The Care Quality Commission
  • Care Home
  • Care home

Archived: Eldermere

Overall: Good read more about inspection ratings

Knowle Lane, Shepton Mallet, Somerset, BA4 4PF (01749) 344642

Provided and run by:
Somerset County Council - Specialist Public Health Nursing

Important: The provider of this service changed. See new profile

All Inspections

20 and 26 March 2015

During a routine inspection

Eldermere provides care and support for six people who have a mild to moderate learning disability. People require 24 hour staff support in the home and support to go out. Eldermere is set in its own grounds, close to the town centre.

This inspection took place on 20 and 26 March 2015 and was unannounced. It was carried out by one inspector.

People had communication difficulties associated with their learning difficulty. Because of this we were only able to have very limited conversations with two people about their experiences. We therefore used our observations of care and our discussions with people’s relatives and staff to help form our judgements.

We carried out our last inspection of Eldermere in August 2014. Following this inspection we asked the provider to make improvements to the home’s quality assurance system as it had failed to identify potential risks to people's health and welfare. The provider sent us an action plan to tell us the improvements they were going to make, which they would complete by 22 September 2014. During this inspection we looked to see if these improvements had been made and found they had.

The home was a safe place for people. They were able to take appropriate risks as part of their day to day lives. Staff understood people’s needs and provided the care and support they needed.

The service supported people to have as much control over their own lives as they could. People used many community facilities and were encouraged to be as independent as they could be. People appeared happy with the care they received. One relative said “Staff are very helpful, pleasant and very kind. We are very happy with the care.”

Staffing levels were good and people also received good support from health and social care professionals. Staff were skilled at communicating with people, especially if people were unable to communicate verbally.

People, and those close to them, were involved in planning and reviewing their care and support. There was a close relationship and good communication with people’s relatives.

There had been many improvements to the service. The environment had been significantly improved and adapted to meet people’s needs. Relatives and staff all specifically commented on how the home had been “opened up.” One staff member said “I think the care is excellent here. I’ve worked here a long time and this is the best it’s ever been.”

Staff had good knowledge of people including their needs and preferences. Communication and morale throughout the staff team was good. Staff were well supported and well trained. All staff spoken with said the training and ongoing support they received was very good.

There was a management structure in the home which provided clear lines of responsibility and accountability. The management team were passionate about trying to provide the best level of care possible to people. Relatives and staff spoke very highly of the registered manager and the positive effect they had on the service. Staff had adopted the manager’s ethos and this showed in the way they supported people.

There were effective quality assurance processes in place to monitor care and plan ongoing improvements. There were systems in place to share information and seek people’s views about the running of the home. One person’s relative said “We always chat with the staff so we know what’s been going on.”

19 August 2014

During a routine inspection

A single adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, what staff told us, the records we looked at and what relatives we spoke with told us.

Is the service safe?

The service was safe. Records showed people had comprehensive person centred support plans in place. Staff we spoke with were knowledgeable about people's needs, and records showed they sought support and advice from specialist professionals as required. For example, the GP, psychiatrist, community learning disability nurse and the speech and language therapist team.

We found the provider had safeguarding and whistle-blowing policies in place and staff had received the required training in this area of their work. Staff we spoke with were clear about their role and responsibility regarding identifying abuse, and in taking appropriate action.

We found an incident, which involved a person receiving an injury, had not been fully managed in line with the provider's policy. On the day of our visit we were informed the registered manager was on planned leave. The registered manager is a person who has registered with the Care Quality Commission to manage the service and share's the legal responsibility for meeting the requirements of the law with the provider. Following our visit we spoke with the manager, and they reassured us action had been taken to address this.

We found the provider understood their responsibilities to people using the service in relation to the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS). The service manager told us authorisation requests had been made to the Local Authority. This meant they had responded appropriately to recent changes in the law.

We saw that people were supported to make day to day decisions. We found that, in line with the requirements of the Mental Capacity Act, people's capacity to make decisions were assessed. Where a person was found to lack capacity to make a specific decision a best interest checklist was completed and a best interest decision was made and recorded. Staff we spoke with were aware of the need to provide care in the least restrictive way.

We spoke with family members on the telephone. They told us that if they had any concerns they would know what action to take. One told us they were happy with the care provided and had no concerns but 'if I had a concern I would have no problems contacting the manager and would complain if I needed to'. They also said 'if I ask a question I always get a truthful answer'. Another relative told us they did not like complaining but did know how to, and would if they really needed to.

Is the service effective?

Records showed that people's needs and preferences had been identified within their support plans. Staff were able to give us examples of signs they would look for as indicators as to whether someone was happy, or in plain. They could tell us how individual people communicated, including in verbal and non-verbal ways.

We found people had access to the specialist support they required to manage their health effectively. For example, GP and District Nurse. Records indicated where they had been involved, both in response to specific concerns raised by staff and to undertake routine health checks. One relative we spoke with said they were 'very happy with the treatment' the person received.

We found that staffing levels in recent months had been affected by staff sickness. We found that contingency measures were in place to limit the effect this had on people who use the service.

Is the service caring?

Staff we spoke with appeared to know the people using the service well and we observed them interacting with people in a calm and supportive manner. We saw staff attended to people's personal needs in a discreet and professional manner. This meant that people using the service were treated with dignity. One relative we spoke with was positive about their observations of how staff interacted with people using the service.

Is the service responsive?

We saw that the care and support people received was monitored by staff. In addition to care and support plans we saw that daily records were completed. This meant that the care people received on a daily basis was recorded. We found that the provider had a monthly summaries system in place, which gave an overview of different aspects of the person's life over the previous month. We found there were some gaps in the completion of these documents. Staff told us that this issue was due to be raised at their next monthly meeting.

We found that people's likes and dislikes had been taken into account when planning activities. Staff considered how people were able to communicate how they felt about an activity. For example, they said that one person would smile and hold out their hand to hold if happy.

Is the service well-led?

On the day of our visit the manager was not available, however, we spoke with them and their line manager following the visit. On the day of our visit we were assisted well by the shift leaders on duty. We spoke with five members of staff during our visit, who told us they felt supported within the team. One member of staff told us that they 'loved their job', and 'received the training they needed to do it', another told us that the manager's ideas were 'very service user led'. They told us the manager was 'very supportive'. Staff told us that they had regular staff meetings and could go to the manager with any concerns. One said that 'until recently it has been amazing with staffing levels but there's been a lot of sickness in last few months'. They said 'it is covered as well as it could be". Staff told us that they felt that measures were being taken to cover the shifts as well as possible.

We found that plans were in place which guided staff how to manage a range of emergencies. For example, in the event of pandemic flu, and a power failure. We saw personal evacuation plans were in place to support staff to maintain people's safety in the event of a fire.

We saw that there were a number of quality assurance checks in place, including the checking of fire equipment and health and safety.

We saw that an environmental health visit in November 2013 had praised the home but had identified staff had not recorded food temperatures, using a food probe. We found that this due diligence advice had not been acted on. We found the provider's quality assurance checks had failed to identify this and. This meant that people's health and welfare were potentially put at risk from food that had not been cooked appropriately.

4 October 2013

During a routine inspection

People who used the service were not able to give us feedback directly about the care that they received, however we made observations and were able to speak with four members of staff during our inspection.

Staff showed a good understanding of the needs of the people who used the service and they were observed providing support in a way that maintained the respect and dignity of people. We saw evidence that people were enabled to make choices wherever possible. Support plans were seen to provide thorough assessments of peoples needs and the least restrictive ways of providing support were identified. Capacity assessments and best interest meetings were evidenced.

A range of communication skills were being developed with people and observations were conducted to identify the most appropriate method for each person. This meant that people were being enabled to make choices wherever possible.

3 January 2013

During an inspection looking at part of the service

At our last inspection on 10 September 2012 we found that the registered person was non compliant in three outcomes.

We found the support plans did not tell staff how to support people who used the service. We read the daily records were incomplete and did not demonstrate that the care in the support plans had been implemented. We saw information relating to restraint kept on people's files which was no longer relevant.

We saw the provider did not have an effective system to assess and monitor the quality of service people received. This was because the process used had not identified any of the issues relating to the support plans or the lack of involvement of people who used the service.

We judged these to have a moderate impact on people and issued compliance actions to the provider. We received a provider action plan on 27 September 2012 and visited the service on 3 January 2013 to follow up the compliance actions.

We found the provider had taken action to ensure the service was compliant. We saw that support plans told staff how people should be supported.The daily records indicated the plans were being implemented. We found that restraint was not being used at the service and people had been risk assessed appropriately for restrictions that affected their well being.The quality assurance process identified issues and actions indicating how people who used the service were involved in the service. We judged the service was compliant for these outcomes.

10 September 2012

During an inspection looking at part of the service

This visit was carried out to follow up two compliance actions and two improvement actions made at the last inspection.

During this visit we followed up compliance actions made at the last inspection against Outcome 4 and Outcome 16, which took place on 8 February 2012.

We also followed up two improvement actions. One against Outcome 1 respecting and involving people who use services and one against Outcome 7 Safeguarding people who use services from abuse. We also looked at Outcome 2 consent to care and treatment and Outcome 10 Premises.

People who lived in the home appeared well cared for and staff were responsive to them.

We observed staff interacting and communicating with people. People who lived in the home were unable to communicate verbally. We saw that they took time to allow people to respond to them. Staff demonstrated knowledge and understanding of people's communication needs. For example, when people were not able to express their choices, verbally staff interpreted their responses to choices or their body language.

We observed people moving around the home and preparing their lunch. The atmosphere was relaxed and people were given choices of what they wanted to eat and drink.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed three of the six people who used the service. We saw staff interaction with people was frequent and positive. We observed people were relaxed in their own environment.

We found the home was clean and comfortable. People's bedrooms were personalised to their own tastes and preferences. We found furniture and fittings to be of a good standard.

We saw changes in progress to the communal gardens which when completed would improve access to outside areas.

We spoke with four members of staff who told us 'I enjoy working at Eldermere, it is a lovely house to work in', and 'I think the staff team are lovely, caring and professional'.

Another member of staff commented 'We have a good team and a nice staff atmosphere'.

We asked what staff enjoyed about working at the home. One staff member said 'The way we work with people has changed, we work with them to be more independent'.

8 February 2012

During a routine inspection

People who lived in the home had communication difficulties. We observed how staff interacted with people who lived in the home and all the interactions we saw were kind and respectful.

Most people were not able to express their choices verbally so staff needed to interpret their responses to choices or read their body language; some people led staff by the arm to show staff what they wanted. The experienced staff knew people well, appeared confident in communicating and understood people's needs.

People were able to move around communal areas of the house independently. They did not have independent access to their own bedrooms as these were kept locked. We were told this was to prevent others entering their rooms and taking personal items. People were not able to unlock their own bedroom doors although some liked to spend time in their own rooms. There was a fob system in use designed to help people open their doors without having to use a key. Only one person was able to use their fob. Others were reliant on staff to open their door for them.

People had lunch during our visit. People chose to eat together in the dining area. People were reasonably well supported but we did see one person took another person's food from them and ate it. Later we also saw this person eat food which had spilled onto another person's clothes protector whilst this person still wore their protector. They also had a behaviour which presented a significant infection control risk. Although the home involved other professionals for advice on this matter, on the day of the inspection there was no clear strategy in place to manage this.

Staff supported people with intimate personal care. Experienced staff appeared very sensitive to people's needs and knew people's preferred routines. Less experienced staff did not know people's routines as well and told us they had not had time to read people's care plans; experienced staff had simply told them or shown them how to support people.

Each member of staff we spoke with said that the home was a safe place for people to live. Staff knew how to recognise signs of potential abuse and how to report any concerns they had.