Date of inspection 12 March 2025 to 13 May 2025. The service is a domiciliary care service providing care to people in their own homes. At the time of this inspection 63 people were receiving the regulated activity of personal care. The inspection has been undertaken of a specialist service that is registered for use by autistic people or people with a learning disability. At the time of the inspection, the service was not used by anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group. The inspection was carried out remotely and conducted in response to safety concerns received about the service. We found 3 breaches of regulations relating to safe care and treatment, consent, and governance. Governance systems were ineffective, and they failed to identify, monitor and mitigate risks to people’s safety and welfare. Risks assessments were not in place to guide staff on how to safely support people. Safe medicine practices were not promoted and were not in line with best practice or the providers medicine management policy. The service was not working to the principles of the Mental Capacity Act 2005 which failed to safeguard people. Records were contradictory, inaccurate, incomplete with poor grammar and some terminology recorded was not in line with best practice. Staff were suitably recruited, and systems were in place to supervise and monitor staff. Staff felt suitably trained although the provider had not identified that staff involved in assessments of people, including completion of risk assessments and supervision of staff were not trained or deemed competent for the roles in line with the providers policies. Whilst people and their relatives gave mixed feedback on the timing and continuity of calls, systems were in place to ensure staff were suitably deployed to meet people’s needs and agreed package of care. The provider was proactive in response to our feedback, and they took immediate actions to address the findings, to safeguard people. We have asked the provider for an action plan in response to the findings and to enable us to monitor progress within the service.
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Eleanor Nursing and Social Care Ltd - Oxford Office improved from Requires Improvement to Good following a focused inspection, having resolved previous breaches of Regulations 12 and 17 relating to medicines management, infection control, record-keeping, and governance. The service demonstrated effective systems across all inspected key questions, with person-centred care, robust safeguarding, and an open, well-managed culture, though minor concerns remained around wide visit time windows and an isolated record falsification complaint.
Concerns (2)
minorMissed or late visits: “I have had a very wide window of time when the carers are meant to arrive in the evening... between 5:30 and 9:30 pm. As a result, I never knew exactly when the carer was going to arrive”
minorRecord keeping: “a female carer had turned up and only stayed for 20 minutes, but signed the black book saying that she had been here longer”
Strengths
· Medicines management improved significantly; staff trained, assessed for competency, and care plans included full medicines information
· Infection prevention and control measures in place with appropriate PPE provision and staff training
· Robust safeguarding processes with staff trained to identify and report concerns and partnership working with local authority
· Thorough pre-admission needs assessments with involvement of people and relatives in care planning
· Effective governance systems including regular audits of medicines, care notes, and staff competencies with spot checks
Quality-Statement breakdown (20)
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
First inspection of this newly registered Oxford domiciliary care service rated Requires Improvement overall, with breaches of Regulation 12 (safe care and treatment) for unsafe medicines management including overmedication, and inadequate Covid-19 infection control, and Regulation 17 (good governance) for ineffective audits and incomplete records. Staff were praised as caring, but care planning, communication with families and leadership oversight required significant improvement.
Concerns (11)
criticalMedication management: “PRN protocols contained contradictory information... one person had been overmedicated for a long period of time which posed a risk of liver damage.”
criticalMedication management: “Sometimes there is no information regarding medication on site so new staff are struggling. Sometimes we find missed medicines, new carers do not know what to do.”
criticalInfection control: “The provider had failed to mitigate risk in relation to infection, prevent and control. This placed people at risk of infection.”
criticalGovernance: “Quality systems were not effective or robust in identifying and driving improvement across the service. The shortfalls we found during our inspection had not been identified by the provider.”
moderateCare planning: “Some care plans did not contain enough information to instruct staff and did not always follow best practice guidance.”
moderateRecord keeping: “failing to have a complete and contemporaneous record for people was a breach of Regulation 17 (good governance).”
moderateStaff training: “There are gaps in training. Medication training was online and was only provided by the management after things were raised with the local council.”
moderateMissed or late visits: “They arrive on time most of the time, but at times they can be late. Recently they missed a call completely.”
moderateCommunication with families: “the majority of people's relatives told us they did not feel engaged and that communication between them and the provider's office needs improving.”
moderateLeadership: “Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.”
minorPerson-centred care: “People's preferences for a male or female care worker were not always explored before commencing provision of care.”
Strengths
· Staff were described as kind, caring and respectful, protecting privacy and dignity
· Safe value-based recruitment practices were followed
· Safeguarding concerns were dealt with appropriately and recorded
· Staff had a good understanding of MCA principles and sought consent
· Good partnership working with healthcare professionals such as GPs and occupational therapists
Quality-Statement breakdown (22)
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Staffing and recruitmentNot rated
safe: Learning lessons when things go wrongNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experience
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsGood
well-led: Continuous learning and improving care; Working in partnership with othersGood
Not rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies; supporting people to access healthcare servicesNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles; continuous learning and improving careNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: How the provider understands and acts on the duty of candourNot rated
well-led: Working in partnership with othersNot rated