Archived: Elstree Court Care Home

At the time of this inspection 32 people were living in the service. This inspection took place on 25 and 26 May 2016 and was unannounced.

The service had 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.

Management systems that included quality monitoring did not always ensure safe and best practice was followed in all areas. Some records had not been completed or maintained in a consistent way to support the care and treatment provided. This could lead to staff not having up to date information on people’s needs and care provided. Lack of clear and accurate records could also lead to staff not following best care practice.

People were looked after by staff who knew and understood them well. Staff treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity. All feedback received from people and their representatives through the inspection process were positive about the care, the approach of the staff and atmosphere in the home. People told us they would recommend the home and comments included, “Oh I do like it here, I’m so happy here,” “There’s nothing better than this place,” “I’d give it ten out of ten,” and “It’s just lovely, nice atmosphere and nice kind people.” Feedback from visiting professionals was positive with a multi-disciplinary approach to care and treatment.

Staff had a good understanding of safeguarding procedures and knew what actions to take if there was an allegation of abuse. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a deprivation of liberty.

Staff were provided with a full induction and training programme which supported them to meet the needs of people. Staffing arrangements ensured staff worked in such numbers, with the appropriate skills that people’s needs could be met in a timely and safe fashion. The registered nurses attended additional training to update and ensure their nursing competency.

People were given information on how to make a complaint and said they were comfortable to raise a concern or give feedback. A complaints procedure and comment cards were readily available for people to use.

Staff monitored people’s nutritional needs and responded to them. Preferences and specific diets were provided. People were supported to take part in a range of activities that met their individual needs.

Feedback was sought from people on a daily basis and satisfaction surveys had been completed. The management style fostered in the home was transparent listened and responded to people and staff’s views.

We spoke with a number of people who used the service and their visitors along with a visiting health care professional.

We interviewed in private all staff involved in direct care on the day of the inspection and two housekeeping staff. We also spoke with the clinical lead and the registered manager.

The Care Quality Commission (CQC) had received anonymous information that the home had staffing issues that had impacted on the provision of care for people living in the home.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

To see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was clean and well maintained.

Risk assessments were in place to provide information to staff to help minimise the risk of any harm to people.

All feedback indicated that there was enough staff and they were competent in the work they undertook.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager was able to describe when a DoLS would be used and the necessary review process. Staff had been trained on the Mental Capacity Act (MCA) and its associated guidelines.

Is the service effective?

We saw individual plans of care were in place. There was evidence to confirm that these were reviewed and updated to reflect any changing need.

People and their relatives told us that the care provided was appropriate and met people's needs. Discussion with staff confirmed that staff knew and understood people's individual care and social support needs.

Training records seen confirmed staff had received appropriate training to meet the needs of people living at the home.

Is the service caring?

People were supported by kind and caring staff. We saw that staff were very kind and polite and were responding to people when they requested any help.

Is the service responsive?

Individual care plans were developed for each person following admission. People were given choices and when they declined, this was responded to appropriately. People had access to activities and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

We saw that a number of quality assurance processes were in place. These included feedback from people who used the service and their representatives.

People, visitors and staff told us that if they had any concerns they would speak with the manager or other senior staff.

The registered manager was supported by a clinical lead and a stable team of registered nurses. Staff told us they were clear about their roles and responsibilities. Senior care staff worked in the home alongside more junior staff to lead and guide. Staff said they were kept up to date with any changes as required.

There were 35 people living at Elstree Court Nursing Centre at the time of this inspection visit. We spoke with the manager, the deputy manager, two registered nurses, three care staff on duty and one of the chef managers. We also spoke with ten people who used the service and two visiting relatives.

We looked at the records relating to the staffing arrangements within the home. We found that there were enough staff working in the home to meet peoples assessed needs. Staff received a programme of training that ensured they had the skills to undertake their allocated roles within the home.

In this report the names of a two registered managers appear. Ms Linda Shorman was not in post and not managing the

regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered

manager on our register at the time.

People told us that they were treated with kindness and respect and that they had given consent to the care that was given.

We looked at the systems and processes that the home had in place to ensure the people who used the service were protected from abuse. These processes ensured that staff knew what constituted abuse and what to do if it was suspected.

We saw that the staffing numbers allocated by the home were working. However, there was evidence that the number of staff available did not always ensure safe care was being provided.

We looked at the systems and processes the home had in place to respond to complaints. These processes ensured complaints raised were resolved to people's satisfaction with information used to change practice.

In this report the names of a two registered managers appear Ms Linda Shorman was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.