Elm Lodge Nursing and Residential Home

Updated 20 July 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

This inspection was carried out by two inspectors, a medicines inspector 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.

Service and service type

Elm Lodge Nursing and Residential 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. Elm Lodge Nursing and Residential Home 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 a registered manager in post.

Notice of inspection

This inspection was unannounced. Inspection activity started on 19 April 2023 and ended on 18 May 2023. We visited the location’s service on 19, 22 and 26 April 2023. We spent time reviewing documents remotely and speaking with relatives, staff and professionals. The Inspection finished when we gave formal feedback to the management team on 18 May 2023.

What we did before the inspection

We reviewed information we had received about the service since their date of registration. We sought feedback from the local authority, Healthwatch and professionals who work with the service. Healthwatch is an independent consumer champion which gathers and represents the views of the public about health and social care services in England.

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.

During the inspection

We spoke with 12 people and 20 of their relatives. We spoke with 18 staff members including the registered manager, senior staff, nurses, housekeeping, catering and care staff. We also spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with 4 health and social care professionals who work closely with the service.

We are improving how we hear people’s experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked this was a suitable communication method, and people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves. In this report, we used this communication tool with 2 people to tell us their experience.

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people

Updated 20 July 2023

About the service

Elm Lodge Nursing and Residential Home is a residential care home providing personal and nursing care to up to 64 people. The service provides support to older and younger people including people who were living with dementia and people with physical disabilities. At the time of our inspection there were 59 people using the service.

Elm Lodge Nursing and Residential Home is a large building made up of three floors, each of which has separate adapted facilities and various communal spaces and a shared garden.

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

People told us they were often bored with little to do. While there were some planned events, people were not always engaged in meaningful activities or given opportunities for regular, informal chats with staff.

People were still positive about the care they received and told us they did really like the staff who treated them well despite being very busy. People were supported by a kind and compassionate staff team who had got to know people as individuals.

People did not always receive personalised care in practice, but staff were aware of people’s likes, dislikes, and preferences. People were involved in reviews of their care and able to make choices about how they were supported. People's independence, privacy and dignity was, in the main, promoted by staff.

People were kept safe by a staff team which knew how to safeguard them from harm. Risks to people had been assessed and procedures were in place in all areas of their care. Staff had received training relevant to their role.

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. People were supported to see health professionals and to live healthy lives.

People were supported in an environment which was clean and odour free. The environment did not currently support people living with dementia, but the new provider was making improvements to the premises to further improve people's care and support.

People had access to a complaints procedure and complaints were dealt with promptly and thoroughly. People were supported with dignity and respect at the end of their lives.

The registered manager completed audits to monitor the quality of the service and put improvements in place where necessary. People, relatives, and the staff team were encouraged to feedback about the service. The registered manager and staff team worked with other professionals to promote good outcomes for people.

People and the staff team were positive about the management of the service and the management style of the new provider. They were also very positive about the changes the new provider had made and the plans for further improvement.

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 the service under the previous provider was good, published on 27/09/2019. At our last inspection, under the previous provider, we recommended the provider improve opportunities for how people spent their time. At this inspection we found people had some opportunities open to them but people continued to lack opportunities for ad-hoc interactions with staff unless it was task based. The new provider has developed an action plan to address this shortfall which is yet to be fully implemented.

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.

Enforcement and Recommendations

We have identified a breach in relation to a lack of person-centred opportunities for how people spend their time at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.