Elliott House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good.

At this assessment the rating has changed to requires improvement: This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safeguarding and infection, prevention and control.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Relatives told us they could raise safety concerns and that these would be listened to. Incidents and accidents had been reported, investigated and shared with the provider’s quality team. Lessons learned from incidents were shared with the staff.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care. There were processes in place to promote effective transitions into and out of the service. Relatives told us they were involved with the transition of their loved ones moving into the service. One relative told us “I was able to move [name] in and was supported by the care worker [name] had previously. The home was very supportive and did what they could. It was quite traumatic, but they dealt with it very well.” There was a service user guide available to anyone moving into the service. The registered manager explained that transitions were tailored to the individual and their preferences.

The provider had safeguarding systems in place. Safeguarding concerns were shared appropriately in a timely manner. However, we were not assured that practices in place demonstrated that they were the least restrictive. Although people had mental capacity assessments (MCA’s) in place, these lacked detail and were not decision specific, for example people’s mental capacity assessments detailed a number of restrictive practices including locked exits, laundry room and kitchen doors being locked within one assessment meaning that individual decisions were not assessed in line with the Mental Capacity Act code of practice. There were blanket restrictions in place for people living in the main house, impacting on their levels of independence and rights. For example, there were blanket restrictions including locked doors to the kitchen and laundry requiring staff support to access. We were not assured that these restrictive practices were being regularly reviewed to ensure the least restrictive option. Staff had access to policies to guide and inform them in relation to safeguarding, equality and human rights, bullying and hate crimes. Staff understood the signs of abuse and who to report their concerns to and had completed safeguarding training.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risks assessments were not in place or lacked sufficient detail. For example, a swimming risk assessment for a person who is prescribed rescue medication for epilepsy. This meant there was not a clear procedure for staff to follow in the event of the person having a seizure whilst in the swimming pool. Another epilepsy risk assessment details that a bed monitor is in place however we were told that this was no longer in use. People had personal emergency evacuation plans (PEEP) in place which detail how a person needs to be supported in the event of a fire however, these lacked detail, for example one person lived in an annex in the back garden and the PEEP did not document codes that staff or the emergency services would need to access the building in the event of a fire. PEEPs did not include information regarding evacuation points. This meant there were not clear procedures for staff to follow to support individuals in the event of a fire. There were a number of blanket restrictions within the main house and restrictions in place within the annex were not always reviewed to ensure that these were the least restrictive.

Families felt that their loved one’s needs were understood. Information was included in people’s records where they had input from other professionals around managing risks. One professional told us, “They [the service] have worked tirelessly to promote [name] abilities, which has now meant [name] is not requiring certain medications, [is] able to attend more social events and has been able to go abroad.” People had positive behavioural support plans in place to enable staff to support people to manage their emotions.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care. Processes to identify and monitor health and safety concerns were not robust, where issues were identified, there was no evidence of actions taken to resolve these. We found concerns including a fire door in a poor state of repair. This increased the risks around fire safety at the service. There were doors that did not open/open fully which placed people at risk in the event of fire, hindering escape and increasing the risk of injury. During our onsite visit we found broken fence panels in the back garden which had not been identified on the health and safety weekly checklist. This posed a security risk as people at the service had been assessed as being at risk of absconding. Whilst there was keypad access to the garden, once in the garden security oversight was not managed effectively. We identified that some window restrictors within the main house did not meet the required regulation, although this did not pose a significant risk to people, the provider had not ensured this equipment met the required specifications. We found shortfalls in the storage arrangements for the Control of Substances Hazardous to Health policy (COSHH). The service risk assessment did not cover how the use of products are safely managed in line with the providers COSHH policy. We found two occasions where the COSHH cupboard was unlocked, and items where not stored securely. This posed a risk that people could access these dangerous chemicals.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Relatives we spoke with told us there were sufficient staff working at the service. Staff told us they had a thorough induction when joining the service and received ongoing supervision and development opportunities. The provider ensured staff received training relevant to their role and training compliance rates were high. Safe recruitment processes were in place. This included right to work information, references and disclosure and barring service (DBS) checks.

The provider did not assess or manage the risk of infection. Processes to identify and escalate infection prevention and control risks within the service were not robust, and there was limited evidence that identified risks were consistently addressed or actioned in a timely manner. Cleaning schedules and infection control audits were not detailed or completed fully, however following the inspection the provider updated these documents to address these shortfalls. We found concerns including the management of clinical waste, for example open bags containing soiled laundry. Colour coded brushes were stored on top of one another increasing the risk of the spread of bacteria and germs. Personal Protective equipment (PPE) was stored in an open shelved bookcase near the general waste and soiled laundry. The service was not always clean, for example limescale on sinks, dirty toilets, floors and skirting boards. Most staff had completed infection, prevention and control e-learning. There was an infection control and communicable diseases policy available to all staff. However we found significant shortfalls in the application of these processes.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Relatives we spoke to told us that they felt their loved ones were looked after, particularly if they are unwell, However, staff did not always involve people in planning around managing their medicines. Assessments were not in place to consider any level of involvement or empowerment in the administration of individuals medication.

Policies and procedures were in place for how medicines should be managed within the service. However, we were not assured that there were reliable systems in place to ensure that these were always followed. For example, not all staff had up to date medicines training or a thorough assessment to check that they were competent to administer medicines; audits were undertaken but were not effective in identifying the issues found at the time of inspection.

Information to support staff in administering people’s medicines in a person-centred way was not always available. For instance, protocols for non-prescription medicines to treat minor illnesses (homely remedies) did not contain all the information required for staff to know when and how to administer; the protocols for giving ‘when required’ medicines (PRN) did not explain how the person might show signs or symptoms that they would need the medicine.

The storage of medicines was not in line with best practice. Medicines records were not always clear in recording changes to people’s medicines. Risk assessments were in place for most medicine related concerns; however, some areas such as managing seizures when away from the service had not been fully considered. Staff had received training in positive behavioural support, enabling them to manage challenging behaviours with person-centred strategies, without the need of medicines.