This inspection took place on 1 and 2 March 2017 and was unannounced.
Elderholme Nursing Home is situated within the grounds of Clatterbridge Hospital on the Wirral. It is a single storey purpose built care home offering both nursing and personal care for up to 61 people. All 61 bedrooms are single occupancy. There are three communal lounges, two main dining rooms and a pleasant garden with seating area for people to access. It also provides short term care for people who require assessment prior to returning home or moving to long term care.
During the inspection, there were 57 people living in the home.
We last completed a comprehensive inspection of Elderholme in February 2015. We found that the provider was in breach of regulations with regard to person centred care, consent and good governance. The service was rated as ‘requires improvement.’ In June 2015, we conducted a focused inspection to check that improvements had been made. We found that the provider was meeting regulations in relation to consent and good governance. The overall rating for the service was not reviewed during that inspection.
During this inspection we found that care files we viewed were detailed and person centred. They contained information specific to the individual, such as their preferred hobbies, their family history, previous occupations and preferred daily routines. This helped staff get to know people as individuals and provide care based on their experiences and preferences.
Staff we spoke with knew the people they were caring for well. We asked staff about people’s preferred foods and specialist dietary requirements and all staff had a good understanding and the information they told us was reflected in people’s care plans. The provider was no longer in breach of this regulation.
Most risk assessments we viewed had been completed accurately, however we found that some contained inconsistent information. This meant risk to the person may not have been accurately identified; however we found that appropriate care had been provided. We discussed this with the registered manager and on the second day of inspection, they told us that the risk assessments had been updated. We looked around the home and found that risk was not always minimised. For instance, we saw a fire door wedged open and chemicals were not always stored securely.
Medicines were stored safely and the temperature of the room was monitored daily as well as the medicine fridge and they were within safe ranges. Medicine Administration Record (MAR) charts were not always completed fully as gaps were evident in the recording of medicine administration. We checked the stock balance of one medicine with gaps evident on the MAR chart and found that there were more medicines left than there should have been. Staff had completed training in relation to safe medicine administration and had their competency assessed each year.
We found that staff were kind and caring in their approach when supporting people and we observed staff respecting people’s dignity in a number of ways during the inspection. We found however, that people’s privacy and dignity was not always maintained as information specific to individuals and their needs, was visible around the home. This meant that private information about people was accessible to people who did not require to see it and this did not protect people’s dignity.
People told us they felt safe living in Elderholme and relatives we spoke with agreed that the home provided a safe environment for their family members to live in. All staff we spoke with were aware of safeguarding procedures and how to raise concerns.
Records showed that staff were recruited safely and most people told us there were enough staff on duty to meet people’s needs in a timely way and our observations confirmed this. Call bells were answered quickly and people did not have to wait for support when they requested it.
Records showed that incidents were recorded and reported appropriately and arrangements were in place for checking the environment to ensure it was safe. A fire risk assessment of the building was in place and people who lived at the home had a PEEP (personal emergency evacuation plan) to ensure their safe evacuation in the event of a fire. External contracts were in place to help ensure the building and equipment were well maintained.
Applications had been made appropriately to lawfully deprive people of their liberty when assessments showed this was required. Staff we spoke with had a good knowledge of DoLS and how this impacted on people living in the home.
When people were unable to provide consent, records showed that mental capacity assessments were completed. We viewed mental capacity assessments and found that most were decision specific and discussions took place with relevant people to make a decision in the person’s best interest when they lacked capacity. We found however, that when people required a capacity assessment for more than one decision, the assessments were not all fully completed.
Staff were supported in their role through an induction when they commenced in post and received regular training. Annual appraisals took place and although regular supervisions were not all clearly recorded, staff told us they were well supported and could raise any issues with the registered manager at any time.
People living in Elderholme were supported by the staff and other external health care professionals to maintain their health and wellbeing. A visiting health professional we spoke with during the inspection confirmed that they received timely and appropriate referrals from staff within the home.
Feedback regarding meals was positive. A menu was on display in the dining rooms and people were asked what meal they would prefer each day. We observed drinks and snacks being provided to people regularly throughout the day and jugs of juice were available in people’s rooms.
We observed staff providing support to people in such a way as to promote their independence and people we spoke with told us staff encouraged them to be independent.
Care plans we viewed showed that when able, people were involved in the creation and review of their care plans. The registered manager told us the service writes to family members twice a year to request they visit the home to review their family member’s plans of care. We viewed one of these letters.
People told us that their religious needs were respected by staff. Elderholme provides support to people at the end of their life and care plans contained advance care plans to help ensure people’s needs and preferences could be met during these times.
The registered manager told us there were no restrictions in visiting, encouraging relationships to be maintained. People we spoke with and their relatives, confirmed that they could visit at any time and that they could visit in private if they chose to. For people who had no family or friends to represent them, contact details for a local advocacy service were available for people to access.
Care plans were in place to help meet people’s individual needs. They had been reviewed regularly and most reflected people’s care needs accurately.
There were two activity coordinators employed by the service who provided activities within the home in groups and on a one to one basis, as well as organising day trips in the minibus. During the inspection we saw that a game of dominoes was underway and a church service also took place. A schedule of activities was on display within the home. People we spoke with were satisfied with the activities available to them.
Systems were in place to gather feedback from people and listen to their views, such as resident meetings and quality assurance surveys. A complaints policy was on display and people knew how to raise any concerns they had. The complaints policy and newsletter reflected that the service welcomed complaints and saw them as an opportunity to learn.
The registered manager completed regular audits to monitor the quality and safety of the service provided. When audits identified issues, it was evident that actions had been taken to address these issues. We found however, that these systems were not always effective as they did not identify all of the issues we highlighted during the inspection. We also found that when issues were raised through quality assurance questionnaires, it was not clear that they had been addressed.
A registered manager was 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. We asked people their views of how the home was managed and feedback was positive.
Staff were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any issue they had. Staff told us they were encouraged to share their views regarding the service and felt well supported by the management team.
The registered manager told us they aimed to work in partnership with other agencies to help ensure quality of care provision and joined up care and that the service always volunteered to participate in any pilot projects that may help improve the quality of care provided. Innovation was encouraged and recognised within the service and new ideas implemented to help improve quality.
A range of policies and procedures were in place to help guide staff in their role and ensure they were clear of their responsibilities and aware of the culture of the service. Most of these policies provided detailed and relevant information, however some required updating to reflect the current regulations and local authority contacts. The registered manager was aware these needed updating and