Elm House

About the service

Elm House is a residential care home providing personal care for up to 5 people. At the time of the inspection, 5 people were using the service.

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

Right Support:

People did not consistently receive safe care at the home. Environmental risks had not always been identified and resolved to limit unnecessary risk to people. People were placed at increased risk from the spread of infection.

People's medicines were being managed safely.

People had their own rooms which had been personalised. People were able to use communal areas as they wished.

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.

Right Care:

People were not always consulted on planning the food menu and had limited choice around what they wanted to eat. Staff did not ensure people using the service had a fulfilling and meaningful everyday life.

Staff were polite with people, but they did not always help them follow their interests.

The home was not clean, needed decorating and items replaced.

People were treated with kindness and staff respected their privacy. Staff were appropriately skilled to meet people's needs.

Right Culture:

The provider was not effectively assessing the quality of the care at the home or considering the quality of people's experiences.

The service did not always ensure risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

Based on our review of safe, effective and well led, the service was not able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

The provider took immediate action to seek support to address leadership and governance concerns and implemented an urgent action plan to mitigate risks to people's safety and quality of life.

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 03 May 2019).

Why we inspected

We received concerns in relation to poor care, staff training and lack of management oversight. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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 Elm House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, premises and equipment, staff deployment, nutrition and hydration 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 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.

We found the following examples of good practice.

People were supported to stay in regular contact with their family and friends, who were able to visit with no undue restrictions. Staff made sure this was done in a safe way. Family and friends who were not able to visit, kept in touch with people through video and telephone calls.

When residents could not participate in external activities due to COVID-19, staff organised events in the service. The provider had been able to maintain staffing levels to make sure people experienced the same level of service.

The provider ensured current government guidelines in relation to COVID-19 were being followed by staff and visitors to reduce the risk of infection to people living at the service. This included comprehensive checks for visitors on arrival.

There was a system in place to record individuals COVID-19 vaccination status and COVID-19 test results. Detailed and up-to-date policies and procedures were in place.

There was a designated lead for IPC at the service who undertook regular audits to make sure staff complied with current guidance and practice. The service's IPC policy and plans for managing an outbreak were up to date and in line with current guidance.

Staff had been trained in COVID-19, infection prevention and control (IPC) and in the use of personal protective equipment (PPE). Staff told us there were enough supplies of PPE and there were designated areas for donning and doffing this. Handwashing facilities were easily accessible to people, staff and visitors.

The environment was clean and hygienic. Enhanced cleaning took place on a daily basis. Communal spaces were well ventilated and used creatively to ensure people could continue to interact with each other and staff in a safe way.

People’s experience of using this service: People that we spoke with told us that they were happy living at Elm House. Where people were unable to communicate verbally we observed positive interactions between staff and people. A relative that we spoke with was positive about the progress their relative had made since moving into the home. Staff knew people well and supported people to be as independent as possible.

People were supported by staff that knew them well and there were always regular staff on duty. This ensured that people felt comfortable and were able to build rapport with staff. Staff understood how to keep people safe and report any concerns. Risks to people’s safety was recognised and management plans were in place to guide staff appropriately. Medicines were safely managed and people were actively encouraged to understand their medicines.

People’s needs were assessed in line with current legislation. People were involved in choosing the home and where they were able, had input into the pre-assessment. Staff understood the principles of the Mental Capacity Act (2005) and how this impacted on the care that was provided. People were encouraged to make decisions about their care where possible. Nobody living at the service had been unlawfully deprived of their liberty. People could choose the food that they wanted to eat and there was a varied menu available.

The home actively supported staff understanding around equality, dignity and respect. Staff had access to up-to-date information around people’s rights. People, staff and relatives were involved in understanding dignity in care and the home had held several events to promote this.

People received person centred care and people’s care records supported this. Staff understood that each person was different and this was reflected in records, observations and discussions with care staff. There were systems in place for people and relatives to complain. People were actively informed of the complaints process in residents’ meetings.

There were systems in place to look at how the home was being managed. Various audit were completed to monitor the home and where areas for improvement were identified, action plans were completed to address this. The registered manager was visible around the home and people knew who she was and appeared comfortable approaching her. Staff were positive about the support they received from the management and there were various ways for staff to feedback to the registered manager and senior management.

More information is in the detailed findings below.

Rating at last inspection: Good (report published in September 2016)

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The home had a registered manager. 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.

The home is registered to provide care and support for five people with mental health issues and learning disabilities. On the day our inspection there were four people using the service.

People told us that they felt safe within the home and well supported by staff. We saw positive and friendly interactions between staff and people.

Staff understood people’s individual needs in relation to their care. People were treated with dignity and respect.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report it to if people were at risk of harm.

Staff had an understanding of the systems in place to protect people who could not make decisions and were aware of the legal requirements outlined in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

Care plans were person centred and reflected individual’s preferences. There were regular recorded keyworking sessions. There were focused keyworking session that looked at specific aspects of an individual’s care. People were involved in writing their care plans and risk assessments and were able to express their care needs.

People were supported to have their medicines safely and on time. There were records of medicines audits and staff had completed training on medicine administration. The home had a clear policy on administration of medicine which was accessible to all staff.

People’s views on how the service was run were listened to. There were regular residents meetings that allowed people to have their views and opinions heard.

People were supported to maintain a healthy lifestyle and had healthcare appointments that met their needs. Staff were aware of how to refer people to healthcare professionals when necessary. There were records of appointments and reviews in people's files.

Staff training was updated regularly and monitored by the registered manager. Staff had regular supervision and annual appraisals that helped identify training needs and improve the quality of care.

People were supported to have enough to eat and drink. People were encouraged and supported to cook and plan their meals.

There was a complaints procedure as well as an accident and incident reporting system. Where the need for improvements was identified, the manager used this as an opportunity for learning and to improve care practices where necessary.

There were regular health and safety audits and monthly medicines audits. These allowed the provider to ensure that issues were identified and addressed. The provider undertook comprehensive six monthly audits that looked at all aspects of care provided and how it was managed by the home.

There were systems in place to identify maintenance issues. Staff were aware of how to report and follow up maintenance.

There was an open atmosphere within the home. The management encouraged a culture of learning and staff development.