Eleanor Nursing and Social Care Ltd - Bexley Office

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.

At the time of the inspection the service was providing personal care to 92 people, most of whom were aged 65 and over.

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

Medicines were not always safely managed. Most risks to people were assessed. However, there were risks in relation to epilepsy and behaviour where staff did not always have sufficient guidance.

Systems and procedures to monitor the quality and safety of the service in relation to medicines, call scheduling, wearing of PPE and the monitoring of Covid-19 testing for staff did not always operate effectively.

There were enough staff to meet people’s needs but call scheduling did not always allow for travel time between visits. We had mixed feedback from people about the timing of care and support provided and if staff stayed the full length of the call.

People told us they felt safe using the service and that staff were kind and caring and attentive to their needs. Staff were familiar with safeguarding procedures and where to raise any concerns.

Staff had received training on infection prevention. The provider had updated policies and processes in place to reflect current guidance on Covid-19 and developed initiatives to reassure and support staff during the pandemic.

Staff were positive about the registered manager and provider about the way they managed the service and supported them.

Most people and their relatives said they were consulted about their needs and wishes and thought the service was well run and that any issues they raised were addressed. Their views about the service were sought through telephone monitoring, spot checks and surveys.

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 rating for this service was Good (report published 14 December 2018).

Why we inspected

The inspection was prompted in part due to concerns we received from the local authority about a number of complaints they had received about the service. These related to short or late calls and some staff not wearing appropriate PPE. A decision was made for us to carry out a focused inspection of Safe and Well-Led to examine those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from the concerns found. The registered manager took action to address some of the issues highlighted following the inspection, including improving the systems to record staff Covid-19 tests and call scheduling.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Eleanor Nursing and Social care Ltd – Bexley office on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety.

This announced inspection took place on 25 October 2018. At our last inspection in July 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

People received their medicines as required and medicine administration records were completed correctly. Risk assessments were in place and detailed plans were available to manage identified risks and to keep people safe. There were sufficient staff available to care for people as required. Recruitment procedures were robust and safe. Staff knew signs to recognise abuse and how to report any concerns appropriately. Staff knew how to report incidents and accidents to the registered manager. Staff followed infection control procedures.

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. Staff and the registered manager understood their roles and responsibilities under the Mental Capacity Act (MCA) 2005. People consented to their care and support before this was delivered.

Staff were supported through effective induction, supervision, appraisal and training to provide an effective service to people. People were supported to eat and drink appropriately and to meet their dietary and nutritional requirements. Staff liaised appropriately with social care and health care professionals to ensure people received the support they required. People were supported to arrange healthcare appointments where required. People’s care and support needs were thoroughly assessed. Relevant professionals were involved to ensure people received appropriate support and care that met their needs.

People told us staff treated them with kindness, compassion and respect. Staff gave people control over their care and support. Staff maintained people’s dignity, privacy and independence.

People had care plans in place which gave staff information about how to support people appropriately and these were reviewed and updated regularly to reflect people’s changing needs. People and their relatives were involved in planning their care. People were supported to socialise and maintain interactions with others. The provider made information accessible to people. Staff understood and promoted equality and diversity. People’s end of life wishes were noted in their care plans.

People and their relatives were given opportunities to feedback about the service provided. People and their relatives knew how to complain about the service and the registered manager understood their role in investigating and responding to complaints in line with the provider’s procedure.

The registered manager complied with the requirements of their registration. People, relatives and staff told us that the service was well managed. Staff told us they had the support and leadership they needed to carry out their roles. The registered manager checked the quality of service delivered. Regular spot checks and audits were carried out to identify any shortfalls in the service. The service worked in partnership with other organisations.

Eleanor Nursing and Social Care Ltd – Greenwich Office provides personal care and support services to people living in their own homes in the boroughs of Greenwich, Bexley and Bromley. At the time of our inspection there were approximately 137 people using the service and there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

We checked whether the service was working within the principles of the MCA. Care plans contained some information on people’s mental health and capacity where appropriate through the provider’s generic assessments; however the provider did not have systems in place for staff to assess people’s mental capacity in line with the MCA. These issues required improvement and we recommend that the provider follows best practice in relation to working within the principles of the Mental Capacity Act 2005.

There were systems in place that ensured people received their care on time and people were kept safe. There were policies and procedures in place for safeguarding adults from abuse. Appropriate recruitment checks took place before staff started work and staffing levels were appropriate to meet the needs of people using the service.

Risks to people were identified and assessed and there were suitable arrangements in place to manage foreseeable emergencies. Where people required support with their medicines, we saw there were robust arrangements in place to ensure medicines were managed and administered safely.

Staff received supervision, appraisals and training appropriate to their needs and the needs of people who they supported to enable them to carry out their roles effectively. There were processes in place to ensure staff new to the service were inducted into the service appropriately.

People’s nutritional needs and preferences were met and people had access to health and social care professionals when required. People told us they were treated with respect and they were consulted about their care and support needs. People were provided with information about the service when they joined and we saw that people were provided with a copy of the provider’s ‘service user guide’.

People’s support, care needs and risks were identified, assessed and documented within their care plan. People’s needs were reviewed and monitored on a regular basis. People were provided with information on how to make a complaint in a format that met their needs. The service worked with health and social care professionals and with local authorities who commissioned the service to ensure people’s needs were met.

People told us they thought the service was well run and staff told us they received good support that enabled them to do their jobs effectively. There were systems in place to ensure consistency and quality was maintained and there were effective processes in place to monitor the quality of the service. People were provided with opportunities to provide feedback about the service.