About the service 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.