Ellershaw House Limited

Ellershaw House Ltd is a residential care home for up to 12 people. The service provides support to people who live with a Learning disabilities or autistic spectrum disorder. At the time of our inspection 11 people were using the service.

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

People living at Ellershaw House Ltd are referred to by the provider as ‘students’ to reflect how the service promotes learning in a supportive and caring environment. Ellershaw House Ltd is set in a rural setting in open countryside. People enjoy the indoor riding school and extensive outdoor space. Equestrian and care of the horses is integral to the culture of the service and the therapeutic support it offers.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was able to demonstrate how they were meeting the underpinning principles of ‘Right support, right care, right culture’

Right support: 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.

Staff were safely recruited in line with the provider's policy and legislative requirements. Enough suitably skilled staff were employed to spend quality time with people to develop skills and promote independence. Staff received supervision and appraisal along with spot checks recorded to maintain best practice.

People received initial assessments of their needs with care plans in place to manage known risks. Care planning was moving from paper to electronic records. Regular reviews ensured information remained relevant and up to date as an accessible point of reference for staff. People's care plans and risk assessments reflected their needs and preferences, and staff were knowledgeable about the level of support people required to keep them safe.

Right care: Care was person-centred and promoted people's dignity, privacy, and human rights;

Staff were respectful, caring and understanding around people’s emotional and physical needs.

People were involved in planning their care and support. Care was delivered following a robust assessment of needs to ensure people’s wishes, preferences and any personal characteristics were recorded and supported. Regular reviews with people ensured adjustments were made to meet people’s changing needs and aspirations.

Where people received support to take their medicines this was done safely. Medicines management and administration followed best practice guidance. Where medicines were prescribed as part of behaviour support planning, professional health reviews ensured reliance on these medicines was monitored and reduced to support people to stay well and have a good quality of life.

Right culture: The ethos, values, attitudes and behaviours of leaders and care staff ensured people using services led confident, inclusive, and empowered lives; The culture of the service was open and empowered individuals to express their views and be in control of their lives with the support of staff. People felt confident to approach staff and management, indicative of a family environment and their suggestions were listened to and acted on.

A range of quality assurance checks including regular audits were completed to manage and improve the service and to maintain compliance with required regulations. The provider was in the process of implementing new electronic recording. This would benefit from improved management planning to ensure a smooth transition within achievable time scales.

Staff followed latest guidance to maintain effective infection prevention and control and had good access to any required protective equipment which helped to reduce the spread of any infections. Where we identified some areas of the home required maintenance, this was proactively completed during the inspection.

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 (17 May 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ellershaw House Limited 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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 12 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on students was mitigated by the building design fitting into the surrounding rural area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with students.

People’s experience of using this service: People living in the service are referred to by the provider as students to reflect Ellershaw House is a place of learning and care.

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 a full a life as possible and achieve the best possible outcomes. The principals 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 received planned and coordinated person-centred support that was appropriate and inclusive for them.

The outcomes for students using the service reflected the principals and values of Registering the Right Support in the following ways: promoting choice and control, independence and inclusion. Student’s support focused on them having as many opportunities for them to gain new skills and become more independent.

The provider made changes to improve its recording and quality assurance systems following the inspection.

Health and safety checks were not always completed. This was rectified during the inspection.

Risks to students were well-managed, keeping them safe. Staff had a positive approach to risk management.

Students were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Students lived healthy lives. Excellent links had been developed with community health professionals. Students were involved in meal preparation and planning and were encouraged to make healthy choices.

Students had personalised rooms. They made full use of the surrounding land, which had a therapeutic value.

Staff treated students with dignity and respect and valued the unique contribution they made to the Ellershaw House community. Students were the lead decision-makers in their lives. They were supported to be independent.

Students were able to live fulfilling lives. The service encouraged them to set ambitious goals to work towards, which transformed their lives.

The service was integrated into the local community, working with voluntary organisations and local services to provide work opportunities for the students.

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

Rating at last inspection: Good (report published on 12 September 2016).

Why we inspected: This was a scheduled inspection based on the previous rating.

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 any concerning information is received we may inspect sooner.

Ellershaw House provides residential care for up to 12 people with learning disabilities. On the day of the inspection there were eight people living at the service.

The registered provider is a limited company and one of the directors is also the registered manager. In February 2016 an additional manager was registered and this position became a shared role. 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 home is a large farmhouse set in open countryside in an isolated location.

Transport is required to access all services and facilities.

Ellershaw House is a unique service; riding and care of the horses is integral to the culture of the home along with other therapies such as rebound therapy and arts.

Staff were referred to as tutors and people who used the service as students. Many of the people living at the service had moved there as children and had grown up together. During the inspection we found a strong family culture and sense of community. This included sharing out practical work in the grounds, the vegetable patch, care of the horses and a shared ownership of the operation of the service. We saw students and tutors worked alongside each other and any decisions made were jointly and fairly agreed amongst everyone.

People had complex needs and these were supported in a person centred way. They were very much involved in their plan of care and support, their goals and aspirations. People were supported to consider their needs through the medium of therapies including equine, art and music therapy. Each person’s plan was designed and delivered exclusively according to their needs.

The service consulted and encouraged external bodies to support people, for example social workers, psychologists and occupational therapists. It also supported people to be active members of the community for example, in work placements and local social groups such as the church choir.

The staff had a good working understanding of the Mental Capacity Act 2005 and deprivation of liberty safeguards.

People were supported to maintain relationships with their family and the service had played an active role in some people being reunited with close family members.

People told us they felt safe and secure. They referred to close relationships with staff and felt they were given time to express any concerns or worries. Staff received training with regard to safeguarding adults and the service worked closely with safeguarding authorities.

The provider had good systems in place for health and safety. Risk assessments were completed and people were assessed carefully to ensure they were safe within the equine areas. Risk assessments ensured people could be as independent and self-determining as possible.

There was a very low turnover of staff who were recruited carefully to ensure they were suited to the culture and ethos of the service. Appropriate checks were made to ensure staff were suitable to work with people in this environment.

Staff were valued and had good opportunities to develop their skills and confidence. They were supported by the registered managers and were clear about their roles and responsibilities.

Staff told us leadership was exceptional, and the registered managers led by example and provided excellent role models.

The service had effective systems in place to monitor and audit the service. Tutors and students met regularly to discuss life at Ellershaw House; what was working and where changes may need to be made. This was fundamental to the ethos and culture of the service. Any challenges were confronted and discussed openly and honestly with the aim of a shared resolution.

On the day following this inspection, registered manager and co-director, Sandra Kreutzer-Brett was involved in a tragic riding accident at the service and very sadly died of their injuries. With the agreement of the co-director, Robert Kreutzer Brett and the registered manager this inspection process was completed and the inspector is extremely grateful to people using the service and the entire staff team for their cooperation and on-going input during such a traumatic and difficult time.

Below is a summary of what we found. The summary describes what people using the service told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary, please read the full report.

This is a summary of what we found.

Is the service safe?

People were treated with dignity and respect by the staff. Systems were in place to ensure that the registered manager and staff learnt from incidents such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act (MCA), 2005 and Deprivation of Liberty Safeguards, (DoLS). All staff had been trained to understand when an application should be made, and how to submit one. Documentation was available in people's care files to support this.

Staff had received up-to-date training in all mandatory areas, as well as those specific to their job role. Staff told us they felt the training they received was thorough and offered to them on a regular basis. Staff recruitment procedures were thorough and in accordance with the provider's policy. Staffing levels were determined based on the individual needs of each person living in the care home. Policies and procedures were in place to make sure unsafe practices were identified and people were protected.

The home was clean and tidy and provided a safe environment for the needs of people living in the home.

Is the service effective?

Staff had the skills and knowledge to meet people's needs. The registered manager gave effective support to most staff including induction training, supervision and appraisal. This was supported by a comprehensive training programme. The care home worked effectively with other agencies and health care services to ensure a co-ordinated approach to people's care was achieved.

Is the service caring?

People living in the care home were supported by kind and attentive staff. They were cared for sensitively and given encouragement. People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. One person we spoke to told us, "They let me walk my pony and I enjoy making things."

Is the service responsive?

The complaints procedure was understood by staff and people living in the care home. The registered manager had encouraged relatives to have greater involvement in the care offered.

Is the service well led?

There was a quality assurance process in place. Records showed that any adjustments needed were dealt with promptly. This enabled the quality of the service to continually improve. Staff told us they were clear about their role and responsibilities. The staff we spoke to felt they were strongly supported by the registered manager. One member of staff told us, " I appreciate being asked to discuss the different aspects of people's behaviour." Staff had received training in order that they may continue to provide effective care. The registered manager monitored the needs of the people and adjusted staffing levels accordingly. This meant that people were safe and their health and welfare needs were met by sufficient numbers of appropriate staff.

We found people's care and welfare needs were identified and they were given the support they needed to meet these needs. People's privacy, dignity and independence were respected.

We found people who used the service were safe and staff were aware of how to recognise and report any concerns about people's safety and wellbeing. We saw staff were supported to maintain and develop their knowledge, abilities and skills.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. People we spoke with described the staff as 'nice' and 'alright.'

There was an effective complaints system available. At the time of our inspection there were no outstanding complaints.

We spoke to five people who use the service who were able to tell us about their experiences. They told us 'Yes it's really nice here, they look after us and take us on holidays', 'I like living here' and 'Everybody is nice to you.' People using the service were calm and relaxed, and engaged in a number of tasks and activities during our visit. Some of the people were keen to demonstrate projects they had been working on, including a riding display and art projects.

Staff interacted with people in a nice friendly manner and we saw relaxed banter between staff and people living at the home.

Staff told us they felt settled and happy in their jobs, and were well supported by their manager. Comments included 'It's been fantastic- I love it here', 'They're such lovely students and great to work with' and 'The manager's standards are extremely high- it's a five star service.'