Elmcroft Care Home

Updated 4 February 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

The inspection team consisted of two inspectors, one who was a registered nurse 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. The Expert by Experience visited the service and made phone calls to relatives.

Service and service type

Elmcroft Care 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. The service 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 not a registered manager in post. The last registered manager had left in 18/11/2021. A new manager had been in post for a couple of months and had submitted their application to register before the publication of the report.

Notice of inspection

We carried out two unannounced visits to the service.

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 and professionals 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.

The inspection

We spoke with fifteen people who used the service and used observation to understand people’s experience of care. We met with two family members and three external professionals who were visiting the service. We had phone contact with ten family members for feedback about the service. We reviewed eight people's care records and medication administration records.

We spoke with the new manager, the administrator, reception staff, three nurses, the chef, the activity coordinator, six care staff and two domestic staff. We met with the nominated individual. A nominated individual is responsible for supervising the management of the service on behalf of the provider. We also met with the quality lead, medicine specialist, a consultant, the regional support manager, the associate operations director and the provider’s maintenance manager.

We looked at three staff files. We also looked at a variety of records relating to the management of the service and quality assurance arrangements.

After our visit we continued to seek clarification from the provider for further information and to gain assurances about some of the concerns we found during our visit to the service.

We had email contact with five professionals who worked with the service.

Updated 4 February 2023

About the service

Elmcroft Care Home is a residential care home providing personal and nursing care for up to 54 people. The service primarily provides support to older people and people with dementia. It is also registered to provide support to people with a physical disability, people with a learning disability and autistic people and younger adults. At the time of our inspection there were 42 people using the service.

The care home is in a rural location and has two separate units, called Blythe and GNU.

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

Feedback from people and families was negative in relation to poor management. They gave us examples where people’s individual needs were not met. They also told us some staff provided good care and recently there had been some improvements to the management of the service.

There had been significant management changes since our last inspection, and a new manager had just joined the service. Although the provider had detailed improvement plans and quality audits in place, these had not always been effective or implemented in a timely manner to ensure people received good quality care.

Morale among some staff was low. Senior staff did not always know what was happening across the service and did not communicate or organise staff effectively. Staffing were recruited safely, however improvements were needed in the oversight of agency staff. A revised timetable for staff training was helping ensure staff had the skills to support people safely and in line with their needs.

People did not consistently have a good quality of life. Staff did not always understand and meet people’s needs in a person-centred manner, including around communication and end of life care.

Concerns about people’s safety and complaints were not always managed well. The provider had focused on improving safety and practice around medicine management, risk assessment and care planning was improving. Maintenance and refurbishment works were helping minimise the risk of infection.

Staff did not consistently support people to have maximum choice and control of their lives and to support them in the least restrictive way possible and in their best interests. The policies and systems in the service were in place to support this practice but were not applied effectively.

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.

The provider did not demonstrate an understanding of Right support, right care, right culture.

Right Support:

Staff and managers did not consistently support people to have a fulfilling and meaningful everyday life.

Right Care:

People’s care, treatment and support plans were being amended to reflect their range of needs.

Right Culture:

The values, attitudes and behaviours of the management and staff did not demonstrate a consistently caring and open culture.

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 good (published 5 May 2019).

At our last inspection we recommended the service looks at good practice guidance and environments for people with dementia. At this inspection we found the provider had invested in this area however there was still room to improve the care and environment for people with dementia.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

We received concerns in relation to poor governance, safety and lack of person-centred care. As a result, we undertook a focused inspection to review the key questions of safe, responsive 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 good to requires improvement based on the findings of this inspection.

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

Enforcement

We have identified breaches in relation to poor governance and lack of person-centred care at this inspection.

Please see the action we have told the provider to take at the end of this report.

We made a recommendation about Right support, right care, right culture.

Follow up

After the inspection we met with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan from the provider. We will work with the local authority and health professionals to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.