3 and 7 August 2015
During a routine inspection
Elliscombe House is registered to accommodate up to 40 people. The home provides personal care and nursing care for older people, some of whom may be living with dementia. Accommodation is arranged over two floors, although the first floor is not currently being used. It is an Edwardian country house which has been adapted to meet people’s needs. There were 21 people living at the home at the time of our inspection.
There was no registered manager 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 and associated Regulations about how the service is run. The home was being managed by a temporary manager as the new permanent manager resigned and left employment on the 16th August 2015.
This inspection took place on 3 and 7 August 2015 and was unannounced.
People said the home was a safe place for them to live. However, people’s medicines were not well managed to ensure people received them safely or effectively. There were not enough staff to ensure people received safe and effective care. Accidents and incidents were not always followed up to prevent a recurrence.
Although people and their visitors made some positive comments about the care provided by staff, we saw that people often had to wait for care to be carried out. Staff were very calm, caring and dedicated despite working in challenging circumstances due to staffing numbers and a shortage of permanent staff. One relative said “They simply don’t have enough staff. Some of the agency staff are brilliant but others don’t know people here.”
People were not involved in planning and reviewing their care. Some people’s care plans did not accurately reflect their care needs. When people were unable to make all of their own decisions they could not be assured that care and treatment was always provided with the consent of a relevant person.
Staff did not always respond appropriately to people’s changing needs. People did not always have enough to eat or drink. Mealtimes needed better organisation.
Permanent staff had good knowledge of people, although staff practice was inconsistent. There was a lack of consistent staffing and high use of temporary agency staff. Staff were supervised but not well trained.
People’s privacy was respected. Staff ensured people kept in touch with family and friends. The choice of activities and opportunities for people to go out were limited. There were very limited opportunities for staff to spend quality time with people.
People saw appropriate health and social care professionals to ensure they received treatment and support for their specific needs. One person said “I do see my doctor if I’m not well. They always make sure of that.”
There were quality assurance systems in place; these were not effective. The management, leadership and staffing of the home had been inconsistent. There was a lack of leadership ‘on the floor’ where care was being delivered. Some key information given to us by the provider before the inspection was found to be inaccurate.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.