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 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.