Ellesmere House

Updated 8 September 2020

The inspection

This was a targeted inspection to check specific concerns we had about the staffing levels at the service and how the provider ensured staff were supported with their roles and responsibilities. We will assess all of the key questions at the next comprehensive inspection of the service. As part of this inspection we looked at the infection control and prevention measures in place. This was conducted as part of our Thematic Review of infection control and prevention in care homes.

Inspection team

The inspection was carried out by three inspectors. Two inspectors visited the service and a third inspector conducted telephone calls to people who use the service on 14 August 2020. Calls were also made to relatives and staff after the site visit. Therefore, inspection activity commenced on 6 August and concluded on 24 August 2020.

Service and service type

Ellesmere House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of the inspection the registered manager was inducting the new home manager.

Notice of inspection

This inspection was announced at very short notice. We notified the registered manager that we were outside the premises to ascertain if it was safe for us to proceed with an inspection site visit, in accordance with Covid-19 risk management protocols.

What we did before the inspection

We initially conducted a telephone meeting with the provider on 18 June 2020 to discuss our concerns about staffing levels. We requested information in relation to staffing arrangements and systems for calculating people’s individual dependency needs, which was sent to us by the registered manager. We continued to gather further information about staffing levels from the service prior to carrying out this inspection. We also spoke with the local authority quality assurance officer and reviewed copies of their weekly telephone quality assurance monitoring reports. Additionally, we contacted the local authority safeguarding adults lead to obtain updates for completed safeguarding investigations.

Our planning also took account of the information provided by the registered manager and regional manager during the first Emergency Support Framework (ESF) call on 26 May 2020 and the second ESF call on 3 August 2020. ESF calls help us to give targeted local advice, guidance and support to providers and care staff using a structured framework to guide conversations and help them to respond to emerging issues, and to deliver safe care which protects people’s human rights.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We carried out informal and formal observations within communal lounges and dining areas of how staff supported and interacted with people who used the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We looked at systems for infection prevention and control and requested relevant policies, audits and staff training records to demonstrate how the service was managing COVID-19 infection risks.

Additionally, we acquired from the provider a wide range of documents relating to the management of the service for us to check during and after the inspection visit. This included staff rotas, staff training records, minutes for clinical and general

Updated 8 September 2020

About the service

Ellesmere House is registered to provide accommodation for up to 70 people with personal care and nursing care needs. At the time of the inspection 39 people were residing at the service and three people were in hospital. The premises are purpose-built and people are accommodated on four separate units for nursing care and residential care needs. The service supports older people with physical frailties and/or people living with dementia.

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

People told us they were pleased with the quality of their care and support and they described staff as being “kind” and “lovely.” Although relatives spoke well of the individual staff who looked after their family member, we received mixed comments in relation to whether there were sufficient staff. Some relatives described the care their family members received as being “amazing” and other relatives were concerned that their family members were deteriorating due to insufficient staff to provide person-centred care.

When we looked at staffing arrangements we found that there were sufficient staff on the day of our inspection and the staffing rotas matched the number of staff we met on the individual units. During our observations we saw that people’s care was delivered in an unhurried way and the atmosphere on the units was calm and orderly.

People’s call bells were answered and staff were observed going into people’s rooms to check on their welfare and support them.

People were protected by good infection control practices which were based on current guidance from the government and local public health professionals. Staff were provided with correct and sufficient personal protective equipment (PPE) and safe arrangements had been introduced to enable people to receive visits from relatives or friends in the care home’s garden.

The management team and staff acknowledged that the service had experienced a very challenging time due to the COVID-19 pandemic. Sadly, some people who lived at the service passed away and some staff needed to shield or take time off for health care reasons.

During this period we noted the service received an increase in safeguarding concerns, some of which the registered manager was awaiting investigation outcomes at the time of the inspection visit. Some of these concerns had been raised by an external agency that provided temporary care staff for three and a half weeks at the height of the pandemic and alleged neglect of people's needs.

People were effectively and patiently supported to meet their nutritional needs at lunch time. However, we found that specific practices on one of the units did not consistently uphold people's entitlement to receive a dignified dining experience. We have made a recommendation within this report.

Staff mainly told us they felt well supported by the registered manager and the management team. Staff reported to us that the registered manager had stayed overnight at the service on days when staff particularly needed additional support and guidance. The provider had put in place a number of actions to formally support staff, for example staff were not financially penalised if they needed to self-isolate and individual risk assessments were carried out to reassure and support staff.

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 good (published on 11 March 2020). The overall rating for the service has not changed following this targeted inspection and remains good.

Why we inspected

We carried out this targeted inspection to follow up on specific concerns about the service. Information we received indicated concerns about low staffing levels that could negatively impact on the safety and wellbeing of people. Information was also brought to our attention that some staff found the leadership approach and culture of the service was unsupportive. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question

Follow up

We will continue to monitor the service and return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.