Ellesmere House

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.

Ellesmere House is registered to provide accommodation for up to 70 people with personal care and nursing care needs, and at the time of the inspection 65 people were residing at the service. The premises were purpose-built and people were accommodated on four separate units for nursing care and residential care needs. The service supported older people with physical frailties and/or people living with dementia. Facilities for people included communal lounges and dining areas, a cinema room, a passenger lift and sensory gardens.

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

People received effective care that promoted their safety and wellbeing. Their individual needs were assessed before they moved into the service to ensure the care home was suitable. Staff developed care plans in consultation with people and/or their representatives where possible, to ensure people’s care and support was person centred. Care plans reflected people’s wishes and preferences.

Risk assessments were devised to mitigate identified risks that could impact on people’s welfare, independence and safety.

People’s rights to be cared for with dignity and privacy were respected by a kind and caring staff team. People and their relatives spoke positively about staff, who knew how to meet people’s individual needs. People were supported to meet their healthcare and nutritional needs by staff with appropriate training and guidance.

People were supported by safely recruited staff who had sufficient time to meet their needs. People were cared for by staff who understood how to safeguard people from the risk of abuse and avoidable harm. Staff also received training in the safe management of medicines and how to reduce the risk of infection

People were supported to take part in fulfilling activities and keep in touch with their relatives and friends. People’s cultural and religious needs were understood, and they were supported to meet these needs.

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.

People and their representatives were encouraged to take part in meetings and/or complete surveys to give their views about the quality of the service. Complaints were managed in an open manner.

The provider had clear systems in place to monitor and audit the quality of people’s care and support. Improvements were made in response to any shortfalls the provider identified.

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 04 October 2018) and there was one breach of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

At the last inspection on 6, 7 and 10 July 2017, we asked the provider to take action to make improvements in relation to medicines management and this action has been completed.

Ellesmere House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ellesmere House provides care and support for up to 70 people who require nursing and personal care. There were 62 people using the service when we visited. The home is divided into four units. Two 15 bed units located on upper floors provide accommodation for people with nursing needs. A 20 bed unit on the first floor is allocated to frail older adults requiring nursing care and the lower ground floor provides residential care for people living with dementia.

There was no registered manager at the service, however the manager had applied to register with the Commission and their application was being processed. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider ensured there were enough suitably trained staff to care for people.

Care staff received an induction and ongoing support through supervisions and appraisals to ensure they were competent in their roles.

Risks to people’s care were investigated and risk management guidelines were put in place. Care staff were aware of the risks to people’s care and had a good understanding of how to mitigate these.

There was a safeguarding policy and procedure in place which was understood and implemented by care staff. Care staff were aware of the need to report concerns.

The provider followed good infection control practices and the home was clean and odour free throughout our inspection.

People were given appropriate nutritional support. People’s care records included detailed information about their needs and kitchen staff were aware of these.

People’s care records contained a good level of information about their healthcare needs and care staff had a good understanding of how to support people with these.

People using the service and their relatives were involved in decisions about their care and how their needs were met.

The organisation had good systems in place to monitor the quality of the service. Audits were conducted by the manager on a monthly basis and further monitoring was conducted by the regional manager.

The provider followed safe medicines practices although guidance in relation to ‘when required’ medicines was not always clear. We recommend that the provider seeks further advice in relation to this area of their practise.

Staff a good understanding of their responsibilities under the Mental Capacity Act 2005. People were provided with care in line with their valid consent and this included implementing best interest decisions where needed, in accordance with legislation.

People gave good feedback about their care workers and told us they were caring. Care workers had a good understanding of the people they were supporting and we observed people being treated in a kind and dignified way. People confirmed their privacy and dignity was respected and care staff gave us examples of how they ensured this.

People knew how to make complaints and there was an appropriate complaints policy and procedure in place.

The provider conducted a varied activities programme and monitored people’s involvement in these.

At our previous inspection on 25 and 28 September 2015 we found the provider was meeting the regulations we inspected. We indicated that some areas of service delivery required improvement.

Ellesmere House provides accommodation for up to 70 people and is currently divided into four units. Two 15 bed units located on upper floors provide accommodation for people with nursing needs. A 20 bed unit on the first floor is allocated to frail older adults requiring nursing care and the lower ground floor provides residential care for people living with dementia. There were 70 people living in the home at the time of our inspection.

The manager was relatively new in post. She had begun the application process with the CQC to become the registered manager of the home. 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.

People told us they felt safe and comfortable with the staff providing care and support. Staff members wore uniforms and name badges making it clear what their role was within the home.

Although the provider had taken steps to ensure that risks to people's health and safety were being assessed and monitored, we found incidences where recording charts were not always being completed.

Assessments were completed to identify people’s support needs and this information was used to develop their care plans. Care planning records demonstrated that people’s capacity was assessed and documented in their care files.

The provider had systems in place to ensure people were protected from the risk of harm. Staff received safeguarding training and were familiar with the provider’s policies and procedures in relation to safeguarding vulnerable adults and reporting any concerns. Staff understood the principles of the Mental Capacity Act 2005 (MCA) and promoted people’s rights to make choices and decisions.

People were supported to maintain good health and had access to healthcare services and visiting practitioners when required.

People's medicines were stored safely. However, staff were not always observing that people had taken their medicines before signing medicines administration records (MAR).

Robust recruitment practices were in place to ensure people received care and support from staff who were suitably qualified and had the experience to carry out their duties effectively.

People’s privacy and dignity was promoted and staff recognised the importance of encouraging people to maintain as much independence as they could.

Where people required support to eat and drink, staff provided people with appropriate support and encouragement.

The service advertised a programme of activities and we were shown pictures of past events and social occasions. However, activities were not always taking place according to the schedule.

People and their relatives told us they had been provided with information about how to make a complaint. Not everyone felt their complaints were listened to.

There were protocols in place to monitor the quality of the service. A range of audits, maintenance and fire checks were carried out on a regular basis. However, these systems were not always identifying and managing the shortfalls we found during the inspection process.

The provider had systems in place for gathering feedback, including visits by Healthwatch dignity champions, relative's surveys and care plan reviews. Daily handovers, supervision and meetings were used to reflect on the standard of care practice and discuss how the service could implement improvements where this was needed.

We have made one recommendation in relation to better communication.

We carried out a follow up inspection on the 27th August 2014 to check whether appropriate action had been taken to provide people who used the service with one to one activity plans and adequate stimulation to meet their needs. There were 57 people living at the home on the day of our visit.

People we spoke with told us they liked living at the home and that staff were caring. One person who used the service told us the activities coordinator was "very, very good" and that the home was "a very happy place." Another person told us they "enjoy all of the activities" and have "great fun."

The home had activity schedules posted on the walls along with pictures of residents engaged in past activities and projects. There were two good sized seating areas where activities took place. The home had a sensory room although we did not see this in use on the day of our visit.

We saw a group of people taking part in a morning exercise and music session. In the afternoon we saw that some people were doing a jigsaw puzzle together and others were engaged in a mixed activity session with one of the activities hostesses.

Although the provider had taken steps to provide training to staff and organise appropriate activity projects for people with dementia, we did not see activities taking place in the sensory room, on a one to one basis or with people who were confined to their rooms.

We saw staff interacting with people who used the service but there was some evidence that staff did not always deliver care or provide support that met people's individual needs and/or was safe and appropriate.

The provider does need to ensure that appropriate activities and one to one stimulation is provided to all of the people living at Ellesmere House.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. People were made aware of the complaints procedure and this was provided in a format that met their needs.

People living at Ellesmere House interacted with staff and it was evident that staff were known to them. Comments made by people living there included "the staff are very good here".