Elpha Lodge Residential Care Home

Updated 20 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was undertaken by 1 inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Elpha Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Elpha Lodge is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A new manager had been in post for 2 months and had submitted an application to register. We are currently assessing this application.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we held about the service, including the statutory notifications we had received from the provider. Statutory notifications are reports about changes, events or incidents the provider is legally obliged to send to us. We contacted the local authority commissioning and safeguarding teams, the local NHS IPC team, fire service and Healthwatch to request feedback. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 3 people who used the service and 12 relatives about their experience of the care provided. We spoke with 5 members of staff including the manager, deputy manager, care staff and the Nominated Individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We emailed 32 staff to request their feedback about working at the service and received 7 replies. We also emailed 7 health and social care professionals to request feedback about the service and received 1 reply.

We reviewed a range of records, this included care records for 9 people and multiple medicines records. We looked at the recruitment records for 3 staff and reviewed the training records of 4 staff. We also reviewed a variety of records relating to the management of the service, including policies and procedures.

Following the inspection site visits we requested additional information by email and continued to seek clarification from the provider to validate the evidence we found.

Updated 20 May 2023

About the service

Elpha Lodge is a care home providing accommodation and personal care for up to 24 people with physical disabilities. At the time of the inspection there were 21 people living at the service. Support was provided across two buildings which had been adapted to meet the needs of people.

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

The service was not well-led. There had been 3 changes of manager at the home during the last 12 months. The previous registered manager had left their employment after working at the home for a substantial number of years. These management changes had impacted upon the morale of some staff. A new manager had been recruited shortly before the commencement of our inspection. They were applying to register with CQC.

Some records across the service were disorganised and were difficult to locate. In addition, effective systems were not in place to audit and monitor quality across the service. For example, audits had not been completed at the frequency identified by the provider or had not identified the issues we found during our inspection.

An effective system to ensure all notifications were submitted to the CQC in a timely manner was not fully in place. The failure to notify CQC of incidents and other matters in line with legal requirements meant people were exposed to a risk of harm as there had been no overview by CQC to check whether the appropriate actions had always been taken.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Safeguarding systems were not robust enough to ensure people were always protected from the risk of abuse. Staff said they would report any concerns to the management team. However, we were not assured they understood their safeguarding responsibilities.

Safe and effective infection control procedures were not fully in place to ensure people were protected from the risk of infection. Medicines were not always managed safely. There were inaccuracies and omissions with the administration and recording of medicines. Staff were not always recruited safely and there were not always enough staff to meet people’s needs. Risk assessments had not been completed for all the risks people were exposed.

Effective systems to ensure staff were supported and received the necessary training to enable them to carry out their job role were not in pace. Training was not delivered to all staff which was specific to the needs of people receiving support. For example, staff had not received training in relation to supporting people with learning disabilities and autism even though they were providing this support.

Consent had not always been assessed and the appropriate applications had not been made to authorise care and support where restrictions were in place for people in line with legal requirements. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The care and support provided by staff was not always person-centred to the individual needs of people and records did not confirm people had regular opportunities to take part in activities which were person-centred to them. In addition, people were not always treated with dignity and respect. We have made a recommendation about this. Systems were in place to investigate and respond to complaints. People were supported with their communication needs and advocacy services were used to support people where people required support to express their views. End of life care plans were not in place to ensure any wishes people had for their end-of-life care were recorded. We have made a recommendation about this.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for this service was outstanding (published 27 December 2017).

Why we inspected

We received concerns in relation to the treatment people received and the overall management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

We inspected and found there was a concern with the management of safeguarding matters, staff training and the overall governance of the service, so we widened the scope of the inspection to become a comprehensive inspection which included the key questions of safe, effective, caring, responsive and well-led.

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 outstanding to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Enforcement and Recommendations

We have identified breaches in relation to person-centred care, need for consent, safe care and treatment, safeguarding, good governance, staffing, safe recruitment and a failure to notify incidents to CQC at this inspection. We have also made recommendations in relation to dignity and respect and end of life care for people.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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