Eastcliffe

Eastcliffe is a residential service providing personal care for up to 10 people with a learning disability. At the time of the inspection there were 10 people living at the service.

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

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.

Right Support

People were supported to have maximum possible choice, control and independence. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Some relatives felt people would benefit from having same gender staff working with them, which the registered manager was trying to facilitate. Staff supported people to achieve their aspirations and goals. Relatives felt staff offered very person-centred care. People were supported safely with medicines and staff proactively addressed any issues, which might arise and took appropriate action to reduce their occurrence. Infection prevention and control practices reflected current guidance.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to people’s individual needs. Staff understood how to protect people from poor care and abuse. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. We discussed enhancing the rotas to ensure they indicated exactly what 1:1 and 2:1 people received. On the whole, people’s care, treatment and support plans reflected their range of needs, and this promoted their wellbeing and enjoyment of life. The service worked well with other agencies.

Right culture

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. Staff always tried to place people’s wishes, needs and rights at the heart of everything they did. Staff were aware of and were working to best practice guidance for supporting people with a learning disability and/or autistic people.

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

Rating at last inspection

The last rated inspection for this service was good (published 21 August 2018).

A focused inspection was completed 24 March 2022, which looked at looked at infection prevention and control.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

This report only covers our findings in relation to the key questions safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

• Systems were in place to help prevent people, staff and visitors from catching or spreading infection.

• The environment was clean. Additional cleaning was taking place, including of frequently touched surfaces.

• Staff wore appropriate PPE and there were sufficient supplies. The provider carried out weekly checks to ensure the service always had enough PPE for staff to access. PPE stations were placed around the home for ease of access to staff.

• Staff had undertaken training in putting on and taking off PPE and other COVID-19 related training.

• People and their relatives were supported to keep in contact using a range of technology as well as visits to the home, in line with government guidance. There was also an covered outdoor area for relatives to visit with people, if preferred.

• People and staff participated in a regular testing programme, in line with government guidance.

Eastcliffe 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.

Eastcliffe accommodates ten people. At the time of inspection the service was providing support and care for ten people.

The manager had started their application to become the registered manager for Eastcliffe and the adjacent service Park Lodge. At the time of the inspection the manager was on annual leave and we were supported by the deputy manager. Following the inspection we spoke with the manager on their return from annual leave.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection, the service was rated as requires improvement. At this inspection we found the service had improved to good.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Risks to people’s safety in the event of a fire had not been managed effectively. The deputy manager took immediate action following our findings ensuring this matter was addressed.

People were involved and consulted about their needs and preferences in regard to all aspects of their lives.

Staff understood what constituted abuse and what actions they should take to ensure people remained safe. Safeguarding concerns were fully investigated. The provider recorded, collated and analysed safeguarding concerns and accidents and incidents to identify any patterns or trends for lessons learnt.

Identified risks were assessed and managed to minimise the risk to people who used the service and others. Medicines were managed safely.

An effective recruitment process was in place. Suitably trained staff were readily available to support people. Staff received regular supervisions and an annual appraisal.

People's independence and choice was enabled by staff who knew them well. Staff treated people with dignity and respect.

People were supported to engage in activities and interests of their choice. People were promoted and supported in maintaining a healthy diet.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The provider ensured people received care and support from healthcare professionals including GPs and community nurses. People were supported in maintaining a healthy and balanced diet.

Comprehensive care plans were available to staff. These were personalised and described how people preferred to be supported.

Relatives were aware of how to make a complaint. The provider had an effective quality assurance process in place.

The manager and deputy manager were supportive to the staff team and were both passionate about their role in ensuring people lived fulfilled lives.

Eastcliffe is registered to provide residential care and support for up to ten adults with a learning disability or autistic spectrum disorder. At the time of our inspection there were ten people receiving a service living over three floors and in an independent flat within the grounds.

During this inspection we found the provider had breached a regulation. The registered manager failed to engage with relatives and inform them of changes to the service and staffing structure. Relatives felt communication with the registered manager was poor and they didn’t meet with or see them regularly when they visited. The registered manager didn’t hold resident and relative meetings but told us that they were exploring ways to improve communication. Eastcliffe is next door to its ‘sister’ home, Park Lodge. We found that the registered manager was present in the home during different times of the day but their office was based in Park Lodge. Quality audits were not always effective as they failed to identify that Mental Capacity Act 2005 assessments had not been completed in line with the Code of Practice.

Staff were trained in safeguarding and had a good understanding of how to respond to safeguarding concerns.

Risks to people and the environment were assessed and plans put in place to mitigate any identified risks. Policies and procedures were in place to manage medicines.

The provider ensured there were sufficient numbers of staff on duty to support people with their assessed needs. The provider followed safe and robust recruitment procedures.

The provider had an ongoing training plan in place to ensure staff were appropriately equipped with the right skills and knowledge to meet the needs of the people using the service.

Staff received regular supervisions and an annual appraisal to promote and encourage their personal development. People contributed to menu planning and were provided with a varied diet to meet their nutritional needs.

People had DoLS authorisations in place where required. However, MCA assessments completed by staff were not completed in line with the MCA Code of Practice as their capacity was sometimes pre-determined following stage one without always following the required two stage assessment process.

People were supported by staff in a caring, friendly, familiar manner. Staff maintained people’s dignity and were respectful to their wishes. Staff explained support they proposed to provide to people and gained permission prior to doing so.

Advocacy services (this is where vulnerable people and people lacking capacity are supported to make decisions by independent persons who will promote and act in the individuals best interests) were advertised in communal areas of the service and were accessible to people and visitors. This helped to ensure people’s rights were respected and their voice heard.

Staff knew people's individual preferences, interests and abilities. They also know how to communicate with each person in the most effective way to meet their needs.

The deputy manager was based at the home and was present throughout the inspection. Staff attended regular meetings in the home to discuss the people who used the service and identifying any potential improvements to the service.

We spoke to seven members of staff who all spoke positively and without prompt regarding local management, training and working conditions.

We reviewed the comments and complaints file kept in the office. There had been no formal complaints in the five years preceding our visit. Five recent compliments had been received, including a family member who stated "Thank you so much for all you have done."

Some people found it difficult to express their views. We looked at the responses from relatives to a recent annual survey from the provider. One relative wrote, 'The staff and the home have made such a difference to his life - he is happy, respected and understood.'

The house was decorated and furnished to a good standard. The bedrooms were spacious, comfortable and individual to reflect the tastes of each person. People said they 'liked' their bedrooms, and they spent time relaxing in their rooms.

We found the service made sure there were sufficient staff available to meet people's individual needs. The people we spoke with said they 'liked' the staff and we saw people appeared to enjoy spending time chatting with staff.

There was a copy of the complaints procedure in easy-read and pictures to help people understand it. This was not in an easy place for people to access and some of the details were out of date. There had been no complaints in the last year.