Ellerslie House

Updated 18 May 2023

The inspection

This was a targeted inspection to check whether the provider had met the requirements of Warning Notices in relation to Regulations 12 and 17 (Safe care and treatment, and Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Ellerslie House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.

Registered manager

This service is required to have a registered manager. A registered manager is a person who has registered with CQC to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection the registered manager was on leave.

Notice of inspection

This inspection was unannounced.

Inspection activity, including our visit to the location, took place on 4 April 2023.

What we did before the inspection

We reviewed the information we had about the service, including the Warning Notices and last inspection report. We used the information the provider sent us in the provider information return. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all of this information to plan our inspection.

During the inspection

We reviewed care records for 5 people using the service, and other records relating to the management of the service. We spoke with the service manager, head of care and managing director.

Updated 18 May 2023

About the service

Ellerslie House is a residential care home providing accommodation and personal care to

people with a learning disability and/or autism. The service can support up to six people. At the time of the inspection five people were being supported. Ellerslie House has four bedrooms and two adjoining flats.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the safe, effective and well-led key questions the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

The model of care and setting did not fully maximise people's choice, control and independence. For example, people lived in an environment which was not always clean and communal areas were not always homely. We made a recommendation about this.

The manager did remove some of the clutter prior to our second day of inspection. People had privacy for themselves and their visitors. The service was located so people could participate in the local community following a short car journey.

Ethos, values, attitudes and behaviours of leaders and care staff did not fully ensure people using services led confident, inclusive and empowered lives. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We have made a recommendation about this.

Care was not fully person-centred. For example, while regular staff knew people well, people were not always treated with kindness and respect and care plans were not always person centred. We observed one person who consistently had two staff, one either side of them, the staff members continually had hands on this person’s arms and were preventing them from going in the direction they wanted to go. The staff were constantly redirecting this person even when they were the only ones in the large enclosed garden. This meant the person’s freedom was constantly restricted. The manager told us they would speak to the staff to ensure people had as much freedom as possible, they also told us they were reviewing care plans and would update them to include relevant detail and to be more person centred.

People were at risk of harm because staff did not always have the information, they needed to support people safely.

People did not always receive a service that provided them with safe, effective, compassionate and high-quality care.

The service was not maximising people's choices, control or independence. There was a lack of person-centred care.

Leadership was poor, and the service was not always well-led. Governance systems were ineffective and did not identify the risks to the health, safety and well-being of people or actions for continuous improvements.

The provider did not have enough oversight of the service to ensure that it was being managed safely and that quality was maintained. Quality assurance processes had not identified all the concerns in the service and where they had, enough improvement had not taken place. Records were not always complete. People and stakeholders were not always given the opportunity to feedback about care or the wider service. This meant people did not always receive high-quality care.

Medicines management had improved since our last inspection although medicines audits had not identified gaps in medication administration records. We made a recommendation about this.

Staff had not always received the training and support they required to carry out their roles safely and effectively. We made a recommendation about this.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 January 2022) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the safety of people and a lack of effective leadership at Ellerslie House. As a result, we undertook a focussed inspection to review the key questions, safe, effective and well-led only. 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.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

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 Ellerslie House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to equipment being checked and maintained, risks not being identified and mitigated, notifications, mental capacity assessments and good governance.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.