Eco Nights

About the service

Eco Nights is a respite service providing accommodation and personal care for up six younger people who have a learning disability and/or living with autism. On our first ‘out of hours’ visit the service was supporting two people and at the time of our second ‘out of hours’ visit the service was supporting seven people. One person was undertaking a teatime visit and not staying the night.

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

Right Support

• The service recorded when staff restrained people. However, improvements were required to demonstrate staff’s interventions prior to restraint being used and lessons learned to show how staff learned from those incidents and how they might be avoided and reduced.

• The service is a large bungalow which enables people who use the respite service to access the community. The premises is situated within the local community and did not feel unfriendly, intimidating or institutionalised.

• People were able to use communal areas as they wished and to have privacy for themselves if they chose to be alone.

• Each bedroom at Eco Nights was decorated to a specific theme. The provider’s representative stated people had been involved in choosing the theme.

• Staff enabled people to access healthcare provision and services as needed in consultation with their relatives.

• Staff supported people with their medicines.

Right Care

• Staff understood how to protect people from harm and abuse. Where internal investigations were completed, improvements were required to ensure these were robust.

• People received appropriate care that was kind, and which met their needs. However, we were concerned that an agency member of staff used at Eco Nights, did not know the names of two people they supported or the gender of one person. Profiles for people using the service were evident but not for all people being supported on our second ‘out of hours’ visit to Eco Nights. The agency member of staff confirmed they had not read the profiles.

• People’s care and support plans reflected their range of needs. Risks to people were assessed and recorded. Where appropriate, people were supported to take positive risks.

• People who had individual ways of communicating, using body language, sounds, objects of reference and Makaton, could interact with staff.

• The service had enough staff to meet people's needs. Steps were being taken to recruit permanent members of staff so as to reduce reliance on staff from the provider’s ‘sister’ services and staff from external agencies.

Right culture

• The service's quality assurance, monitoring and oversight arrangements required improvement.

• Staff were not aware of the ethos and values of the provider or the principles of 'Right support, Right Care and Right Culture'.

• Despite not all staff having up to date training, people received appropriate care. The provider and their representative told us staff had not received updated training due to the COVID-19 pandemic.

We have made recommendations about safeguarding investigations and the security of COSHH items.

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 [published October 2019].

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support, right care, right culture.

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.

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.

Eco Nights is a residential respite care service providing personal care for younger adults at the time of the inspection. People who use the service have varying complex needs such as; sensory impairment, autism, learning and/or physical disability. The shared residential care home was registered for the support of up to 6 people in line with best practice guidance. 39 people regularly used the service for varying lengths of stays. When we visited there were 6 people using the service. The residence has shared amenities of kitchen, lounge, bathrooms and garden.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The registered manager and staff told us how important the services' shared values were to them, and how they were passionate about providing outstanding person-centred care to young people when they needed it, to enable them to live fulfilled, meaningful lives.

The registered manager told us, “We intend to continue to support people and their families who are approaching and are in crisis. We are prepared to do as much as we possibly can to support everyone involved.”

Relatives told us they thought the staff were highly compassionate, caring and empathic people who had made a difference to their lives when they had nowhere else to turn. The consistency of staff enabled meaningful relationships to be created between staff and people. The manager told us, “We strive to be a home from home setting for people, so families can get the respite they need.”

People’s medicines were well managed, and they were supported to access healthcare services. A community professional told us, “Eco Nights have worked closely with me and colleagues in health and have developed a very good understanding of people’s needs.”

People were treated with dignity and respect. Their lifestyle and equality needs and choices were understood and respected. Care plans were detailed and outlined the support people needed. These records were regularly reviewed to make sure they reflected changes to people's circumstances.

People were protected from the risks of harm and abuse. Enhanced risk assessments were in place to identify and help reduce the likelihood of people experiencing injury or harm. People’s privacy was respected.

Recruitment processes were ongoing. Staff were trained and supervised to make sure they met people's needs effectively. They had been recruited using appropriate procedures.

The service had effective leadership. Staff understood their responsibilities and worked together as a team. There were systems to monitor the quality of people's care to make sure it was effective and safe.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the provider at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. Some minor restrictive intervention practice was used as a last resort, in a person-centred way, in line with positive behaviour support principles.

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 (published 29 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Eco Nights provides a respite care service for younger adults who have a range of complex needs such as learning disability, autism and physical disability. At the time of our inspection 27 people regularly used the service for varying lengths of stays. There were two people using the service when we visited.

A registered manager was 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. The registered manager was supported by a deputy manager to ensure the daily management of the service.

The service provided good care and support to people enabling them to live fulfilled and meaningful lives. People were supported by skilled and well trained staff who ensured people were safe. The registered manager and staff understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS).

There were sufficient numbers of staff available to meet people’s individual needs. The registered provider had effective recruitment procedures in place to protect people from the risk of avoidable harm. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed. There were safe systems in place for the administration of medicines and people received their medication as prescribed.

There was a strong emphasis on person centred care. Assessments were undertaken to identify people’s care and support needs prior to them using the service. Care plans included people’s preferences and individual needs and were regularly reviewed. The service also gathered information from health and social care professionals involved in people’s care to ensure effective support and care was provided.

The service responded well to meeting people’s diverse care and support needs. People were supported to maintain their daily routines and activities during their stay at the service.

There were effective systems in place to regularly assess and monitor the quality of the service provided. The registered manager was able to demonstrate how they measured and analysed the care and support provided to people, and how this ensured that the service was operating safely and was continually improving to meet people’s needs. There was an effective complaints system in place.

Staff felt valued, enjoyed working at the service and were committed to providing a high quality service to people.

Is the service safe?

When we arrived at the service the staff asked to see our identification. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

We saw that the staff were provided with training in safeguarding of vulnerable adults from abuse, and the Mental Capacity Act (MCA) 2005. This meant that staff were provided with the information that they needed to recognise signs of abuse and respond to any concerns identified.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that people were relaxed in the company of staff. We saw that staff were attentive to people's needs. Staff we spoke with were able to demonstrate that they knew people well. We saw that staff treated people with dignity and respect.

Is the service responsive?

People who used the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to. We saw that when one activity was cancelled for a person without notice, the service immediately organised another activity.

Is the service well-led?

The service had a number of quality assurance measures in place. The registered manager was proactive in monitoring and looking for ways to improve the service. We saw that the quality of the service had been maintained.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work. We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. This referred specifically to staff training and supervision. The provider had an effective system to regularly assess and monitor the quality of service that people received.

Further improvements were required in relation to care plans and risk assessments. Also ensuring that where restraint was used a clear audit of interventions provided by staff was maintained.

It was apparent from our findings at this inspection that the absence of robust quality monitoring by the provider has been a contributory factor to the failure of the service to identify non-compliance, or any risk of non-compliance sooner. Improvements were required to ensure that support plans reflected the young people's care needs and any potential risks. Improvements were also required in relation to staff recruitment procedures and selection processes and ensuring that all staff received appropriate training, supervision and appraisal.