Archived: Ebdon Lane

Updated 9 April 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection started on 30 December 2015 and was unannounced. We also carried out a short second inspection visit on 5 January 2016 which was announced. The inspection was carried out by one adult social care inspector.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and any improvements they plan to make. Before our inspection, we reviewed the information included in the PIR along with other information about any incidents we held about the home. We contacted the commissioners and safeguarding adults officers of the local authority to gain their views of the service provided at this home.

During the visit we spent time with people and observed how staff supported them. We also spoke with a relative. We spoke with a service manager and two support workers. We looked around the premises and viewed a range of records about people’s care and how the home was managed. These included the care records of two people, the recruitment records of two staff, training records and quality monitoring records.

Updated 9 April 2016

We carried out an unannounced inspection of Ebdon Lane on 30 December 2015. We completed the inspection on 5 January 2016.

The last inspection of this service was carried out on 1 October 2013. The service met the regulations we inspected against at that time.

Ebdon Lane is a large purpose built detached bungalow set in a mainly residential area with good access to shops and local amenities. Six people can live there and it has good access both in and out of the property. There were six people living there when we visited.

There was a registered manager for this service. 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.

During this inspection we identified three breaches of regulations. There had been many incidents of physical and verbal aggression between people who used the service, and the provider was working with social and health care professionals to support people. However the incidents had not been reported to safeguarding adult’s team or to the CQC. This meant safeguarding adult’s protocols had not been followed so vulnerable people may not always have been protected. Some staff had not received one to one supervision with a manager, which was contrary to the provider’s own procedures. Some people’s individual care records were incomplete which meant that it was not always possible to be clear if a person was supported in the right way.

You can see what action we told the provider to take at the back of the full version of the report.

There were enough staff to assist people in the house in a safe way, although some staff felt it would be better if they could support people out into the community more. The recruitment of staff included the right checks and clearances so only suitable staff were employed.

Potential risks to people’s safety were assessed and managed. People’s medicines were managed in a safe way, although it would be better if eye-drops were dated when opened so that staff were certain of their expiry date.

Staff had training in the Mental Capacity Act 2005 for people who lacked capacity to make a decision and deprivation of liberty safeguards to make sure they were not restricted unnecessarily. Staff asked for permission before carrying out care tasks. People told us they made their own choices about their daytime routines.

People were supported to access community and specialist healthcare services, such as GPs and speech and language therapists, when necessary. Each person’s nutritional well-being was assessed and they were supported to enjoy a healthy diet. People who could express a view told us they liked the meals.

People who were able to express a view told us they “liked” the staff. One person commented, “I like all the staff – they’re very nice.” Another person commented, “You can have a good talk with them and they listen.” Everyone seemed comfortable in the presence of staff and spent time socialising with them in the lounge or dining room.

Staff were very knowledgeable about people’s individual needs, preferences, likes and dislikes. People and relatives had information about how to make a complaint and said they had done this when they were unhappy. The provider had a quality assurance programme to check the quality of the service.

People said they liked the service manager and they were relaxed in his company. A relative commented that things were “settling down” after a difficult period. Staff said they felt the service manager had made significant improvements to the service in the short time he had been running the service. One staff member told us, “I feel things are really getting sorted out now.” Another staff member commented, “[The service manager] has been amazing. He has made a huge difference.”