We carried out a review of the data available to us about Elmdon House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Elmdon House, you can give feedback on this service.
Elmdon House is registered to provide accommodation and personal care for up to six people with a diagnosis of a learning disability or autistic spectrum disorder. The property is a large family type home that has been extended and adapted to provide additional bedrooms and living space. At the time of the inspection three people were living there.
People’s experience of using this service and what we found
People were looked after safely. Staff received safeguarding adults training and knew how to report any safeguarding concerns to the local authority or CQC. Risks to people’s health and welfare were assessed and management plans in place to reduce or eliminate any risks. Staffing numbers on duty each shift was kept under continual review and adjusted as and when necessary.
The provider followed safe recruitment procedures to ensure they only employed suitable staff. People received their medicines as prescribed. Medicines were well managed and administered by those staff who had been trained and were competent.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People received personalised care based on their assessed support needs and their preferred way of spending their time. Each person had a care plan which set out how they were to be looked after. Staff received the training they needed to enable them to do their job well. For new staff there was an induction training programme and other staff had a mandatory refresher training programme to complete. Staff were well supported to do their job and received a regular supervision session with a senior member of staff.
People were assisted by the staff team to access any healthcare services. People received the food and drink they needed to maintain a healthy, balanced diet. Any preferences they had regarding food and drink were accommodated.
People were encouraged to retain as much choice and control of their daily lives and staff supported them in their best interests. The service was meeting the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards.
People were looked after by a small team of support workers who were kind and caring. People were content in the home environment and their interactions with the staff team were calm and friendly. People were encouraged to make their own decisions about how they spent their time but best interests’ decisions were made and recorded when the person lacked the capacity to make important decisions. Those staff we met were kind, friendly and genuinely cared for the three people.
People were provided with a personalised service that was responsive to their specific care and support needs. The support team were able to determine whether people were unhappy by acting upon facial expressions, body language and understanding of behaviours exhibited. Whilst meaningful social activities were encouraged, the support team respected people’s wishes not to leave their home where they feel safe.
The registered manager provided good leadership and management of the staff team but also managed other care services. The provider had systems in place to monitor the quality and safety of the service for the three people, the staff team and any visitors to the service. The staff worked well with other health and social care services and ensured they kept up to date with best practice.
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 November 2017).
Why we inspected
This was a planned inspection based upon the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Elmdon House provides care and accommodation for up to six people with a diagnosis of a learning disability or autistic spectrum disorder. There were five people living in the home in the time of our visit.
There was a registered manager in post at the home. 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.
People felt safe living at Elmdon House and there were enough staff to support people safely. Procedures were in place to protect people from harm and staff knew how to manage the risks associated with people’s care. Accidents and incidents were analysed and action had been taken to reduce the risk of reoccurrence.
The provider’s recruitment procedure minimised the risks to people’s safety. New staff were provided with effective support when they stated work at the home. Staff received on-going training to ensure they had the skills to care for people effectively.
The provider was working within the principles of the Mental Capacity Act (2005). Staff respected the decisions people made.
Staff were caring and knew people well. They approached people in a friendly way and we saw interactions between people and the staff were positive. People were happy with how the home was run and they were involved in planning and reviewing their care. They told us they felt listened to and they had opportunities to feedback on their service they received.
People were offered choices and supported to pursue their hobbies and interests. Staff were responsive to people’s needs and understood the way people preferred to communicate. People were supported to be independent and staff respected people’s right to privacy.
People’s medicines were stored and administered safely. People received the care and treated they required from health professionals. People had enough to eat and drink and staff were knowledgeable about people dietary needs.
People knew how to make a complaint and felt comfortable doing so. Staff felt supported by their managers and enjoyed working at the home Effective systems to monitor and the review the quality of the home were in place.
This inspection took place on 19 and 20 November 2015. The first day of our inspection was unannounced.
Elmdon House provides care and accommodation for up to six people with a diagnosis of a learning disability or autistic spectrum disorder. The communal areas of the home are on the ground floor, together with three bedrooms. The rest of the bedrooms are on the first floor. There were five people living in the home at the time of our visit.
There was a registered manager in post. 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.
There were sufficient staff to meet the needs of people both inside and outside the home. There were ‘on-call’ arrangements to ensure night staff received extra support if there was an emergency. Staff received regular training and new staff were provided with a thorough induction to help them understand people’s needs and how to support people effectively. Additional training was provided when there was an identified change in people’s needs.
Staff had received training in keeping people safe and understood their responsibility to report any observed or suspected abuse. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks. Staff were knowledgeable about each person’s risks and need for support.
The provider was working within the principles of the Mental Capacity Act 2005 (MCA). Where people had been assessed as lacking capacity, the registered manager had obtained the services of an advocate or arranged best interest meetings. Where people were able to make their own decisions, staff respected the decisions they made. Where people’s freedom was restricted, the provider had applied to have this authorised by the local authority.
Staff were kind and considerate to people, patient and attentive to their individual needs. Staff respected and understood people’s need for privacy and promoted their dignity when providing personal care.
People received a balanced diet, and were involved in menu choices. People were referred to external healthcare professionals to ensure their health and wellbeing was maintained. Medicines were managed safely so that people received their medication as prescribed.
The leadership team had a good understanding of their roles and responsibilities, and provided good support to staff and the people who lived at the home. People, relatives, staff and visiting healthcare professionals were asked their opinions about the service and there were processes to monitor the quality of care provided. Action had been taken when a need for improvement had been identified.
We found the service had appropriate arrangements in place for the management of medicines.
There were protocols in place for people who required their medication on an "as required" basis to support staff in administering that medication consistently.
Staff administering medication received appropriate training and had their competency to administer medicines assessed.
During this inspection we saw progress had been made to ensure staff received regular training. All staff had received formal supervision since our last visit. A central record of staff training and supervision was maintained.
Below is a summary of what we found. This summary is based on our observations and evidence we found during the inspection. During our visit we were able to spend time and chat with the people who lived at the home.
If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
Elmdon House was suitable, safe and accessible for the people who lived there. Bedrooms were large enough for staff to be able to assist those people who required the support of a hoist when being moved. We saw the home was clean and well maintained with no unpleasant odours.
We saw risk assessments had been carried out for the service as a whole and for individual risk areas in people lives. There were appropriate certificates in place to confirm external checks of electricity, gas and emergency equipment.
The service was aware of their obligations in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLs). For one person the appropriate healthcare professionals and an independent advocate had been involved in a meeting to ensure any decisions made about the person's care were made in their best interests.
We looked at how medicines were managed within the home. We found one person was on medication to manage their behaviours. There was no protocol in place to inform staff when this medicine should be administered. We found the amounts in stock of medicines administered directly from the packet or box did not always correspond with medication records. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.
Is the service effective?
Care records contained sufficient information to support staff in consistently meeting people's needs. The plans were person centred and reflected people's individual needs. Where risks to health or well-being had been identified, risk assessments had been put in place to manage those risks. Where people had identified physical health needs there were guidelines in place for staff to follow to meet those needs.
We looked at staff training records. We found staff did not always receive the required training to support people effectively. We found some staff had not completed the necessary training which had the potential to place people at risk of receiving inappropriate care or support. We also found the provider did not have an effective system in place that made sure staff had regular supervisions to discuss any concerns, performance or training needs.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff and making sure all staff are trained to the appropriate level.
Is the service caring?
People living at Elmdon House showed interest in each other and what others had been doing. When new staff came on duty people reacted positively and appeared pleased to see them. People approached the staff as they wanted throughout the day. People we spoke with appeared relaxed and comfortable in their surroundings. One person told us, "I am happy. I like it here."
People were well presented and wearing clothes that reflected their individual choices, age and preferences.
People living in the home chose the meals they wanted at weekly meetings. At lunch time staff assisted people to make choices. For example, people were shown a box of crisps and were asked to choose which flavour they wanted. This meant people were able to understand the choices they were offered.
Is the service responsive?
Records showed that other health professionals were involved in people's care. Staff told us they would contact the relevant health professional when needed and records confirmed this. Staff we spoke with were able to tell us about the individual needs and abilities of people and how they supported their mental health as well as their physical health.
Is the service well-led?
At the time of our visit the service had been without a registered manager since December 2013. The provider had put plans in place to provide managerial oversight during this period. A recently appointed deputy manager had been in post for two weeks and taken over some of the responsibilities of the registered manager. Staff we spoke with confirmed that after a difficult period, the service was now more settled. One staff member told us, "It is more relaxed." We have asked the provider to keep us informed of their progress in appointing a registered manager.
The service carried out a range of checks and audits to monitor the quality of the service provided. Staff meetings provided an opportunity for staff to discuss ideas for the benefit of people who lived in the home.
During this follow up inspection we looked at three people's care records. We saw that where risks to people had been identified, risk assessments had been put in place to support staff in managing that risk.
We found that records were kept securely and were located promptly when required.
We saw records were in good order and well maintained.
On the day of our visit we observed staff being sensitive to people's needs and responding to requests. People appeared relaxed in their home and when approaching staff. We saw there were enough staff on duty to meet the needs of people. One person described the staff as 'kind'.
Care plans were in place detailing people's care needs. These provided staff with detailed information about what support they needed to provide. Records showed that people were referred to other health care professionals at regular intervals and if a change in health was identified.
Staff we spoke with demonstrated a good awareness of their responsibilities for keeping people safe and reporting any concerns about suspected abuse.
We saw there were systems in place to monitor the quality of the service provided.
We found some improvements were needed in relation to the management of records in the home. We saw risk assessments were not always being regularly reviewed. Risk assessments were not in place to manage some identified risks.
There was a relaxed friendly atmosphere in the home which was clean and well maintained. Each person had their own bedroom with en-suite shower room and toilet.
We saw people moved comfortably around the home. Staff respected it was their home. We saw people being assisted to make choices and maintain independent living skills. One person told us, 'I like living here.' Another said, 'I am happy.' The manger told us, 'This is generally a calm and loving home.'
People's records provided detailed information that enabled staff to provide care in the way people preferred. Staff records were not maintained in such good order.
We saw medicines were stored safely and people received their medication in accordance with their care plans.
Whilst the home was clean and tidy, we saw infection control procedures in the laundry were not always followed. This compromised the health of people who lived in the home.
There were detailed recruitment and selection processes in place for new staff. Staff told us they felt supported by their manager. One staff member described the manager as, 'Very much hands on. Great to work with.'
People told us that they were happy with their care or indicated this by gestures.
People told us at the home the food was good and that they were able to choose what they ate.
People told us about the various activities they had take part in and the holidays they had last year. They also went on to tell us about the activities and holidays they hoped to have this year.
People told us they felt able to tell someone in the home if they had any worries or concerns.
People told us that the doctor would be called if they felt unwell.