Archived: Elm Lodge Nursing and Residential Home

Elm Lodge Nursing and Residential Home is a residential care home providing personal and nursing care to 56 people and over at the time of the inspection. The service can support up to 64 older people or younger adults who may be living with a physical disability or dementia. Elm Lodge Nursing and Residential Home is a large building made up of three floors each of which has separate adapted facilities.

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

People were not always engaged in meaningful activities for a sufficient amount of time. People told us that they were sometimes bored, and staff did not always have enough time to sit and engage with them in activities for a reasonable period of time. We have made a recommendation to the service about the provision of activities.

People were positive about the care they received. One person told us, ‘‘It is lovely here. The staff are so kind and caring and I would not have things any other way.’’

People were supported by a kind and compassionate staff team who had got to know people as individuals. People received personalised care that met their needs and there was an emphasis on knowing people’s likes, dislikes and preferences. People were involved in their care and able to make choices about how they were supported. People’s independence, privacy and dignity was promoted.

People were kept safe by as staff team that knew how to safeguard them from harm. Risks to people had been thoroughly assessed. People were supported safely because of policies and procedures in place at the service in all areas of their care including medication and infection control. There were enough suitable trained and competent staff to meet people’s needs safely.

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 were supported to eat and drink depending on their support needs in this area. People were supported to see health professionals and to live healthy lives.

People were supported in an environment that enabled them to be supported safely. The registered manager was making improvements to the premises to further improve people’s care and support. People had access to a complaints procedure and complaints were dealt with promptly and thoroughly. People were supported with dignity and respect at the end of their lives.

People and the staff team were positive about the management of the service. The registered manager completed audits to monitor the quality of the service and put improvements in place where these were necessary. People, relatives and the staff team were encouraged to feedback about the service. The registered manager and staff team worked with other organisations to ensure good outcomes for people.

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 requires improvement (published 5 October 2018). At this inspection we found improvements had been made and the service is now rated as good overall.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Elm Lodge can accommodate up to 64 people in one adapted building, over two floors. At the time of our inspection there were 57 people living there.

There was a registered manager in post. 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 the last inspection in May 2016, we rated the service as Good. During this inspection, which took place on 15 August 2018, we identified some areas requiring improvement. Consequently, we have changed the rating from Good to Requires Improvement. This is the first time the service has been rated Requires Improvement.

Why we rated the service Requires Improvement:

People did not always receive their medicines in a safe way. Staff had missed the fact that one person had not been given an essential medicine on two occasions. We also found that staff were not maintaining accurate records in terms of stock levels for certain prescribed medicines or how often people were being given homely remedies, such as paracetamol.

In addition, audits were being carried out to check the quality of records being maintained by staff and the service provided to people. However, these checks were not always effective and had failed to identify areas that required improvement, or result in robust action to address these in a timely way.

We did find that the service continued to provide a good service in other areas that we checked. For example, there were processes in place to protect people from avoidable harm and staff were aware of their responsibilities to report potential concerns. Risks to people were assessed and managed appropriately. People were protected by the prevention and control of infection and the provider had processes in place for when things went wrong, so that lessons could be learnt, in order to improve the service.

Staff had been recruited using a robust recruitment process. They had attended a variety of training to keep their skills up to date and were supported with regular supervision. There were enough trained staff to support people with their needs.

People had enough to eat and drink. They could make choices about what they ate and were provided with support when required.

People had access to additional health care professionals, to ensure they received effective care or treatment when required.

Staff gained consent to care before supporting people; this was sought in line with legislation. People were enabled to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff treated people with kindness and compassion. People were treated with dignity and respect, and had the privacy they required.

People’s needs had been assessed prior to admission. Care and support plans were personalised and reflected people’s individual requirements. People and their relatives were involved in decisions regarding their care and support needs.

There was a variety of activities on offer and people were supported to follow their interests. They were able to make decisions about how they spent their time.

The provider had a clear vision, and was open and transparent. They involved people and their relatives in developing the service. There was a complaints procedure in place and people knew how to complain if they needed to. People also knew who the registered manager was and could see them when they needed to.

Further information is in the detailed findings below.

Elm Lodge Nursing and Residential Home provides care and accommodation for up to 64 people. Some people may require nursing care and people living at the home may have dementia. At the time of our inspection there were 61 people living at the home, 22 of whom required nursing care.

The home had a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 received their medicines as they had been prescribed.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home, and these were reviewed regularly. Accidents and incidents were recorded and the causes of these analysed so that preventative action could be taken to reduce the number of occurrences.

There were enough skilled, qualified staff to provide for people’s needs. Robust recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. They received training to ensure that they had the necessary skills to care for and support the people who lived at the home and were supported by way of supervisions and appraisals.

People’s needs had been assessed before they moved into the home and they had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People had a variety of nutritious food and drink available to them. There were freshly made, home cooked meals from a menu that had been devised using people’s likes and dislikes. Snacks and fruit were available to people throughout the day.

Staff were kind, caring and protected people’s dignity. They treated people with respect and supported people in a way that allowed them to be as independent as possible.

There was an effective complaints system in place. Information was available to people about how they could make a complaint should they need to and the services provided at the home. People were assisted to access other healthcare professionals to maintain their health and well-being.

People and staff were encouraged to attend meetings with the registered manager at which they could discuss aspects of the service and care delivery. People were asked for feedback about the service to enable improvements to be made. There was an effective quality assurance system in place and the provider was an active participant in the day to day running of the service. .

We noted that people were cared for in safe and adequately maintained premises. One person told us they liked their bedroom because they had a good view out of their window.

We found the provider had effective staff recruitment processes, and people were supported by staff who were a trained and received regular supervision. We observed that the staff were knowledgeable and responsive to people's needs.

During our visit on 17 December 2012 we observed staff interactions with people living at the service. We saw that staff were responsive to the needs of people and offered assistance when required. We spoke with two people at the service. One said "I am very comfortable here." We saw choices were offered and most people chose their meals the day before or up to 10.30 on the day.

We saw that care plans had been reviewed and a document had been introduced to record the consent and agreement of people or their representative with the proposed care plan.

An activities co-ordinator had been appointed and they were able to take people on short outings to the local shops. We saw information about events organised to take place during the Christmas period and there were photographs on display of a group outing in September 2012.

We noted that the premises were free from offensive odours and were clean. We spoke with a member of cleaning staff who informed us that the team worked hard to manage the cleanliness, and had made changes to their ways of working do this.The majority of staff had completed infection control training.

We found that five additional care staff had been employed since our last inspection on the 19 May 2012 along with an activities co-ordinator and two nurses.