Eleanor Nursing & Social Care Ltd – Lewisham Office was rated Requires Improvement overall following a February 2023 inspection, with a breach of Regulation 19 found due to unsafe recruitment practices including significant employment history gaps in 7 of 10 staff files reviewed. Effective, Caring and Responsive domains were rated Good, supported by safe medicine management, strong multi-agency working and person-centred care planning.
Concerns (6)
criticalGovernance — “We were not assured that the provider was fully aware of the requirement of employing only suitable staff as care workers.”
criticalRecord keeping — “We reviewed 10 staff files and identified 7 staff members who had significant gaps in their employment history.”
criticalOther — “We identified some gaps in relation to 2 care workers ongoing right to reside or work in the UK.”
moderateStaffing levels — “42% of calls were later than 45 minutes.”
moderateMissed or late visits — “Monday to Saturday, they normally turn up on time, but not on Sundays.”
minorComplaints handling — “I complain sometimes, not frequently, sometimes they don't answer the phone or leave you on hold.”
Strengths
· Medicines were managed safely with completed administration records, risk assessments, and routine competency checks.
· Staff completed a structured induction including the Care Certificate and training in safeguarding, dementia, infection control and other areas.
· Effective multi-agency working with GPs, pharmacies and local authority to meet people's health needs.
· Risk assessments were thorough, covering physical environment, falls, allergies and mental health risks.
· Infection prevention and control policy was up to date and staff had sufficient PPE.
Quality-Statement breakdown (23)
safe: Staffing and recruitmentRequires improvement
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: Lessons learned 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
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
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in decisions about their careGood
responsive: Planning personalised care to ensure people have choice, control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
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 staffGood
well-led: Continuous learning and improving careGood
This targeted inspection found Eleanor Nursing & Social Care Ltd - Lewisham Office had made enough improvements to medicines management to no longer be in breach of regulation 12, though minor gaps in audits and follow-up recording remained. The overall rating remains Good and a recommendation was made to strengthen medicines management processes.
Concerns (4)
moderateMedication management — “Medicines were not always been managed safely. At the last inspection, the provider's audits were not always identifying medicine errors.”
moderateMedication management — “two of the eight audits did not always pick up when people missed their medicine.”
moderateGovernance — “In cases where errors were found there was a lack of recording when follow up action was required. This meant there were no processes in place to ensure follow up work was completed.”
minorRecord keeping — “the provider was still using different medicine codes which increased the opportunities for inaccurate recording.”
Strengths
· Provider no longer in breach of regulation 12 following improvements since last inspection
· Care workers completed in-house training on medicines administration with annual refresher courses including competency assessments
· Clear recording systems implemented to ensure staff had correct information to mitigate potential risks
· MAR charts contained correct information on medicines prescribed, dosage, frequency, administration and allergies
· Effective risk assessments in place for people using emollient based creams