Elmsdene Care Home

Elmsdene care home is a residential care home providing support for up to 33 people. The home supports people living with various types and levels of dementia. The home is over 2 floors and has a large lounge, dining room and separate television room. A kitchen and laundry are located on the ground floor and the upper floor is accessible by both a lift and stairs. At the time of the inspection the home was supporting 23 people.

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

We found blanket decisions had been made across the home which affected people’s safety and breached the requirements of different legislative frameworks, including the Mental Capacity Act, the Health and Social Care Act and the Human Rights Act.

People were not supported to have maximum choice and control of their lives and staff did not 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 identified concerns around how medicines were managed including how people could access medicines at the time they were prescribed or needed. We also identified risk management was not as developed as was required to ensure risks to people could be mitigated where possible. Governance systems were beginning to develop but audits and reviews in place only monitored small numbers of peoples’ records each month. The analysis of information collated through audit, to drive improvement, required further development.

There was enough available safely recruited staff to meet people’s needs and the home was clean and tidy. The home had recently changed management and a new system was being updated to provide more effective care planning. Staff and people, we could speak with, told us they were happy. The provider reacted immediately when serious concerns around people’s rights were highlighted and took steps to rectify the circumstances of the concerns.

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 13 October 2020) and there were breaches to the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 21 August and 3 September 2020 and found breaches of legal requirements. We found beaches in relation to suitable staffing and good governance. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elmsdene care home on our website at www.cqc.org.uk.

We have found evidence that the provider needs to make improvements. Please see the safe and well led key question sections of this full report. The provider took immediate action to address concerns identified with the use of yale locks to bedroom doors and assured us they would address blanket bans on people eating food in their bedrooms.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staff competence, medicines management, protecting people from abuse and good governance at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Elmsdene Care Home is a residential care home providing personal care to people aged 65 and over. The home specialises in providing care for people who live with dementia. The accommodation, which is on the ground and first floor, consists of twenty-five single bedrooms, nine of which have en-suite facilities and four double bedrooms, two of which have en-suite facilities. The communal space consists of a large dining room, lounge area and a separate television lounge. At the time of our inspection visit there were 21 people who lived at the home.

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

The service was not always well-led. At this inspection we identified issues with the provider's quality and assurance systems. Some records relating to care and the management of the service were either incomplete, inaccurate and/or not kept up to date. This could have compromised the quality and safety of the service provided.

The service was not always safe. The provider had not ensured a sufficient number of suitably trained staff were deployed at all times to ensure people’s safety. People did not always have risks to their personal safety identified and recorded. When they had been identified, control measures were not always documented to mitigate the risk. Staff were able to tell us about the risks to people and knew how to support people to minimise the risks. We found some issues with the cleanliness and maintenance of the environment. We have made a recommendation around infection prevention and control. The home had an adequate supply of personal protective equipment.

There was a positive staff culture at the service and staff told us they enjoyed their jobs. One staff member told us, “It is one of the nicest homes I have ever worked in, the residents are beautiful, it’s a good team.” We spoke to one relative who told us, “We are more than happy with the care provided which is what is important to us.” Another said, “We are kept informed and updated and know that our relative is happy.”

We found the management team receptive to feedback and keen to improve the service. The registered manager and provider worked with us in a positive manner and provided all the information we requested. Additionally, they responded immediately to our concerns during and after the inspection.

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 18 November 2018).

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. We carried out this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about staffing and risk management. A decision was made for us to inspect and examine those risks. 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 coronavirus and other infection outbreaks effectively.

We inspected and found there was a concern with staffing, training, risk management, documentation and governance, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led. 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 have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. The provider submitted an action plan after this inspection to show what they would do and by when to mitigate the risks and improve.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elmsdene Care Home 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 staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

At the last inspection carried out on 05 April 2016 the service was rated Good. At this inspection we found the evidence continued to support the rating of Good. 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.

There was a registered manager in place. 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.

Although a number of people had limited verbal communication and were unable to converse with us, we were able to speak with two people who lived at the home. They told us they were happy and supported by staff who cared for them and treated them well. We also spoke with three visiting relative’s who told us they were happy with the care provided and knew their relatives were safe. One person said, “Really nice friendly staff and I know [relative] is safe. I am highly satisfied with the care.”

Throughout the inspection visit we observed staff being kind and attentive to people in their care. We saw they were caring, patient and engaged people in conversation whilst providing their support. We saw staff were always in attendance in communal areas and available when people needed their help.

Procedures were in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs. We saw safe staffing levels in place and people received care and support when they needed it. People had support to enable them to pursue activities of their choice including going for walks.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. People received their medicines as prescribed and when needed and appropriate records had been completed.

Care plans were organised and had identified care and support people required. We found they were informative about care people had received. We saw people had consented to their care and treatment and where appropriate family members who had the legal authority to do so.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required. The design of the building and facilities provided were appropriate for the care and support provided.

We saw there was an emphasis on promoting dignity, respect and independence for people supported by the service. They told us they were treated as individuals and received person centred care.

We observed the daily routines and practices within the home and found people were treated equally and their human rights were constantly being respected.

The service had safe infection control procedures in place and staff had received infection control training.

Meal times were relaxed and organised around people’s individual daily routines. People who required help to eat their meals were supported by caring, attentive and patient staff.

People were supported to have access to healthcare professionals and their healthcare needs had been met.

The service had information about support from an external advocate should this be required by people they supported.

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.

The service had a complaints procedure which was on display in the entrance hall for the attention of people who lived at the home and their visitors. A visiting relative told us they were aware of the procedure but had never had reason to make a complaint.

The service used a variety of methods to assess and monitor the quality of the service. These included regular audits and satisfaction surveys to seek people’s views about the service provided.

Further information is in the detailed findings below

At the last inspection on 05 June 2014 the service was meeting the requirements of the regulations that were inspected at that time.

Elmsdene Care Home is registered for the regulated activity providing accommodation for persons who require nursing or personal care. The service provides support for people who live with dementia and can accommodate a maximum of thirty three people. The accommodation, which is on the ground and first floor, consists of twenty-five single bedrooms, nine of which have en-suite facilities and four double bedrooms, two of which have en-suite facilities. The communal space consists of a large dining room, lounge area and a separate lounge. At the time of our inspection visit there were 31 people who lived at the home.

There was a registered manager in place. 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 found sufficient staffing levels were in place to provide support people required. We saw staff members could undertake tasks supporting people without feeling rushed. People told us when they requested assistance this was responded to in a timely manner. One person visiting the home said, “Always plenty of staff on duty when I visit which is daily. What I like is the girls sit with the residents and spend time with them.”

We found recruitment procedures were safe with appropriate checks undertaken before new staff members commenced their employment. Staff spoken with and records seen confirmed they had received induction training when they commenced working at the home.

Staff had received training and were knowledgeable about their roles and responsibilities. They had skills, knowledge and experience required to support people with their care and social needs.

We found the registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

The environment was well maintained, clean and hygienic when we visited. No offensive odours were observed by any members of the inspection team. Hand sanitiser dispensers were prominently placed around the home for the use of staff involved in the delivery of personal care.

The service had a redecoration and refurbishment programme in place. Bathrooms and ensuite facilities were being updated when we visited. People who lived at the home told us they were happy with the improvements being made.

We found equipment used by staff to support people had been maintained and serviced to ensure they were safe for use.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept with appropriate arrangements for storing in place.

People were happy with the variety and choice of meals available to them. Regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. The cook had information about people’s dietary needs and these were being met.

People visiting the home told us they were happy with their relatives care. One person said, “I find the staff are kind and caring. I have never seen anything that has caused me concern during my visits. I know [relative] is safe and well cared for.”

People told us they were happy with the activities arranged to keep them entertained. These were arranged both individually and in groups.

The service had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they were happy and had no complaints.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys and care reviews. We found people were satisfied with the service they received.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. We also spoke with Blackpool council's contracts monitoring team and Healthwatch Blackpool who are an independent consumer champion for health and social care.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe and their rights and dignity was respected. They told us they were receiving safe and appropriate care which was meeting their needs. Safeguarding procedures were in place and staff understood how to safeguard people they supported. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and in how to submit one. This meant that people would be safeguarded as required.

The service was safe, clean and hygienic. One person visiting the home said they chose the home for their relative because it was spotless when they looked around the home. The person said, 'I was very impressed how clean and fresh the place smelt. No unpleasant smells anywhere. It's always clean when I visit'. Equipment had been maintained and serviced regularly ensuring people were not put at unnecessary risk. People living at the home told us they were happy and well looked after. Systems were in place to make sure the manager and her staff learnt from events such as accidents and incidents, complaints and concerns raised about the service.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support. People's health and care needs had been assessed with them or their relative, and they were involved in writing their plans of care. Specialist dietary needs had been identified where required. Care plans had risk assessments completed to identify the potential risk of accidents and harm. Staff members we spoke with confirmed guidance was provided to ensure they provided safe and appropriate care. We found the care plans were flexible, regularly reviewed for their effectiveness and changed in recognition of the changing needs of the person. People spoken with said their care plans were up to date and reflected their current needs.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. The people we spoke with were very happy with the care being provided. One person said, 'I am very happy. The staff look after me really well. I enjoy the activities they arrange they keep me entertained'. One person visiting the home said they were very happy with their relatives care. The person said, 'Mum is always clean and tidy when I visit. She is well looked after and I have no concerns about her care'.

We saw the deployment of staff at lunch time was organised. People who had been identified as being at risk from poor nutrition had a care worker allocated to assist them to eat their meals. We observed staff members were attentive to the needs of people who required assistance. Care plans had been maintained recording the care and support people were receiving. Good care practices were observed and people told us they were happy with the support they were receiving.

Is the service responsive?

Records showed admissions to the home were well planned. Information about people's care and dietary needs had been recorded. We also saw potential risks to people's health and welfare had been identified. Guidance had been provided for staff to ensure they provided safe and appropriate care. We saw staff engaging people in a range of activities. We observed people enjoying themselves and interacting with the staff. We found people had access to healthcare professionals. People received regular health checks with their General Practitioner and the outcome of these visits were recorded on their care records.

Is the service well-led?

The service had quality assurance systems in place. Records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving. Staff had a good understanding of their roles and responsibilities. People we spoke with said they received a good quality service at all times.

We found staffing levels were adequate with an appropriate skill mix to meet the needs of people using the service. Staff had been trained and appropriate support arrangements were in place for them. The home had been well maintained when we visited.

The people we spoke with said their relatives were receiving safe and appropriate care which was meeting their needs. One person said, 'This home is great for mum. She is getting excellent care and I find the staff are all very friendly and helpful. They are always organising activities to keep the residents happy. I never leave the home with any concerns about her care'.

During our inspection we contacted the Blackpool contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

We also spoke with Lancashire Fire & Rescue Service. They told us they had no issues when they last visited the home.

During our visit residents were taking part in a gentle exercise session. We chatted with one resident who showed us the exercises she had been doing. She said, 'I enjoy it. I do it every week!'

We saw that residents appeared comfortable and relaxed, chatting with each other and the staff. Residents were nicely dressed and well groomed, demonstrating that they had good support with their personal care.

We noted that the staff at the home went about their duties in a pleasant, cheerful manner. We saw staff supporting residents in a kind and gentle way. They appeared to have plenty of time to spend with individual residents just chatting or providing reassurance where needed.

We spoke with a number of residents and relatives during the inspection and received very positive feedback. Comments included;

'My mother has blossomed since she came here. She is like a different person, eating better, more alert and more content.'

'I visit regularly and I have never seen anything but patience, kindness and caring.'

We looked at a number of standards including how the service promoted the welfare of people who lived at the home and how they safeguarded people from abuse. We found the home was compliant in all the areas we assessed.