Eastleigh House 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.

Eastleigh House accommodates a maximum of 10 people who have a learning disability, Autism and complex needs, in one adapted building. There were nine people resident at the time of the inspection, with ages ranging from mid 20’s to mid 50’s.

The care service had not been developed and designed in line with the values that underpin Registering the Right Support and other best practice guidance, as it was registered prior to this guidance. These values include choice, promotion of independence and inclusion, so that people with learning disabilities and autism can live as ordinary a life as any citizen. A statement from the provider organisation about Registering the Right Support included, ‘The staff team will support and enable people to maximise their potential for independence, supporting them to develop daily living skills and achieve fulfilling lifestyles.’

The service had a registered manager. 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.

The inspection took place on 27 September 2018. It was announced so that people using the service could be helped to understand the reason for the visit.

At the last comprehensive inspection in February 2016 the service was rated Good overall, because we found no concerns. At this inspection we found the evidence could no longer support that rating and now the overall rating is Requires Improvement.

Hygienic practice was compromised because a partly adapted cellar was used as the laundry. Surfaces were not readily cleanable and would harbour dust. Neither did risk management ensure an effective cleaning regime in the cellar/laundry. We have made a recommendation.

There was a breakdown in the staff, management relationship. Staff said they felt undervalued and not listened to. Whilst they had the opportunity to make their feelings clear through an independently commissioned, and confidential staff survey in March 2018, staff said they did not trust that the survey was independent. No action plan was produced following the survey results but a ‘Listening group’ so as to hear first hand staff views, was held in September 2018, the arrangement having fallen through on two previous occasions. This was only attended by staff on duty at the time. Some staff told us they valued their time off and did not feel prepared to use it returning to their work place.

The provider representative was unaware of negative staff feelings, and lack of staff trust. They said the registered manager had their full support, but the concerns raised by staff were of deep concern, unacceptable to the organisation, and would be addressed as a priority.

Current staffing arrangements were inconsistent due to high levels of staff sickness and the need to replace staff who had left. This had the potential to increase risk. The provider and service management had identified sickness as a problem to be addressed. To this end they were about to try a revised staff rota and new staff were being recruited. The registered manager worked to maintain safety by filling staffing gaps, through asking staff to work extra hours, using agency staffing, and personally helping provide necessary care.

People using the service were unable to tell us their experience of living at Eastleigh House but their family members spoke very highly of the care provided and the registered manager. One said, “I can talk to the (registered manager) about anything. I can ring her any time and she

This inspection was unannounced and took place on 1 February 2016. At our previous inspection in November 2013 the home was meeting the regulations at that time.

Eastleigh House provides accommodation for up to 10 people with learning disabilities and autistic spectrum conditions. There were nine people living at the home at the time of our inspection.

The home had a registered manager. 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.

The people living at Eastleigh House were unable to tell us whether they felt safe at the home. We spent time with people observing their interactions with staff. People were spoken to with kindness, patience and humour. We saw people smiling, accepting physical contact from staff and accompanying staff around the home for various activities. This indicated people felt safe in the staff’s company. Staff knew what action to take should they have any concerns over a person’s welfare and they were confident the registered manager would take action if they raised concerns. Staff were provided with information about the “speak out safely” campaign which actively encouraged staff to raise the alarm when they saw poor practice. The health and social care professionals we spoke with confirmed the registered manager and staff provided a safe and supportive home for people.

Risks to people’s health, safety and welfare were assessed and management plans were in place to reduce these risks. Staff were guided about what actions to take should a person become anxious or display behaviour that my place themselves or others at risk. Staff had completed training in managing behaviours that may be aggressive towards others and were confident with distraction and breakaway techniques, as well as using a physical intervention if that was necessary.

Staff were knowledgeable about people’s support needs as well as their preferences and what made a ‘good day’ for them. Each person had a care file that provided staff with very clear information about people’s care and support needs. A ‘communication dictionary’ described how people communicated their needs through words, sounds, signs or objects of reference. Each person had a key worker who supported them to develop their everyday living skills as well as new interests. The key worker developed a profile of the person to describe them as a person with likes, dislikes, personalities and preferences for staff to look beyond their disability. Care files held records of family involvement in care planning and monthly reviews as well as when the home had contacted them about significant events. Advocacy services were accessed for those people who had no family support. The health and social care professionals we spoke with told us people’s needs were well known and understood by staff.

People were encouraged to be involved in a variety of activities both in and out of the home. Each person had an individual plan for the week which included activities such as cooking, painting, going for walks or out to the local café.

People were supported to maintain a healthy diet. Many of the people living at the home were unable to express their meal choices verbally. Staff offered people a choice of two meals to enable them to choose which one they would like to eat.

People medicines were managed safely and people received their medicines as prescribed. People had access to medical care and advice through the GP service or community learning disability services. Some people were also receiving specialist support from the local hospital for more complex health care conditions.

People were supported by sufficient staff on duty to meet their care and support needs, maintain their safety and provide them with meaningful activity. Safe recruitment processes were in place to reduce the risk of employing a person who may be a risk to vulnerable adults. Staff were provided with the training they needed to understand people’s physical and mental health needs. The provider’s in-house training ‘Foundations for Growth’, with over 40 modules supported the externally accredited training staff received. New staff completed an induction programme where they undertook essential training and worked alongside an experienced member of staff. They were also enrolled to undertake the Care Certificate.

The home was adhering to the principles of the Mental Capacity Act 2005, in that people’s capacity to consent to their care and treatment was assessed and best interest decisions made on their behalf when they were unable to consent. Where it was necessary to deprive people of their liberty to keep them safe or to manage a potentially aggressive situation, authorisation had been obtained for the local authority’s supervisory body. Staff were observant for signs people may have concerns or not be happy as many of the people living at the home would not be able to express this.

The registered manager and staff team demonstrated their commitment to providing high quality, personalised support to people. They had effective systems in place to assess people’s needs, recruit and train dedicated staff and to monitor the quality of the support services they provided. Staff told us the home was well managed and they enjoyed working at Eastleigh House. The provider had signed up to quality improvement initiatives and kept up to date with current good practice.

We observed care practices, met people, talked to staff and looked at records to help us understand how people viewed the support they received at this service. This was because the people we met on our visit did not communicate with us verbally, and were therefore not able to tell us about their experiences.

Care records were person centred, clear to read and described how people made decisions in their daily lives. People’s wishes and goals were at the centre of their plans.

Staff were knowledgeable about how people communicated their wishes and wants. We saw that staff listened to people and spent time checking people's facial expressions and body language. Staff were respectful and supported people patiently. People were relaxed around staff.

The service had policies and procedures in place that kept people safe. Staff were knowledgeable and confident about their safeguarding responsibilities and how they would respond to any concerns that may arise.

There were processes in place to monitor the quality of service being provided, and we saw that the opinions of people’s families were obtained through questionnaires.

The home was last inspected by the Care Quality Commission in April 2012. Improvements were required relating to standards of providing care, treatment and support which met people's needs and caring for people safely and protecting them from harm. Improvements were also required relating to standards of staffing and management.

Nine people were living at the home and receiving care. Due to the complexity of their needs we were not able to ask them about their view on the changes. However we were able to observe their behaviour. All the people we saw appeared at ease and comfortable with the staff. People enjoyed spending time in the communal areas. We spoke with four staff and one visiting healthcare professional.

We followed up on the improvements required at this inspection and found that the provider had taken the necessary action. We looked at three care plans and saw that all had been reviewed on a regular basis. Feedback from staff and records showed that people were taking in part in meaningful activities. Restraint was not in use and staff had received training on how to manage behaviour that challenged the service.

Staff were up to date with training. A major refurbishment programme was near completion and staff were confident about continued improvement at the home. One member of staff said “I can see where we’re going to be.” Another said “There’s so much more structure since the new manager’s been here. She’s on it. She’s there.”

People living at the home, because of their complex needs, were not able to tell us (the Care Quality Commission) about their experiences. To gain an understanding of their experience we used a number of different methods. We spoke to a relative of one person, one visiting healthcare professional and five staff. We also spent time throughout the day observing care and lunch time. We looked at four care plans in detail. On the day of our inspection nine men were living at the home.

A relative said that staff kept them very well informed and they were always made to feel very welcome. They felt that the environment was good as it was large and spacious and their relative needed lots of room to pace around. They added that they had never had reason for concern.

A relative felt that staff had a good understanding of needs and responded promptly to any changes in health. She said she was always invited to meetings and if not able to attend was kept informed.

We were able to speak to a visiting healthcare professional from a mental health trust. When asked about their experience of the home they said they “never had a problem” and that the home was “transparent” in its approach to care, would “always ring” if concerned and would “follow up” on advice given. The staff were described as “good” and when asked if there were enough staff to meet people’s needs the nurse replied “there always seems to be”.

We were told by the manager that a major refurbishment had been planned for January 2012. At our inspection in early April 2012 work had not started.