The Eleanor Centre was rated Requires Improvement overall following an April 2023 inspection, with breaches of regulations relating to consent, safe care and treatment, staffing, and good governance, including a Warning Notice issued for governance failures. Key concerns included unsafe medicines management, insufficient staffing, inconsistent application of the Mental Capacity Act, poor incident learning, and a leadership culture where staff felt unable to raise concerns.
Concerns (13)
criticalMedication management: “Handwritten medication administration records (MARs) were not signed by 2 members of staff to ensure they had been transcribed correctly.”
criticalMedication management: “One person was prescribed a fortnightly injection, which was administered by staff who had not completed formal training or had their competencies assessed.”
criticalStaffing levels: “Visits could not take place at night in 1 person's accommodation due to a shortage of staff. There was only 1 member of staff on duty on a night shift.”
criticalConsent / capacity: “Assessments of people's capacity to make specific decisions, for example finances or medicines, had not always been completed and best interest meetings had not been arranged.”
criticalGovernance: “The management team had failed to identify the concerns and shortfalls found at this inspection.”
moderateIncident learning: “Accident and incidents were reviewed by the registered manager, however there was not always evidence that lessons had been learned.”
moderateSafeguarding: “Staff were not always aware of safeguarding concerns that had been submitted and did not receive any feedback.”
moderateCare planning: “People's care treatment and support plans did not always reflect their range of needs.”
moderateSupervision / appraisal: “Staff supervision and support systems were not consistent and did not meet their needs.”
moderateStaff training: “Staff had not received appropriate training to prevent, de-escalate and manage challenging situations.”
moderatePerson-centred care: “The provider did not ensure people and their relatives were involved in decisions about their care and restrictions were placed on people without their involvement.”
moderateLeadership: “Staff did not always feel able to raise concerns and did not feel valued by senior managers. 'If we raise anything they [senior managers] shut you down'.”
moderateRecord keeping: “Staff in one accommodation told us they did not know who was subject to a Deprivation of their Liberty in the community and there was no paperwork within the care files.”
Strengths
· Recruitment systems were robust and ensured the right people were recruited, including full employment checks before staff started work.
· People were supported to attend annual health checks, screening, and primary care services.
· Staff had good awareness, skills and understanding of individual communication needs.
· Infection prevention and control practices were in place with appropriate use of PPE.
· People were encouraged to undertake voluntary work and vocational courses in line with their wishes.
Quality-Statement breakdown (19)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrong; safeguardingRequires improvement
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standardsRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives and access healthcare servicesGood
caring: Ensuring people are well treated and supported, respecting equality and diversityRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life careGood
well-led: Governance, learning and person-centred cultureRequires improvement
well-led: Duty of candourGood
well-led: Engaging people, public and staff; working in partnershipGood
Grant Thorold Library, a supported living homecare service for people with autism or learning disabilities, was rated Good across all five key questions at its December 2018 inspection. The service demonstrated exemplary person-centred practice and strong community integration, with one minor notification shortfall identified regarding incomplete incident reporting to CQC.
Concerns (1)
minorRecord keeping: “We had not always been informed of full information about some incidents, which was discussed with the registered managers to address in future notifications to us.”
Strengths
· Staff empowered people to make their own decisions, including involvement in staff recruitment, promoting independence and community inclusion.
· Comprehensive, highly individualised care plans with creative strategies to reduce anxiety without resorting to medication.
· Strong multi-agency working and partnership with health and social care professionals, praised by external agencies.
· Accessible management team with open culture; staff morale and communication described as good.
· Robust quality assurance system including audits, surveys, incident analysis, and Board of Trustees oversight.
Quality-Statement breakdown (19)
safe: Safeguarding systems and processesGood
safe: Assessing risk, safety monitoring and management; Preventing and controlling infectionGood
safe: Staffing levelsGood
safe: Using medicines safelyGood
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 skills, knowledge and experienceGood
effective: Supporting people to eat and drink enough with choice in a balanced dietGood
Grant Thorold Library is a supported living service rated Good across all five key questions at its June 2016 inspection, demonstrating strong person-centred care, safe practices, and effective governance. Minor gaps were noted in care plan comprehensiveness, location of MCA documentation, and storage of staff records within people's homes, all of which management committed to address.
Concerns (3)
minorCare planning: “there were some aspects of the care plans which could be more comprehensive in detailing the action staff were to take to support people, for example in managing behaviours which could be challenging”
minorRecord keeping: “some staff supervision records and other office documentation were also held within people's home; this was discussed with the registered manager and these files were to be moved”
minorConsent / capacity: “documentation for the mental capacity assessments and best interest meetings were held with social workers but they told us they would contact them for copies for people's care files”
Strengths
· Staff had received safeguarding training and knew how to recognise signs of abuse and who to report concerns to
· Safe recruitment process including DBS checks, references, and relative involvement in interview panels
· Sufficient staffing levels with allocated one-to-one hours per person based on assessed needs
· Medicines managed safely with lockable storage, signed MARs, and protocols for 'when required' medicines
· Staff supported people to access community health professionals and monitored health, nutrition and weight
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supportedGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Personalised careGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Provider plans and promotes person-centred, high-quality care and understands duty of candourGood
well-led: Managers and staff are clear about their roles; continuous learning and improving careGood
well-led: Engaging and involving people using the service, the public and staff; working in partnershipGood