Nurtrio

Updated 13 June 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 was carried out by 2 inspectors. An Expert by Experience also made phone calls to relatives. 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

The Eleanor Centre is a domiciliary care agency providing personal care to people living in their own houses and flats. It also provides care and support to people living in 13 ‘supported living’ settings so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post for domiciliary care and a registered manager in post for supported living.

Notice of inspection

We gave a short period notice of the inspection because some of the people using it could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this.

Inspection activity started on 3 April 2023 and ended on 20 April 2023. We visited the location’s service on 3 April 2023 and 13 April 2023.

What we did before the inspection

We reviewed the information we 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. We used all of this information to plan our inspection.

During the inspection

We spoke with 5 people who use the service and 7 relatives about their experience of care provided. We spoke with 15 members of staff including the chief executive officer, head of quality and operations, both registered managers, 2 coordinators and 9 support workers.

We reviewed a range of records. This included 10 care records and multiple medication records. We looked at other records relating to the management of the service including recruitment, staff training and supervision, and systems for monitoring quality.

Updated 13 June 2023

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.

About the service

The Eleanor Centre provides care and support through a domiciliary care service and a supported living service to people who live in their own homes. The service provides support to people with a learning disability or autism spectrum disorder, older people, people living with dementia, and mental health needs. It also supports people with a physical disability, sensory impairment, and younger adults. At the time of our inspection there were 84 people in receipt of domiciliary care and 48 people in supported living receiving a service from this provider.

Not everyone who used 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.

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

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not 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. Staff did not understand and demonstrate a good working knowledge of the Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005. Information about risks was not always up to date and safety concerns were not consistently identified or addressed quickly enough. There was not always enough staff to support people. The service was not always clear in its responsibilities and role in relation to medicines. National guidelines were not always followed, this also applied to non-prescribed medicines. Recruitment systems were robust and ensured the right people were recruited. People were supported by staff to pursue their interests, had a choice about their living environment and were able to personalise their rooms.

Right Care:

People’s care treatment and support plans did not always reflect their range of needs. However, we observed positive interactions between people and staff and people were treated with dignity and respect. Staff had received safeguarding training and knew how to keep people safe, however, further training to support staff to manage people in the least restrictive way was required. People were supported to attend regular health checks and systems and processes were in place to ensure continuity of care. People could make choices and were supported by staff. People told us they were supported to plan menus’ and could have snacks when they wanted.

Right Culture:

The service did not have well developed statements of its vision and values. Support from managers was inconsistent and staff and managers did not share an understanding of the risks and issues facing the service. Staff did not have regular opportunities to discuss best practice in a learning and supportive environment and there is limited evidence of learning, reflective practice, and service improvement. Staff supervision and support systems were not consistent and did not meet their needs. Lessons were not always learned and shared with staff. People and those important to them were not always involved in the planning of care or decisions about their care and treatment. People, their families and staff received regular updates about the service and questionnaires to support further improvements.

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

Rating at last inspection

The last rating for the service under the previous provider was good, published on 30 January 2019.

Why we inspected

The inspection was prompted in part due to concerns received about risk, staffing and culture. A decision was made for us to inspect and examine those risks.

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

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

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

Enforcement and Recommendations

We have identified breaches in relation to the need for consent, safe care and treatment, good governance, and staffing. We have made a recommendation the provider ensures staff have received the appropriate training to care for people safely and in a way the person would want.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.