Elysian Villas

Elysian Villas is a residential care home providing personal care to up to 12 people. Ten people were living at the service at the time of our inspection. The people who live at Elysian Villas have learning disabilities, complex needs and behaviours which can challenge. Elysian Villas are three separate houses on the same site which are able to meet as wide range of needs and abilities.

We found the following examples of good practice:

• Creative solutions had been found to help people keep in touch with friends and family. Additional hardware, for example smart displays such as Echo Show had been purchased to support people in being able to contact friends and family.

• Clear guidance was available for visitors arriving at the service. Information about requirements was sent to visitors before they came to the service. The service supplied visitors with PPE where necessary.

• Sunflower lanyards and exemption cards were used by people who are unable to wear a face mask when in the community.

• Staff understood zoning and cohorting principles, and would be able to put these into practice in the event of an outbreak.

• All staff had received additional infection prevention and control training, and training in RESTORE2 was underway.

• Staff who were not at work receive regular phone calls to check on their health and wellbeing and ensure they feel informed and up to date. When they return to work, staff have ‘buddies’ to support them.

• Teams continued to celebrate the positive things that happen and the wellbeing of the team is valued.

• All staff and people who are in high risk groups had individual risk assessments and adjustments had been made where necessary.

• Individual assessments and best interests decisions had been made about Covid testing for people who use the service.

• There was effective communication with a local GP practice and people had received timely treatment and support when necessary.

• Staff ensured people received personalised end of life care which met their needs. Plans were in place to develop this area of people’s care further in the future.

• The service continued to learn from experience and shared learning points and improvements with all staff.

Further information is in the detailed findings below.

Elysian Villas is a residential care home providing personal care to up to 12 people. There were 11 people using the service at the time of our inspection. The accommodation is split in to three individual villas, each with a dedicated senior and staff team.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was registered for the support of up to 12 people. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by accommodation being arranged between three villas with their own regular staff teams.

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

People using the service were safe. Improvements had been made to the security of the premises since our last inspection. Progress had also been made in the recruitment of permanent staff. Staff were trained in safeguarding and told us they felt confident about raising concerns with the provider.

From our observations, it was clear that people were settled and content with staff. Staff were kind and caring and understood people’s needs well. Independence was encouraged. People’s dignity was protected, and they were treated with respect.

Staff received good training and support to carry out their roles effectively. Staff were positive about working in the home. Staff worked with other professionals to ensure people’s healthcare needs were met.

The home was well led. The recent change from nursing to residential care had been well managed with no impact on the quality and safety of care that people received. Systems and checks were in place to ensure that the home was operating well.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion.

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 16 August 2018). There was one breach of regulation. The provider completed and action plan after the last inspection to show what they would and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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.

The service provides nursing care and accommodation for up to 12 people with learning difficulties. The accommodation is divided in to three separate villas on the same site. Elysian Villas is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in place. 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 found that people at the service were not always safe. This was due to the security of the building. Nine months prior to the inspection, the provider notified us of an incident where a person using the service left the building unattended because the gate to their villa was left unsecured. There was a second incident of this nature two months after the first. At this inspection, we found that a solution had not yet been put in place and the gates were still being left unsecured.

The service was also experiencing difficulties in recruiting and maintaining staff which meant there were significant staff vacancies at the service. This was being managed through use of regular bank and agency staff. We received varied feedback about this and the impact of it on people being supported. The majority of staff felt the impact on people was minimal due to the way in which it was being managed.

People received safe support with their medicines. These were stored securely and the administration of medicines was recorded on Medicine Administration Record (MAR) charts.

The service was effective. Improvements had been made in the way in which best interests decisions were being made. People were supported to see healthcare professionals when they needed to. Staff were satisfied with their training and support and received one to one supervision.

Staff were kind and caring and treated people with respect. We saw staff spend time with people sharing humour. Staff encouraged one person to change their clothes on several occasions ensuring they were clean and comfortable.

Staff were responsive to people’s personal needs and preferences. One person had recently moved villas as it better suited their needs. People were also able to take part in activities outside of the home, for instance going to day centres and the farm.

The home was not well led in all aspects because the service had been slow to respond to a safety issue with the premises. Staff were positive about the registered manager telling us they were approachable and they could raise any concerns they had.

Elysian Villas is registered to provide nursing care for up to 12 people who have a learning disability. The service comprises of three separate villas. There were 12 people at the service on the day of our inspection.

A registered manager was in post at the time of our inspection. 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 home is run. The registered manager was on long term planned leave at the time of our inspection. The home had notified the Commission of this absence and had suitable managerial arrangements in place.

The recording of people’s medicines was not always consistent. The registered manager was making positive steps to address these issues. Staff were not fully supported by an effective programme of supervision in line with the providers’ policy.

People’s capacity had been considered and documented in care records on some occasions. However, capacity assessment and best interest decisions were not always completed where appropriate. We made a recommendation in regards to working in accordance with the Mental Capacity Act Code of Practice.

Staffing levels were safe. The service was working to recruit further staff members to ensure consistency of care. Systems were in place to review and monitor reported accident and incidents. Changes were made to reduce and prevent future reoccurrences. Risk assessments were in place for people with supporting guidance available to staff.

People’s nutrition and hydration needs were met. People had access to healthcare professionals when needed. Care records contained detailed guidance supporting people who may not be able to communicate their health needs.

People were supported by staff who were kind and caring. Relatives told us they were welcomed at the home at any time. Staff knew people well and were aware of personal preferences. We observed staff maintained people’s privacy and dignity and treated people with respect.

Care records were person centred. People had access to a variety of activities of their choosing. The service was well-led. Systems were in place to monitor and improve the quality of the service. However, we did find that audits had not suitably identified some areas which required action. Feedback was sought from people and relatives and actions completed.

Elysian Villas is registered to provide nursing care for up to 12 people who have a learning disability. There were 12 people at the home on the day of our visit.

There was a registered manager for the service. 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.

Incidents and accidents that had happened in the home were reviewed by senior staff. Senior staff had been reviewing some records after incidents had happened. However there was no systematic management overview of these occurrences. This meant risks and emerging themes may not be properly identified.

People’s legal rights were protected because the provider had a system in place so that the requirements of the Mental Capacity Act 2005 were implemented when needed. This legislation protects the rights of people who lack capacity to make informed decisions.

People’s nutritional needs were effectively met and they were supported to eat a healthy and well-balanced diet.

People were able to take part in individual activities as well as group ones. Staff supported people to take part in a variety of community based activities that people enjoyed.

People’s care records were personalised, up to date and accurately explained people’s care and support needs. The care plans included information about people’s likes, interests and life before they came to the home. Staff were fully aware of the content of each person’s care records.

People were supported with their physical health care needs. Staff consulted with external healthcare professionals to get specialist advice and guidance when required.

Staff felt they were being well supported in their work. The staff felt they could approach the manager if needed.

Some areas of the home were in the process of being refurbished to provide individual, self -contained accommodation for people. This was a major change for both the people living at the home and the staff who were to support them. Changes had been made to the role of support staff with a greater emphasis in supporting people in the community.

The registered manager was not available on the day of our visit. The acting manager and deputy manager told us about plans that had been drawn up to develop two of the villas in providing self contained individual apartments for some of the people to live in. This proposal had impacted on the service and we saw evidence that changes had already taken place. We spoke with new team leaders who shared the management's views in promoting people's independence. It was evident that the leadership from the management had created a positive atmosphere for staff to embrace the changes.

We spoke with support staff, some were happy that they were more involved with the planning of people's care, while others confirmed that the changes were needed and accepted the new proposals.

We looked at various records to ensure that people had been cared for in a safe way. We saw there were sufficient staff on duty, up to date health and safety management audits had been carried out. Some staff had their names put forward to update some areas of their training.