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 manager had been appointed but was not present during the inspection visits.
Most people and their relatives were content with the service provided at Eynesbury House. Staff enjoyed working at the service and wanted to do the best they could for people living there. Some staff had felt they had not been supported well enough.
Staff had undergone training and knew how to recognise and report any incidents of harm or abuse. A range of potential risks to people had been assessed and guidance provided for staff so that the risks were minimised. Not all risks had been assessed, which meant that people were not always as safe as they could have been. Medicines were managed so that people received their prescribed medicines safely.
The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS), which apply to care services. People’s capacity to make decisions for themselves had been assessed. Staff understood the principles of the MCA and DoLS and supported people to make decisions about their lives.
People’s healthcare needs were monitored and staff supported people to attend appointments with a range of healthcare professionals. People were not always encouraged to eat regular meals.
Pre-admission assessments had not always been robust enough to ensure that the service provided was able to meet each person’s needs. People had been as involved as they wanted to be in planning their care and support. People’s support plans gave staff information about the ways in which each person wanted their care and support delivered but the information was not always up to date.
Complaints were listened to and addressed. People were encouraged to maintain relationships with their families and visitors were welcomed. The activities that were planned did not always take place and people were not offered enough to do to keep them occupied.
People, relatives and staff were given opportunities to share their views about the service and put forward ideas for improvements. Audits of a number of aspects of the service provided were carried out, although these were not always effective in driving improvement. Records were maintained as required. People’s personal information was kept securely.