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  • We have served a fixed penalty notice to Burlington Care Ltd for failure to comply with the notification requirement under Regulation 18(2) of the Care Quality Commission (Registration) Regulations 2009, an offence under Regulation 25 of the 2009 Regulations at The Elms Residential Care Home, Lowgate, Sutton Village, Hull, HU7 4US on 31 October 2019. Fines totalling 31250.00 have been paid as an alternative to prosecution.

Reports


Inspection carried out on 5 June 2019

During a routine inspection

About the service

The Elms is a residential care home providing personal care to 30 people aged 65 and over at the time of the inspection. The service can support up to 37 people, some of whom may be living with dementia.

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

There was a concern the initial assessment for two people was not as thorough as it should be, and they had been admitted to the home when they may have needed a more specialist service. Some people had not consistently received their medicines as prescribed, which had the potential to impact on their treatment.

There was a new manager in post, who had started to implement the provider’s quality monitoring system. However, for several months the system had not been wholly effective in identifying the issues we found during the inspection or shortfalls had not been addressed in a timely way. When reviewing incidents that had occurred in the service before the new manager took up their post, we found several had not been reported to the Care Quality Commission (CQC). It is important we know about these incidents, so we can check what action has been taken.

Staff received training and induction. There were gaps in staff supervision and appraisal. However, these had been identified and we have been assured an action plan will address the shortfalls. We have made a recommendation about keeping the supervision and appraisal under review to ensure staff receive support and guidance.

The provider had been quick to respond to a safeguarding incident when they became aware of it and took appropriate action. Staff had received training in how to safeguard people from abuse and knew how to report incidents.

The provider had a safe system of staff recruitment. There had been a need for the use of agency staff recently, which, although not an ideal situation, had ensured there were always enough staff on duty.

People’s health and nutritional needs were met. Staff ensured people received care and treatment from health professionals when required. People who used the service liked the meals provided.

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. Staff ensured relatives were welcome to visit at any time and provided activities daily, so people could choose to participate if they wished. Staff were described as friendly, kind and caring.

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 17 May 2018).

At this inspection, enough improvement had not been made and the provider was now in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches at this inspection in relation to assessing people’s needs in a thorough way, management of medicines, monitoring and improving quality, and ensuring CQC is notified of incidents affecting people’s welfare. Please see the action we have told the provider to take at the end of this report.

Since the last inspection we recognised that the provider had failed to notify us of incidents that affected the safety and welfare of people. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 16 April 2018

During a routine inspection

This inspection took place on 16 and 17 April 2018 and was unannounced on the first day. At the last inspection in September 2017, the provider was in breach of multiple regulations, was rated Inadequate and placed in Special Measures. The concerns related to person-centred care, dignity and respect, managing risk and the spread of infections, administration of medicines, staffing numbers and quality monitoring. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions to at least good. We checked to see that the action plan had been completed and found improvements in all areas. The service was no longer in Special Measures.

The Elms is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The Elms supports up to 37 older people, some of whom may be living with dementia. Communal rooms consist of a sitting room with a small quiet area at one end, a further smaller sitting room and a dining room. There is also a small seated area in the entrance and another in a walkthrough area near patio doors which leads out to a courtyard. Bedrooms, bathrooms and toilets are located over three floors accessed by a passenger lift.

The service had a registered manager. A registered manager is a person who has registered with the 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.

Risk was identified and managed more effectively, which meant people who used the service were protected from potential and actual harm. Staff received safeguarding training and knew how to protect people from the risk of abuse; they described what they would do if they witnessed abuse or poor practice. The provider used local safeguarding policies and procedures and contacted the safeguarding team for advice when required.

Medicines were managed safely and people received them as prescribed. Medication was stored appropriately and stock was managed more effectively, which reduced unnecessary waste. There was a clear system for returning unused medicines.

People’s health and nutritional needs were met. People at risk of deteriorating health or poor nutrition were monitored and staff liaised with community healthcare professionals for advice and treatment.

Staff were responsive to people’s needs and supported them in an individual way. They knew people very well and could describe in detail the support they required. People and their relatives had only positive comments about the staff approach and described it as caring and kindly. We observed staff were friendly and attentive to people and their relatives.

People were supported 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.

There was sufficient staff deployed in the service. The provider had recruited more care and domestic staff and reorganised the shift pattern to suit the needs of the service. A deputy manager had been recruited, which had enhanced the support available to the staff team. A new activity coordinator ensured activities were higher on the agenda and people received social stimulation.

Staff received training, supervision and appraisal to ensure they felt confident and were skilled when supporting people who used the service.

The quality monitoring system had improved and audits were completed in a more robust way. This ensured any areas identified for improvement were addressed in a timely way. Visits were completed by senior management to ensure they had o

Inspection carried out on 11 September 2017

During a routine inspection

The inspection took place on 11 and 12 September 2017 and was unannounced on the first day.

The Elms is registered to provide care and accommodation for a maximum of 37 older people, some of whom may be living with dementia. Communal rooms consist of a sitting room with a small quiet area at one end, a further smaller sitting room and a dining room. There is also a small seated area in the entrance and another in a walkthrough area near patio doors which leads out to a courtyard. The service has a large lawn at the front of the house and a car park. Bedrooms, bathrooms and toilets are located over three floors accessed by a passenger lift. Most bedrooms are for single occupancy but there are also some bedrooms for shared use. The service has good access to local facilities and amenities. At the time of the inspection, there were 34 people living in the service. We were told two people also attended the service for day care.

The service had a registered manager. 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 on 27 and 28 April 2017, we judged the service as ’Requires Improvement’. This was because we had concerns about recruitment processes potentially placing people who used the service at risk. There were also concerns that we had not received notifications of incidents which affected the safety and welfare of people who used the service.

Prior to this inspection, we received information of concern regarding the safety of medicines management. There were some safeguarding investigations underway from January 2017 which related to potential shortfalls in the delivery of care; these were still on-going and being undertaken by the local authority. There were also some concerns about the number of accidents and incidents which occurred in the service. We decided to complete a focussed inspection to look at medicines management and to see how risk was assessed. Due to the number of concerns and level of risk found during the inspection, we changed the focussed inspection to a full comprehensive inspection.

The concerns identified during the inspection resulted in us finding the provider in breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches included, management of the service, providing person-centred care, not maintaining privacy and dignity, the management of medicines, cleanliness and infection control, identifying and managing risk, good governance and staffing.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’ and the provider must take action to improve and sustain the improvements. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rati

Inspection carried out on 27 April 2017

During a routine inspection

The Elms is located in Sutton on the outskirts of Hull and is registered to provide care and accommodation for a maximum of 37 older people who may be living with dementia. It has good access to local facilities and amenities.

This inspection took place on 27 and 28 April 2017 and was unannounced. The service was last inspected April 2015 and was found to be compliant with the regulations inspected at that time.

At the time of the inspection 37 people were living at the service.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Processes had not been followed to ensure the safety of the people who used the service and to make sure they were not exposed to staff who may pose a risk to them. You can see what action we have told the provider to take and the end of this report.

People were cared for by staff who understood the importance of protecting them from harm and who’d had training in how to identify and report abuse. Staff were provided in enough numbers to ensure the needs of the people who used the service were met. The service was clean and tidy and there were no mal-odours. People’s medicines were handled and administered safely.

The food provided was wholesome and nutritious. People’s food and fluid intake was monitored so they had a healthy well-balanced diet, staff made referrals to other health care professionals if people experienced any dietary issues, for example, the risk of choking or a reduction in their appetites. Systems were in pace to protect people who needed support making informed decisions. Meeting had been held to ensure any decisions made on their behalf would be in their best interest. Staff had received training which equipped them to meet the needs of the people who used the service; they were also provided with opportunities to gain further qualifications and experience.

People were supported by staff who were kind, caring and understood their needs. The interaction between staff and people who used the service was open and respectful. People had been involved with the formulation of their care plans and had been involved in meetings about their ongoing care needs.

A choice of activities was provided for people to participate in if they wished. This included in house activities as well as visits to the local community and the use of local facilities. The registered provider had a complaints procedure which was displayed around the service and people could easily access. All complaints were investigated to the complainant’s satisfaction. The complaint procedure signposted complainants to other agencies if they were not happy with the way their complaint had been investigated, for example, the local government ombudsman.

The registered manager was open and approachable and people found them helpful. Staff found the registered manager approachable and felt confident they could go to them for advice and guidance. People who used the service and other stakeholders were asked for their views about how the service was run. Any issues were addressed by the use of time limited action plans. We have written to the registered provider reminding them of their duty to send notifications to the CQC in a timely way concerning any event or incident which happens at the service which affects the wellbeing of the people who use the service.

Inspection carried out on 7 and 8 April 2015

During a routine inspection

This was an unannounced inspection undertaken on 7 and 8 April 2015. The inspection was undertaken by one adult social care inspector.

The service was last inspected June 2013 and was found to be compliant with the regulations inspected at that time.

The Elms is located in Sutton on the outskirts of Hull and is registered with the Care Quality Commission (CQC) to provide care and accommodation for a maximum of 37 older people who may be living with dementia. At the time of the inspection there were 34 people living at the service. It has good access to local facilities and amenities. The majority of bedrooms are single en-suite and people can bring items of their own furniture with them when they move into the service.

The environment has been adapted to ease the lives of those people who are living with dementia; there were signs and different colours used to help identify toilets, bedrooms and bathrooms. There was an outside enclosed court yard which was on one level, making access easier for people who needed support with mobility to this area.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff understood the importance of keeping people safe from harm and knew how to recognise and report abuse. Staff were recruited safely and the registered provider had systems in place to make sure people were not exposed to staff who had been barred from working with vulnerable adults. Staff were provided in enough numbers to meet the needs of the people who used the service. They had received training about how to effectively meet people’s needs including those people who were living with dementia. People’s medicines were administered safely and staff had received training for this. We found more hand washing facilities were needed for staff to use to lessen the risk of cross infection; we have made a recommendation about this.

People were provided with a wholesome and nutritional diet which was of their choosing. Staff understood the dietary needs of the people who used the service and ensured they received food which met these. People who needed assistance to eat their meals were helped by sensitive and caring staff who supported them discreetly and at their own pace. Referrals were made to the necessary health care professionals and people were supported to access their GPs when they needed. People’s human rights were protected by staff who had received training in the Mental Capacity Act 2005.

People had good relationships with staff who understood their needs and knew how these should be met. People or their representatives were involved in their care planning decisions and their goals and wishes were recorded. People’s choices were respected and staff understood the importance or respecting people’s dignity, rights and supporting people to lead their chosen lifestyle.

The registered provider had a complaints procedure in place which was displayed around the service for people or visitors to access if they felt the need. All complaints were recorded and wherever possible investigated to the complainant’s satisfaction; information was provided so people could take their complaints to an outside body if they wished. People were provided with a range of activities to choose from and staff effectively engaged those people living with dementia in their chosen pastimes.

The registered manager undertook audits of the building to make sure it was safe for people to live in. They also undertook audits of the service provided to ensure it was effective at meeting the needs of the people who used it. The registered manager consulted with the people who used the service to ascertain their views about how the service was run and to see if there were any improvements needed. They also sought the views of people’s relatives and health care professionals who were involved with people’s care and welfare about how the service was run.

Inspection carried out on 4 June 2013

During a routine inspection

We found that people who used the service were involved in the running of the home and their care.

Information was available for staff to follow which ensured people received the right level of care to meet their needs. Staff were able to describe people’s needs and how to maintain people’s dignity and rights.

The home was clean, tidy and was designed to meet the needs of the people who used the service. People told us they were happy with their rooms. One person said “I have a lovely room, it looks out onto the garden and the staff keep it nice and clean for me.”

There were enough staff on duty both during the day and night to meet people’s needs. People who used the service told us, “The girls are always there when I need them” and “No, I never feel rushed and there are always plenty of carers around.”

Records were fit for purpose and stored securely.

Inspection carried out on 31 December 2012

During a routine inspection

We found that people were consulted about their care and appropriate arrangements were in place to ensure decisions made were in people’s best interest if they found this difficult.

We found that people were provided with a varied and nutritional diet. People told us the food was excellent and they had plenty of choice. Comments included, “The food is always good here” and “There’s always plenty of choice.”

We found that people’s medication was administered and stored safely and staff had received medication training.

We also found that staff had received training about meeting the needs of older people and how to keep people safe from harm.

We found that people could make complaints and these were acted on and resolved where possible to the person’s satisfaction. People told us they would approach the manager or the care staff if they had any concerns.

Inspection carried out on 30 January 2012

During a routine inspection

People told us they could lead a lifestyle of their own choosing, could come and go as they pleased and had attended meetings about how the home was run. One person said there was plenty to do and there was plenty of food.

People told us the care staff were helpful and caring and they had been involved with their care plan. They also told us they knew who they could complain to and were satisfied any concerns would be taken seriously.

Reports under our old system of regulation (including those from before CQC was created)