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Archived: Elmwood

The provider of this service changed - see old profile

Reports


Inspection carried out on 13 August 2014

During an inspection to make sure that the improvements required had been made

The inspection was carried out over a period of 12 hours by two inspectors. Elmwood is a small home which is registered for six people with learning disabilities. The home changed provider in November 2013.

There were six people who lived at the home on the day of inspection, one person was in hospital. They had learning disabilities and a range of needs including difficulties with mobility and communication. This meant they were not always able to tell us about their experiences.

The report is based on our observations during the inspection, talking with one person who used the service, five relatives, 10 staff who worked in the home and reviewing records. We gained information from healthcare professionals who were involved with the service, including the GP. We also talked with the manager/owner and deputy manager.

During this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Safeguarding procedures were not robust. However, staff understood their role in safeguarding the people they supported.

The manager/owner of the home restricted staff from seeking advice from and making referrals to healthcare professionals, which led to delays in people who lived in the home receiving the care and treatment they needed.

Some areas of the home were not clean and hygienic. This put people at risk of harm. We spoke with the manager/owner about the lack of cleanliness in the shower room and toilet as well as a piece of equipment.

Medicines within home had not been properly accounted for.

Is the service effective?

People�s health and care needs were assessed by the manager/owner. People and their relatives (where this was appropriate) had not been involved in developing their care plans.

Some people who lived in the home were unable to communicate verbally. Care plans did not contain information about how to communicate with people.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. A relative said, �The staff are lovely�.

We saw that staff knew people who lived in the home and were able to respond to their wants and needs.

Staff told us how they supported people to be involved and as independent as possible. We saw that most people who lived in the home were able to make choices and have some control over their lives. One person who lived in the home had no choice or control in their life and only left the home for a few hours each week.

People had not completed and had not been asked for their views about the home through a an annual satisfaction survey. However relatives had been asked to complete a questionnaire. Some people had not been involved in �Resident�s meetings�. People were at risk of not having their concerns and needs properly taken into account.

Is the service responsive?

Staff were unable to respond to people�s healthcare needs promptly as the manager/owner took responsibility for this. This had led to delays in gaining medical attention for someone who had been unwell.

We looked at the accident/incident record that the manager/owner had completed after a person had been admitted to hospital. The record did not detail the severity of the person's illness which meant professionals such as the person�s care manager did not have all the information they needed.

There had been delays in obtaining specialist equipment that people needed. We gained feedback from healthcare professionals who told us that they were involved with the home. However they told us that they had become involved because other professionals had instructed or arranged this and not because the home had recognised that they needed professional input and advice.

Is the service well-led?

None of the staff we spoke with had a good understanding of the mental capacity act. Staff members were clear about their role and responsibilities for reporting and raising concerns about abuse. All of the staff said that if they witnessed poor practice they would report their concerns.

The manager/owner of the home restricted what food was available within the home in order to prevent waste. This meant that staff had to ask for food supplies regularly.

PRN (as and when needed) medicines were not kept in the medication cabinet along with other prescribed medication. When a person was in pain, staff had to contact the manager to request pain relief. This meant that there were delays in people receiving the medicines they needed.

Laundry was not washed effectively to remove bacteria and this increased the risk of cross infection.

Some relatives told us that communication with the manager/owner was difficult and queries and concerns went unanswered. Two relatives told us that when they had mentioned cleaning tasks that were required, these tasks had been acted on quickly.

The manager/owner of the home had not notified the Care Quality Commission (CQC) of incidents that they had a duty to report. CQC had not been informed about Deprivation Of Liberty Safeguards (DOLS) applications, safeguarding concerns and the hospitalisation of one person who was seriously ill.

Inspection carried out on 14 April 2014

During a routine inspection

The inspection was conducted by one inspector. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

There were six people living at Elmwood who had lived there for a number of years. A new provider, who was also the manager, had taken over the service three months before our inspection. Some people who used the service had difficulty engaging directly with the inspection process because of limited verbal communication skills. This meant they were not always able to tell us about their experiences. The summary is based on our observations during the inspection, talking with people who used the service, and the staff supporting them, and looking at records.

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

There was no effective system in place to make sure that the manager and staff learned from events such as accidents and incidents and the risks associated with the environment. Risks to people�s health and welfare were not always identified or managed adequately. This increased the risk of harm to people and failed to ensure that lessons were learned from mistakes.

The service was clean. However some practices in the home, such as how laundry was managed meant that people were exposed to risk of infection. Not all staff were trained in infection control and there were no policies or procedures in place to provide guidance in how to minimise risk of infection. This was putting people at risk of harm.

We looked at the recruitment of new staff. There were robust recruitment and selection procedures in place. These showed that recruitment checks into qualifications and experience were being followed to make sure that people were supported by suitable staff with appropriate skills.

People were not adequately protected from harm because there were no personal emergency evacuation plans for staff to follow in the event of a fire.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events and managing risk effectively.

Is the service effective?

People�s individual care plans were in process of being updated to make sure staff had the information they needed to meet people�s needs.

Medicines were stored securely and administered safely. Systems for managing medicines in the home ensured that people received the medicines they needed, when they needed them,

Some people who lived in the home exhibited behaviours which could pose a risk to themselves or others. Staff had not received training in how to manage these behaviours. This meant that people might not receive appropriate support.

Some people who lived in the home had specific health needs such as epilepsy or sight impairment in addition to their learning disabilities. Staff had not been provided with training in learning disabilities or the particular health needs of people who used the service. There were no individual health action plans to make sure that people�s health was monitored effectively and staff understood all their health care needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people�s health needs and planning their care effectively.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We saw that people were comfortable with the staff who were working with them.

People�s preferences, interests, aspirations and diverse needs had not always been recorded. Because of this care and support could not always be provided in accordance with people�s wishes.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care.

Is the service responsive?

During our visit we identified a number of shortfalls in the service. The manager took immediate action on some of the issues identified to make sure that people were better protected from risk of harm.

Is the service well-led?

The service did not have effective an quality assurance system. Our findings during this inspection showed that not all aspects of the service were audited or monitored effectively to make sure people received a good service.

Staff meetings provided staff with an opportunity to feedback to their manager, so their knowledge and experience was taken into account. The service worked in partnership with key organisations, including health and social care teams, to support care provision.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.