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Elmwood Residential Home Limited Good

Reports


Inspection carried out on 24 September 2018

During a routine inspection

This unannounced comprehensive inspection took place on 24 and 25 September 2018. The inspection was to follow up whether improvements had been made from the previous inspection in September 2017.

Elmwood residential home is registered to provide accommodation with personal care for up to 38 people with physical disabilities, long term medical conditions or memory loss. 37 people lived there when we visited.

At the previous inspection on the 13 and 14 September 2017, the service was rated as requires improvement overall, with the safe, effective, responsive and well led domains rated requires improvement and the caring domain rated as good. Four breaches of regulations were found in safe care and treatment, safeguarding, quality monitoring and in relation to a failure to notify the commission about an allegation of abuse. Following the inspection, CQC took further enforcement action by imposing a condition on the provider’s registration. This was because the service had been rated requires improvement with breaches of regulations for the fourth successive inspection. The condition required the provider to provide CQC with a monthly report to demonstrate they were making the required improvements at the service.

CQC met with the provider on 10 January 2018. The purpose of the meeting was to ensure the provider was clear that CQC's expected improvement at the next inspection, with no breaches of regulations. We also emphasised the need to ensure these improvements were sustained. Since December 2017, the service has sent monthly reports, which have included examples of continuous improvements.

Since then, the service has worked closely with the local authority, their quality assurance improvement team and the Care Quality Commission to make the required improvements. The local authority quality assurance and improvement team has visited the service regularly to support the provider to continuously improve their quality monitoring systems. Joint meetings were held with the provider, local authority and care manager to monitor progress and ensure continuous improvements were made. At this inspection, significant improvements had been made in the provider’s quality monitoring systems. People's care records had improved, care plans, risk assessments and daily records were more detailed, and personalised. However, further improvements were still needed to make sure staff had the training and sufficient equipment to use electronic care records effectively.

The provider, registered manager and deputy manager, worked well together. People, relatives, staff and professionals gave us positive feedback about the quality of people’s care. They spoke about improvements in communication, professional development and improved quality monitoring systems.

The service has 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.

People were protected from abuse because the leadership team had completed additional safeguarding training with the local authority. They demonstrated a good understanding of their responsibilities to report safeguarding concerns, and worked in partnership with other agencies, where concerns about abuse were identified. The service informed the local authority safeguarding team about suspected abuse and notified the Care Quality Commission (CQC). Where concerns about staff practice were identified, they were robustly dealt with through additional training, supervision, and if needed, by following the provider’s disciplinary procedures.

Staff demonstrated a good awareness of each person's safety and how to minimise risks for them. Improvements had been made in the garden to improve people’s access and redu

Inspection carried out on 13 September 2017

During a routine inspection

Elmwood residential home is registered to provide accommodation with personal care for up to 38 people. The home is mainly for people over 65 years of age who may have physical disabilities, long term medical conditions or memory loss. 37 people lived at the home when we visited.

This unannounced comprehensive inspection took place on 13 and 14 September 2017. This inspection was to follow up to see whether improvements had been made from the previous inspection in January 2017.

At the previous focused inspection on 25 January 2017 the service was rated as requires improvement overall, with responsive and well led rated requires improvement and safe rated as good. We did not inspect effective and caring domains at the inspection. Two breaches of regulations were found in relation to good governance and in response to complaints. Although some aspects of quality monitoring had improved since our previous inspection in August 2016, it was still not fully effective. This was because of some gaps in people’s care plans and daily records and because some complaints had not been robustly dealt with. Following the January 2017 inspection the Care Quality Commission (CQC) took enforcement action and served a warning notice in relation to good governance. This required the provider to make the required improvements by the 10 July 2017. In response, the provider submitted an improvement action plan.

Following this inspection in September 2017, we have now rated the service as ‘requires improvement’ overall on four successive inspections. A breach of regulation 17, good governance, has been identified at the last three inspections. This demonstrates the providers' quality monitoring systems were still not effective and they have not fully complied with the warning notice.

Previously on 2 and 3 August 2016 a comprehensive inspection rated the service as requires improvement. This was because we found two breaches of regulations in relation to people’s safe care and treatment and good governance. Prior to that, on 21 and 28 April 2015, a comprehensive inspection rated the service as requires improvement overall, with three breach of regulations relating to person centred care, consent and safe care and treatment.

On 12 April 2017 we met the provider and the registered manager and set CQC’s expectations that at the next inspection, all required improvements should have been completed with no breaches of regulations. We also emphasised the need to ensure these improvements were sustained over time. The service was also working with the local authority quality monitoring team to make the required improvements.

At our meeting on 12 April 2017 we asked the service to consider whether having the registered manager who also undertook the nominated individual (providers representative) role was the most effective way to monitor quality at the home. In response, the provider notified us that a director in the company was taking on this role. Since June 2017, a director has been based at the home.

The service has 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.

The service had worked with the local authority quality improvement team to make improvements. They quality improvement team last visited the service in March 2017. Their report showed the service were making progress with improved quality monitoring systems, with further improvements needed in communication, direction and leadership.

At this inspection, improvements in some aspects of the quality monitoring systems had been made. However, the provider had failed to identify two new breaches of regulations and we found several areas for improvement. One breach related

Inspection carried out on 25 January 2017

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

This inspection took place on 25 January 2017 and was unannounced. Elmwood residential home is registered to provide accommodation with personal care for up to 38 people. The home is mainly for people over 65 years of age, who may have physical disabilities, long term medical conditions or memory loss. There were 36 people staying at the service on the day we visited.

This inspection was to follow up if the required improvements had been made following our last inspection 2 and 3 Aug 2016. At that visit, we rated the service as ‘Requires improvement’, as we found two breaches of regulations in relation to people’s safe care and treatment and in good governance. We had previously visited the service 21 and 28 April 2016 and rated the service as ‘Requires Improvement’ because we identified breaches in both those regulations and in person centred care. Since the August 2016 inspection we received an action plan from the provider which outlined the improvements being made. The service has worked in partnership with the local authority quality assurance and improvement team to improve their systems and processes. They were using several new audit tools recommended by the local authority quality monitoring team.e met with two representatives of the provider on 9 January 2017 to discuss the improvements, which they said they had put in place.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

The service has 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. When we visited, the registered manager was on planned sick leave. Prior to their absence, they had notified the Care Quality Commission and the deputy manager was in charge of the day to day running of the home.

At this visit we found some improvements had been made in the quality monitoring systems at the home. However, these were still not fully effective, because breaches of regulation were also identified at this inspection. People’s care records had improved. They were easier to navigate, information was accessible and older information had been removed and archived. People’s records had more individualised details about each person, their likes and dislikes, and about their life before they came to live at the home. Care plans and risks assessments had been reviewed and updated and were more comprehensive.

However, two people with diabetes had no care plans to guide staff about how to meet their specific health needs. For another person totally dependent on staff for food and drink, poor record keeping of their nutrition and hydration records increased the risk those needs were not being met. We also found other gaps in people's daily records and in activity records which had not been successfully addressed through audits undertaken.

We identified concerns with regard to how complaints about individual staff performance were managed. Where repeated concerns about some staff had been raised, they had not been robustly dealt with and recurred. People remained at risk because the service’s grievance and disciplinary policies about staff performance had not been followed and the audit of complaints should have picked up these issues and addressed them. We also found communication within the staff wasn’t effective in maintaining and embedding the improvements.

Health and safety risks for people were reduced because improvements had been made to the safety of the environment. People were protected from scalds because thermostatic controlled valves were fitted in all areas to ensure hot water

Inspection carried out on 2 August 2016

During a routine inspection

The inspection took place on the second and third August 2016 and was unannounced. We previously inspected the service in April 2015 and found three breaches of regulations in relation to person centred care, consent and safe care and treatment. Some improvements had been made but new concerns were also identified which need to be addressed.

The service is registered to provide accommodation with personal care for up to 38 people. The home is mainly for people over 65 years of age, who may have physical disabilities, long term medical conditions or memory loss. There were 37 people at the service when we visited, one of whom was staying temporarily for a period of respite.

The service has 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.

At this inspection we identified several environmental risks for people who lived at Elmwood. These included scald risks due to excessively hot water, broken/missing window restrictors in some upstairs bedrooms, and balcony areas that appeared in a poor state of repair. We asked the registered manager to seek further advice to help them risk assess and prioritise what urgent actions were needed to improve people’s safety and reduce environmental risks for them. They updated us within a few days of the inspection, of actions underway to reduce risks and further work was planned.

Although some aspects of care records had improved, we found the standard of record keeping was inconsistent. Some people’s care records were up to date, there were gaps in other records and some were overdue for updating. This increased the risk people would not receive all the care they needed. People were not fully protected because the quality monitoring systems in place were not fully effective. This was because they did not identify the environmental risks or issues with records found during the inspection.

Staff had undertaken additional training and understood their responsibilities in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

People had access to healthcare services for ongoing healthcare support. Staff recognised when a person's health deteriorated and sought medical advice promptly when they were feeling unwell. Staff worked closely with local healthcare professionals such as the GP and district nursing team, who confirmed staff sought advice appropriately about people's health needs and followed their advice. People received their prescribed medicines on time and in a safe way. People were supported to improve their health through good nutrition and staff encouraged people to eat a well-balanced diet, and make healthy eating choices.

Staff were knowledgeable about people's care needs and received regular relevant training and updating. Staff knew people well, understood their needs and care was personalised to their individual needs. Staff treated people with sensitivity, dignity and respect and in a caring and compassionate way. People were supported to keep in touch with family and friends and spend time with them.

Staff demonstrated a good understanding of what might constitute abuse and knew how to report any concerns they might have. The provider had a written complaints policy and procedure, and knew how to raise concerns or complaints, which were investigated and responded to.

The culture at the service was open, and promoted person centred values. Staff worked proactively with other professionals for the benefit of the people they supported. There was evidence of making improvements in response to people’s feedback, and of learning lessons following accidents and incidents.

We identified two breaches of regulations during the

Inspection carried out on 21 and 28 April 2015

During a routine inspection

The inspection took place on 21 and 28 April 2015 and was unannounced. We last inspected the service on 26 August 2014 and we did not identify any concerns. This inspection was brought forward in response to anonymous concerns raised with us.

The service is registered to provide accommodation with personal care for up to 38 people. The home is mainly for people over 65 years of age, who may have physical disabilities due to older age. The home was fully occupied when we visited, one person was staying temporarily for respite care.

The service has 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.

People were offered day to day choices and staff sought people’s consent for care and treatment. However, where people lacked capacity, staff did not demonstrate a good understanding of their responsibilities under the Mental Capacity Act (MCA) 2005 or about the Deprivation of Liberty Safeguards (DoLs). Several MCA assessments needed reviewing and updating as they did not reflect the person’s current level of capacity. There was no record about how relatives and other professionals were consulted and involved in decision making in people’s ‘best interest’.

People were supported to receive ongoing health care support. However, some people’s health care needs were not being appropriately managed. This was because staff did not demonstrate a good understanding of how to use some evidence based tools used for assessing people’s health care needs or formulate a detailed care plan in response. For example, two people’s weight loss was not being promptly or fully responded to and they remained at risk of malnutrition.

Although staff were knowledgeable about people’s needs, they were at increased risk because staff did not have access to detailed care plans about each person's care and treatment needs. Care records were not regularly evaluated and updated as people’s needs changed. This meant they could not be relied upon as an up to date and accurate record about each person.

People, relatives and health and social care professionals were overwhelmingly positive about their experiences of the home. They spoke about how friendly and welcoming staff were, the homely atmosphere and well organised and managed the home was. A few relatives expressed some concerns about the experiences of people who were less able and lacked capacity.

People and relatives said staff working at the service were caring, compassionate and treated them with dignity and respect.

People were supported to remained active, and be as independent as possible. People had access to regular exercise classes, physiotherapy and were supported to access mobility equipment to remain  active. Most people led full and varied lives. They were supported to maintain their interests and hobbies and to access the community regularly.

The culture of the home was open and friendly. People, relatives and staff regularly popped into the registered manager’s office to chat, ask questions and raise any concerns. Systems were in place to monitor the quality of care and improvements were made in response to feedback received.

We identified three breaches of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 26 August 2014

During a routine inspection

Our inspection team was made up of a single inspector. We considered all the evidence we had gathered under the outcomes we had inspected. We used the information to answer the five questions we always ask: 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. The summary is based on our observations during the inspection, speaking to people using the service, staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe at the home. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. Systems were in place to make sure that the managers and staff learnt from events such as incidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve. The home had policies and procedures in relation to the Mental Capacity Act 2005, and the Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people were safeguarded.

Care plans included considerations of the Mental Capacity Act (2005) such as best interest decision making and staff demonstrated an understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DOLS) and how they applied to their practice. We found the location to be meeting the requirements of the Mental Capacity Act (2005). People’s human rights were therefore properly recognised, respected and promoted and appropriate family/advocates were involved.

Recruitment practice was safe for example the Registered Manager asked for all background checks and references to be performed on staff prior to an offer of employment being made. No staff had been subject to a disciplinary action. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

People's healthcare needs were assessed with them but they were not always involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Some people said they had been involved in writing them and said that care plans reflected their current needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. One person told us, “The staff are very helpful. They listen to me and do what I ask them to do. I am quite particular with my personal care and the staff help me to maintain as much of my independence as possible and my dignity”. People were treated with dignity and respect by the staff.

People’s preferences, interests, aspirations and diverse needs had been recorded and care support had been provided in accordance with people's wishes.

Is the service responsive?

People regularly completed a range of activities in the home. Most people enjoyed the entertainment and trips out. All people were offered the choice of outings but some declined.

The service responded well to peoples changing health care needs. The home had good working relationships with local GP's and district nursing teams and plans of care were well documented and person cantered.

People knew how to make a complaint if they were unhappy. No one we spoke to felt the need to make a complaint as they were very happy with the service they received. We looked at how complaints had been dealt with and found that the responses had been open, thorough and timely. People could therefore be assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure that people received the best care that could be provided. The service had a quality assurance system that frequently asked for feedback from friends, family and people using the service to assess the quality of care being provided. Records seen by us showed that identified shortfalls had been addressed promptly. As a result the quality of the service was continually improving. Staff told us they were clear about their roles and responsibilities.

Inspection carried out on 29 April 2013

During a routine inspection

Elmwood residential home provides care and support for older people. We talked with twelve people who lived at the home, ten staff including the manager, four health professionals and four visitors. We looked at the care records of five people living at Elmwood including records relating to their community nursing support.

There were 36 people living in the home at the time of our inspection. People responded positively to visitors who came into the home to visit, provide professional support or voluntarily support them. The home was light and spacious and had a homely atmosphere.

The people we spoke with and their visitors were complimentary about the home and told us about how they were involved in deciding about their care treatment and support. We saw how people’s care and welfare was provided with dignity and respect in line with their care plan.

The home was clean and homely and we saw how the manager worked with other professionals to ensure people received appropriate support and that their safety and welfare was protected.

Medication was managed in line with the providers policy and staffing levels, skills and experience were appropriate to meet the needs of people living in the home. Complaints were responded to in a timely way and the policy was promoted within the home and in the providers’ brochure.

Inspection carried out on 30 May 2012

During a routine inspection

At the time of this unannounced inspection there were 36 people living at the home. We saw or met with the majority of people living at the home. We spoke with 11 people in some depth to understand their experience of living at Elmwood. We also spoke with two relatives; five members of staff, including the manager; one visiting health professional and two visiting social care professionals.

People told us that the majority of staff were respectful, kind and considerate. People described a small minority of staff “0.1%” as less friendly and helpful. Eight of the 10 people we spoke with told us that in their opinion staff were ‘rushed, pushed, or busy’. This meant that on occasion people had to wait for attention; meals were served later than expected and staff did not have the time to spend with people just chatting and engaging in more social type of activities.

People told us that they received the care and support they wanted and needed most of the time. They confirmed that their choices and preferences were respected by staff. People had an opportunity to influence the way the service was run but they had not been fully involved in the development and review of their care plans. This could result in people not being fully enabled to understand the care and treatment choices available to them.

Arrangements for obtaining people's consent for the care and treatment they received had improved. Further improvements would ensure that people’s rights were respected and taken into account consistently.

We were told by people living at the home that the food was good and that routines were generally flexible. Comments included, “The food is good and we have a good choice”, “Lovely food. You can have an alternative to the menu if you want to” and “The food is excellent. Good choice and variety”. We saw that people were provided with a choice of suitable and nutritious food and drink.

There was a weekly activities programme organised, which some people enjoyed. Others felt this was an area for improvement.

People told us that the home was always clean and tidy. Visiting relatives and health professionals also told that the home was always clean and free from offensive odours.

People told us they felt "safe" at the home and would report any concerns. People living at the home and visitors to the home said they knew to report any concerns to the senior staff or the manager.

Visitors to the home, relatives, health professionals and social care professionals, told us that, “The general atmosphere is good. The place seems happy”, “I have visited several homes over 10 years, this is one of the best”, “Their standards here are very good” and “Overall I am happy with everything and X seems to be happy and settled here”.

Inspection carried out on 25 November 2011

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

There were 38 people living at the home on the day we visited. We spoke with eight people, observed some of the care given to two other people, and spoke with a relative of an 11th person.

We saw people engaging in friendly banter with staff in various roles. They confirmed that staff were respectful, and generally promoted their privacy, although some staff didn’t always knock before entering people’s rooms. Two people confirmed they felt the home was run for the residents rather than to suit staff. We observed that where people were offered choices, their decisions were respected, though their dignity and choices were not always promoted. Systems were not in place for ensuring people's consent to their care and treatment was obtained appropriately, which could affect individuals' rights.

Most people confirmed they felt their health needs (such as routine check ups) were addressed by the home. People we spoke with thought there was a stable team of staff, who knew their needs and what support they needed. Some people were at risk of receiving inappropriate care because the planning or delivery of care did not meet their individual needs and medication was not always managed safely.

People felt safe with staff, in terms of their suitability as individuals, naming some staff for particular praise. They felt that senior staff were readily available to them, and that they could speak up if they had a complaint. The complaints procedure was in each person’s room that we visited, and people told us about its availability.

The home sought people's views of the service they received, for quality assurance purposes. People told us there was a meeting for residents and their relatives the week after our visit, and some people we spoke with recalled completing a survey for the home.

People at the home were able to be part of the community around the home, and their visitors were made welcome. Some told us there was going to be a minibus trip to a newly opened supermarket which they had asked to go to see, and there were other opportunities for links with the local community, such as with local churches or the ‘pub club’.

Inspection carried out on 4 July 2011

During an inspection in response to concerns

People we spoke with said that in general they received the support they wanted. One person told us that staff came to them quickly, when they had recently needed help on becoming unwell. We were told that occasionally people had to wait in the mornings till staff were free to help them get up – such as at week-ends, when staffing levels were lower. Three people said staff were very busy and they would appreciate more time with them generally, to chat and so on.

Concerns had been raised before our visit about how staff assisted people who needed support because of mobility problems. We spoke with people who had such needs, and they had no concerns about how staff physically assisted them.

Whilst seven people we spoke with raised no concerns about how they were treated or about the service they received, six people indicated that they were not always treated respectfully by some staff. This included two people who said they had been shouted at, one of who told us that they had raised this with staff at the home. They also told us that the great majority of staff were satisfactory.

Some of the people we spoke with were satisfied with how the home dealt with any concerns or complaints they had raised, and they felt able to make another complaint if necessary. Others said they would ‘keep quiet’, with one saying they didn’t want to appear to be a trouble-maker and another who felt senior staff didn’t always listen to them.

Some people showed us the written complaints procedure in their room, whilst others did not know if they had a copy. One person added that they would need it in large print.

We asked about residents’ meetings, and if people could discuss anything they wished to. One person told us they had attended one where people ‘aired their grievances’ although they didn’t know if anything had come of this. This same person felt that staff listened to people living at the home. Another person said the residents’ meetings were helpful, that even ‘tiny things’ such as being given the wrong cutlery had been addressed and things were now better.

Reports under our old system of regulation (including those from before CQC was created)