Ellerslie House

Ellerslie House is a residential care home providing personal care for up to 6 people. The service provides support to autistic people and people who may have a learning disability, sensory impairment or a mental health condition. At the time of our inspection there were 6 people using the service.

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

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 the Care Quality Commission (CQC) to make assessments and judgements about services providing support to people with a learning disability and autistic people.

This was a targeted inspection that considered aspects of the key areas safe and well-led. We issued Warning Notices in August 2022 requiring the provider to make improvements in these aspects of the service. Based on our inspection of these aspects of safe and well-led, the service was able to demonstrate how they were meeting the underpinning principles of Right Support, Right Care, Right Culture.

Right support:

Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. People were supported by staff to pursue their interests.

Right care:

People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. People received care that supported their needs and aspirations, which focused on their quality of life. People could take part in activities and pursue interests that were tailored to them.

Right culture:

People’s quality of life was enhanced by the service’s culture of improvement and inclusivity. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the CQC website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 August 2022).

At our last inspection we found breaches of the regulations in relation to failures to ensure equipment was regularly checked, to assess and manage risks, to maintain accurate records of people’s care, and to act on feedback from people and their families. The provider completed an action plan after the last inspection to tell us what they would do to improve and by when.

At this inspection we found improvements had been made and the provider was now meeting the requirements of our Warning Notices.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use 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 Ellerslie House on our website at www.cqc.org.uk.

Follow up

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

Ellerslie House is a residential care home providing accommodation and personal care to

people with a learning disability and/or autism. The service can support up to six people. At the time of the inspection five people were being supported. Ellerslie House has four bedrooms and two adjoining flats.

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

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.

Based on our review of the safe, effective and well-led key questions the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

The model of care and setting did not fully maximise people's choice, control and independence. For example, people lived in an environment which was not always clean and communal areas were not always homely. We made a recommendation about this.

The manager did remove some of the clutter prior to our second day of inspection. People had privacy for themselves and their visitors. The service was located so people could participate in the local community following a short car journey.

Ethos, values, attitudes and behaviours of leaders and care staff did not fully ensure people using services led confident, inclusive and empowered lives. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We have made a recommendation about this.

Care was not fully person-centred. For example, while regular staff knew people well, people were not always treated with kindness and respect and care plans were not always person centred. We observed one person who consistently had two staff, one either side of them, the staff members continually had hands on this person’s arms and were preventing them from going in the direction they wanted to go. The staff were constantly redirecting this person even when they were the only ones in the large enclosed garden. This meant the person’s freedom was constantly restricted. The manager told us they would speak to the staff to ensure people had as much freedom as possible, they also told us they were reviewing care plans and would update them to include relevant detail and to be more person centred.

People were at risk of harm because staff did not always have the information, they needed to support people safely.

People did not always receive a service that provided them with safe, effective, compassionate and high-quality care.

The service was not maximising people's choices, control or independence. There was a lack of person-centred care.

Leadership was poor, and the service was not always well-led. Governance systems were ineffective and did not identify the risks to the health, safety and well-being of people or actions for continuous improvements.

The provider did not have enough oversight of the service to ensure that it was being managed safely and that quality was maintained. Quality assurance processes had not identified all the concerns in the service and where they had, enough improvement had not taken place. Records were not always complete. People and stakeholders were not always given the opportunity to feedback about care or the wider service. This meant people did not always receive high-quality care.

Medicines management had improved since our last inspection although medicines audits had not identified gaps in medication administration records. We made a recommendation about this.

Staff had not always received the training and support they required to carry out their roles safely and effectively. We made a recommendation about this.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 January 2022) and there were three 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 enough improvement had not been made and the provider was still in breach of regulations.

This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the safety of people and a lack of effective leadership at Ellerslie House. As a result, we undertook a focussed inspection to review the key questions, safe, effective and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to equipment being checked and maintained, risks not being identified and mitigated, notifications, mental capacity assessments and good governance.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Ellerslie House is a residential care home providing support to four people at the time of the inspection. The service can support up to six people.

Ellerslie House accommodates four people in an adapted building, with two adjoining flats accommodating two more people.

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

People were not consistently protected from risks due to health and safety checks not always being completed as required. We found the communal areas of the premises were not visibly clean and we had concerns about some infection prevention and control procedures. We have asked the provider to make improvements in these areas. We have made a recommendation to the provider to improve how they evaluate and review accidents and incidents to minimise future reoccurrences. People were protected from potential abuse by staff trained in safeguarding and aware of their responsibilities in this area.

We were not assured that the provider was working within the principles of the Mental Capacity Act 2005 and have asked them to make improvements in this area. Care plans were in place for people however not all had sufficient information to enable staff to provide person centred support.

Staff completed an induction on commencing their role at Elllerslie House however records were incomplete and not signed off by a manager. Training was mainly online, and all courses were considered to be mandatory. Staff did not feel confident in using a positive behaviour support method they had been trained in.

People chose what they ate, and meals were provided when people wanted them. Peoples rooms were personalised and there were numerous activity items in the large gardens.

People were supported to maintain their health and attend appointments with relevant health and social care professionals.

Staff knew people well and ensured they were respectful, and people retained their dignity at all times. The provider had a charter that listed the rights of people using their services. People were supported with developing independence skills and to make day-to-day choices such as what to have for meals or drinks.

We were not assured there was effective oversight of service provision and have asked the provider to improve the governance of Ellerslie House. We were concerned at the culture within the service and not all staff felt able to approach the management team to raise concerns. Issues were not always dealt with confidentially. The provider had issued quality assurance questionnaires to staff which were mainly positive.

People were not always supported to have maximum choice and control of their lives though we saw staff support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice, for example staff supporting people were also responsible for other tasks such as cooking meals and cleaning.

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.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence. For example, people were not always able to choose activities or access the community.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights. For example, while care was mostly person-centred, there was work needed to meet the requirements of the Mental Capacity Act 2005 so appropriate assessments and best interest decisions are made on behalf of people. This meant we were not sure if relevant people had been consulted and whether decisions were made to reflect peoples perceived wishes or for service reasons.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. Support workers were caring and communicated effectively with people meaning they could feel confident and included.

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

Rating at last inspection

This service was registered with us on 13 March 2020 and this is the first inspection.

Why we inspected

This was a scheduled, planned inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to how the provider checked and maintained equipment, infection prevention and control practices, how the Mental Capacity Act 2005 was being applied and the governance at Ellerslie House.

Please see the action we have told 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.