Elton Park Care Home

Elton Park Care Home is a residential care home providing accommodation and personal care for up to 35 people. The service provides support to older people in one adapted building over 2 floors, the ground floor and first floor. Only the ground floor was being used when we inspected. There was another floor which was used for offices. At the time of our inspection there were 12 people using the service, some people were living with dementia.

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

Since our last inspection the registered manager had left the service. There had been another manager in post who had also left. At the time of our inspection the service was being managed by a manager from another of the provider’s locations. The provider was actively recruiting to the manager post.

We received positive feedback about the manager and how improvements were being made. The provider and manager understood the improvements needed and there was an action plan in place which was kept under review. Not all of the improvements had been fully implemented and embedded in practice. For example, the records maintained to show the support people received on a daily basis had improved but still needed further work. Systems put in place to learn lessons had not been effective to reduce future risks. We were assured this had now been addressed.

Systems were in place to assess and reduce the risks of abuse and avoidable harm. Improvements had been made and needed to be sustained. Staff were available when people needed them, and staff were recruited safely. We have recommended the provider keep the staff levels under continuous review, when more people move into the service and people's needs change. People were provided with the medicines when needed and audits were undertaken to identify shortfalls and address them.

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 received support from staff who were caring and who promoted their choice, privacy and independence.

Improvements had been made in the provision of staff training and these were ongoing.

A programme of redecoration was being undertaken. The service was visibly clean and infection procedures followed. People were supported to have visitors which reduced the risks of isolation.

People’s care records identified the care and support required to meet people’s assessed needs. This included people’s end of life decisions. People were supported to access health professionals where required. People’s dietary needs were being assessed and met. There was a programme of activities to reduce the risks of boredom.

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 inadequate (published 15 September 2022) and there were breaches 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.

At our last inspection we recommended that the provider seek guidance and advice relating to people with choices of meals which could be understood. At this inspection we found the provider had acted on the recommendation and improvements made.

This service has been in Special Measures since 15 September 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 02 and 03 August 2022. Breaches of legal requirements were found in relation to safe care and treatment, the need for consent, good governance, staffing and safeguarding service users from abuse and improper treatment. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements.

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.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection. The provider is no longer in breach of regulations, however, not all improvements had been fully implemented and embedded in practice. Therefore, there were still improvements needed. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elton Park on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Elton Park Care Home is a residential care home providing accommodation and personal care for up to 35 people. The service provides support to older people in one adapted building over three floors. Only the ground floor was being used when we inspected. At the time of our inspection there were 21 people using the service, some people were living with dementia.

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

The registered manager was new to the role and there had not been a deputy in post until April 2022 to support the registered manager in developing the new service. The deputy manager worked 24 hours a week in this role and also worked as a senior care staff and activities coordinator. We were concerned the support system was limited, considering the improvements required in the service.

There were not enough staff working on shift to ensure people’s safety and to meet their needs effectively. There was no dependency tool in place despite challenges relating to interactions between people using the service. Staffing levels had not been amended to ensure, for example, staff were always present in communal areas to safeguard people.

People were not safeguarded from avoidable harm and abuse. Risk assessments were either not in place or not robust enough to identify risks and provide staff with guidance in how to reduce them.

The governance systems were either not in place or not robust enough to effectively monitor the service, identify shortfalls and address them. Despite a provider audit being undertaken in April 2022, some areas remained unresolved. The action plan completed following the audit did not have timescales for actions.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

We were concerned the assessment processes for when new people moved into the service were not always robust. This was due to people moving into the service with a range of complex needs, which the service was not always able to meet. This included arrangements for staff to receive training in meeting people’s specific needs and staffing levels.

People did not always have access to meaningful activity to reduce the risks of isolation or boredom. There were some group activities provided once a day, however, out of these times there was no time for the care staff to spend with people and socially engage with them.

People’s care plans were not detailed enough to show how people’s specific needs affected them and to guide staff in how to meet people’s requirements and preferences effectively. Records relating to how much fluid people had each day were poor. There was limited information in people’s care records relating to their diverse needs and history and for example how their dignity and independence was being promoted and respected.

We observed medicine administration and found this was done safely. However, we found the audits for managing medicines only consisted of a count of medicines and checks of the medicine administration records. There was no full audit in place which was robust enough to identify shortfalls. For example, medicines not being labelled with the date of opening and staff accessibility of protocols for medicines to be administered when required.

People had access to health care professionals where needed. The registered manager had accepted support and was working with health care professionals to address areas they had identified as needing improvement. Health care professionals had provided training and support to the staff and registered manager.

People told us they had choices in their daily lives. However, there was no choice of meal provided to people during lunch on our inspection visits. We were told by staff that there were alternatives people could choose if they wanted them. We did see that people’s choices in other areas were supported, such as if they wished to stay in bed.

The service was not clean and hygienic throughout. There were areas where there were cobwebs and dust. Items in bathrooms and the wet room did not demonstrate an understanding of infection control procedures. There was no up to date infection control audit to assist the management team to identify shortfalls and address them. However, we did see staff wearing appropriate personal protective equipment and cleaning their hands.

People were supported to have visits from their relatives and friends. The registered manager was following government guidance in this area.

People told us they felt the staff were caring and this was confirmed in our observations. However, due to the shortfalls we had found during our inspection, we were not assured people always received a caring service.

There was a programme of refurbishment being undertaken in the home, which was ongoing.

There was a complaints procedure in place, the registered manager kept a record of complaints and actions taken in response.

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 the service under the previous provider was requires improvement, published on 16 July 2019. This service was registered with us under the current provider on 10 May 2021 and this is the first inspection.

Why we inspected

The service had not been inspected since the new provider had registered with us.

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.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse, staffing, consent and governance.

Please see the action we have told the provider to take at the end of this report.

We have recommended that the provider seek advice relating to providing meal choices to people living with dementia.

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 with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.