Elm Tree House

We found the following examples of good practice.

We were assured the provider and staff at the home had taken appropriate action to help minimise the spread of infection and help ensure people were safe during the COVID-19 pandemic.

Staff had received appropriate training and guidance in infection prevention and control (IPC) and they were observed to follow correct procedures in the use of PPE. There were sufficient supplies of PPE around the premises and appropriate areas identified for staff to safely remove and dispose of PPE. The home was kept clean and hygienic with regular cleaning schedules adhered to.

The service made effective use of available COVID-19 testing for both people, staff and visitors. Safe procedures were in place for admitting people into the home. Staff ensured newly admitted people were given additional support to maintain their health and wellbeing.

The service had safe visiting procedures in place to minimise the spread of infection. Due to the layout of the premises, visits could not currently take place inside. The registered manager and provider were in the process of reviewing this to look at ways to facilitate indoor visits. Staff reassured people throughout the pandemic and provided them with the support they needed to maintain regular contact with family and friends through the use of technology.

Staff followed shielding and social distancing rules and encouraged people to maintain social distancing where able to. Staff were allocated specific zones and areas to help reduce levels of anxiety and maintain people’s health and wellbeing whilst safely cohorting people who had tested positive for COVID-19.

Due to limited space and entrance to the premises, staff had limited access to separate changing areas prior to the start of their shift. We provided additional guidance in relation to this.

What life is like for people using this service:

The atmosphere at Elm Tree House was calm and homely; the management team and staff had developed strong, familiar and positive relationships with people and family members. Throughout the inspection the registered manager, management team and staff were seen to be warm and affectionate towards people and often displayed physical contact that was appropriate and accepted by people.

Staff showed a genuine motivation to deliver care in a person centred way based on people’s preferences. People were treated with kindness, compassion and respect. Staff used techniques to help relax people with positive outcomes. Everyone we spoke with told us Elm Tree House was homely place to live and staff were always kind and caring towards them.

People told us they felt safe living at the service and family members were confident their relatives were kept safe. Risks that people faced were identified and assessed and measures put in place to manage them and minimise the risk of harm occurring. Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm. Medicines were managed safely and people received their prescribed medication at the right time. The environment was safe and people had access to appropriate equipment they needed.

Enough suitably qualified and skilled staff were deployed to meet people’s individual needs. Staff received a range training and support appropriate to their role and people's needs. The registered manager recognised the importance of ensuring staff were happy in their roles and provided incentives to promote this.

People’s needs and choices were assessed and planned for. Care plans identified intended outcomes for people and how they were to be met in a way they preferred. People told us they received all the right care and support from staff who were well trained and competent. People received the right care and support to eat and drink well and their healthcare needs were understood and met. People who were able consented to their care and support. Where people lacked capacity to make their own decisions they were made in their best interest in line with the Mental Capacity Act.

People received personalised care and support which was in line with their care plan. People, family members and others knew how to make a complaint and they were confident about complaining should they need to. They were confident that their complaint would be listened to and acted upon quickly.

The leadership of the service promoted a positive culture that was person centred and inclusive. People, family members and staff all described the registered manager and deputy manager as supportive and approachable. The management team showed a continued desire to improve on the service and worked closely with other agencies and healthcare professionals in order to do this. Effective systems were in place to check on the quality and safety of the service and improvements were made when required.

Rating at last inspection: Good (report published 5 May 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service had maintained a rating of ‘good’.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Elm Tree House provides accommodation and personal care for up to 20 older people who are living with dementia. The home is situated on a main road location in Newton Le Willows and is close to shops and other local amenities. Accommodation is provided on the ground and first floor and a passenger lift and stair lift are in place for ease of access.

The registered manager had been registered with the Care Quality Commission (CQC) since December 2010. 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.

The last inspection of Elm Tree House was carried out in January 2015 and we found that the service was not meeting all the regulations we assessed.

People who used the service said they felt safe. Staff knew about the systems in place to protect people from the risk of harm and they also knew how to recognise and respond to allegations of abuse appropriately.

There were sufficient staff on duty to ensure the needs of people were met. Effective recruitment processes were in place and were followed by the service. Staff received on-going training and support to ensure they carried out their role effectively.

Medicines were managed safely and processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. People received care and support from staff that knew them well, and had the knowledge and skills to meet people’s individual needs. People told us staff always treated them well and promoted their choices regarding their care, support and the activities they participated in. People spoke positively about staff, their comments included, “The staff are all respectful” and “I like the staff”.

People’s risks were anticipated, identified and monitored. Staff managed risk effectively and supported people’s decisions, so they had as much control and independence as possible.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We saw that there were policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and DoLS to ensure that people who could not make decisions for themselves were protected.

People had enough to eat and drink. People were offered drinks and snacks throughout the day. People who were at risk of poor nourishment were regularly weighed. This ensured peoples health and well being was closely monitored and any changes were responded too.

Staff were patient and friendly and knew people well. Staff interacted well with people and engaged in conversation about things of interest to them.

People’s care and support needs were up to date and reviewed on a regular basis with the person or other appropriate people. Staff provided people with person centred care and support.

One formal complaint had been made to the registered provider since the last inspection in January 2015. People were aware of how to make a complaint if required and they told us they would not be worried about complaining if they needed to. People were confident that their complaints would be listened to and acted upon.

Systems were in place to regularly check the quality of the service provided and to ensure improvements to the service were made. The registered manager and staff established good working relationships with family members and visiting professionals to the benefit of people who used the service.

People told us that the staff were excellent and that they received care and support when they wanted it. One person said 'The staff are marvellous. They are good fun'. Another person told us, 'The staff can't be as good as these anywhere else.'

We saw that people were supported to get up in the morning and go to bed when they wanted to. This allowed them to make choices about when they wanted to rise and retire and when they wanted to eat.

Care records were in place and up to date. This meant that all involved were aware of the care and support needs of people.

People living in the home and relatives told us that they were well supported by the manager and staff team. There were regular checks by senior staff to make sure the home was running well.

The home was maintained and equipment was serviced regularly so that it was safe for people to use.

A person living at the home told us they felt well cared for, and described how they spent time on the internet. Staff explained how a particular carer helped this person when using a laptop computer, provided by the home, to support this person in their interests and hobbies.

As part of our inspection, we looked at nutrition, how people were able to express choice, and have suggestions for alternative meals, or the make up of meals, brought into practice. We were able to confirm that when a particular dish was requested, staff would invariably meet this request.