the oversight of the service. Staff were committed to the people they supported. Staff had confidence in the senior team in post when we visited.

The management team had developed a robust action plan to ensure that all necessary actions were taken to continue to stabilise and develop the service. There was a clear emphasis on ensuring people received high quality support.

Audits and checks were being completed to monitor the quality and safety of the service and review improvements made.

Professionals working with the service told us the provider organisation had engaged effectively and that they were reassured by the speed at which new personnel had ensured the service functioned safely again. Professionals told us the new management team was responsive and communicated effectively.

There was a delay in concluding the inspection. Progress continued to be maintained during this time.

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 May 2021).

Why we inspected

We received concerns in relation to staffing and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found evidence that people had been at risk of harm during a distinct period of time. However, robust actions had been taken to mitigate these risks and stabilise the service. We found no evidence during this inspection that people were at continued risk of harm.

Please see the Safe and Well-Led sections of the full report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.