Elderholme Nursing Home

Updated 1 November 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 two inspectors 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

Elderholme Nursing Home 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. Elderholme Nursing Home is a care home with 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 a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. 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 the registered manager, chef and 5 other members of the staff team. We spoke with a visiting health professional, 3 people who used the service and 10 relatives, about their experience of the care provided.

We reviewed a range of records. This included 5 people's care records and a range of people’s medication records. We looked at 6 staff files in relation to safe recruitment. A variety of records relating to the management of the service, including audits, were also reviewed.

Updated 1 November 2023

About the service

Elderholme Nursing Home is a care home providing personal and nursing care to up to 64 people. They also provide specialist care to people who require ventilation or tracheostomy care, as well as short term assessment and reablement support. At the time of the inspection, 64 people were living in the home.

At the time of the inspection, the location supported 3 people with a learning disability or who were autistic. We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

However, the people were being supported in the service primarily for their nursing needs, rather than their learning disability. Therefore, although we checked to ensure people were treated with respect and dignity, had choices and were supported to access local communities, we did not assess the service as a whole, based on ‘Right support, right care, right culture.’

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

Risks to people were assessed, however records did not always reflect actions had been taken to mitigate identified risks and some care plans required additional detail to ensure people’s needs were clearly reflected. We made a recommendation about this.

Medicines were managed safely, but records required further improvement to ensure there was clear guidance when to administer ‘as required’ and covert medicines. Medicines were stored safely and administered by staff that were trained and assessed as competent.

Records showed safe recruitment practices had not always been followed. Although all staff had undertaken a Disclosure and Barring Service (DBS) check, some staff did not have a reference from their previous employer and had gaps in their employment history. The registered manager took action to address this.

Procedures were in place to seek and record people’s consent, but records regarding best interest decisions could be further improved. 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 and their relatives told us they felt Elderholme Nursing Home was a safe place to be. Procedures were in place to ensure safeguarding concerns were managed appropriately. Staff knew how to raise concerns and referrals were made appropriately. There were enough staff to support people when they needed it and rotas showed staffing levels were consistently maintained. Staff had undertaken training to ensure they had the required knowledge to meet people’s needs safely and told us they were well supported in their roles.

Effective infection prevention and control measures were in place. The home was clean, and people’s friends and relatives were encouraged to visit. People were encouraged to personalise their rooms and the environment was safe and appropriate for the people living there.

People were supported to maintain their health and wellbeing and referrals were made to other professionals when required. People’s dietary needs were assessed and met, and people told us they had enough to eat and drink, and always had a choice of meal.

Systems were in place to monitor the quality and safety of the service and helped the registered manager identify any areas for improvement. People and their relatives told us the service was well managed and feedback regarding the care provided was overwhelmingly positive.

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 requires improvement (published 10 February 2021) and there was a breach in regulation regarding the management of medicines. 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 reviewed and updated practices to ensure risks were robustly assessed and managed, and systems in place to monitor the quality and safety of the service were effective. At this inspection we found the provider had made improvements with regards to the governance systems, but further improvements were required to ensure records reflected that identified risks were mitigated.

Why we inspected

This inspection was prompted in part due to concerns received regarding staffing levels, staff training, the management of the service, the management of medicines and the quality of care provided. A decision was made for us to inspect and examine those risks.

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.

As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Recommendations

We have made a recommendation in relation to the management of risk.

Follow up

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