03, 10, 11 and 18 August 2015
During a routine inspection
This inspection took place on 03, 10, 11 and 18 August 2015. The first day was unannounced which meant the staff and provider did not know we would be visiting. We were unable to enter the service on the first day because there was an infection control outbreak. The provider knew we would be returning when the infection had cleared but they did not know when this would be; they did know when we would be returning on the third and fourth day of inspection.
Elmridge provides nursing and residential care for up to 42 adults living with a learning disability; at the time of our inspection there were 34 people who were using the service. Elmridge is a purpose built building in its own grounds within a residential area. The service is split into four units (Ash, Birch, Cedar and Dutch). There is a large communal area within the service where activities take place and there is a sensory room.
At the time of our inspection, the registered manager had left the service and a new manager was in place. They had been in post for three weeks and planned to submit an application to the Care Quality Commission for their registered manager status. 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.
We previously carried out an inspection in April 2014. We found that the service was not meeting the standard for record keeping. Care plans and risk assessments had not been regularly reviewed and there were gaps in the recording of information. We inspected the service again in July 2014 and found that the service and taken action and was meeting the standard for record keeping.
At the time of our inspection there was a high number of safeguarding alerts open for people who used the service. These alerts had been made by visiting professionals and not the service. This meant that the service had failed to identify when a safeguarding alert was needed and take the appropriate action. Accidents and incident forms had not been fully completed which led to a number of safeguarding alerts not being made. There was a whistleblowing policy in place but staff were not confident in using it.
Risk assessments for the overall running of the service were up to date. Risk assessments for people who used the service had not been reviewed regularly. Gaps in employment had not always been investigated.
The service did not use a dependency tool to determine staffing levels. We could see that there were enough staff on duty to provide care and support for people, however we questioned the arrangements in place for the deployment of staff. During our inspection, we found that new members of staff who were meant to be shadowing more experienced members of staff were left on their own. On one unit we found that staff were stretched trying to managing the complexities of people’s needs and on another unit there appeared to be more staff than needed.
Record keeping, administration and audit arrangements for medicines required improvement. We found gaps in records and incorrect totals. Some medicines were not available.
Certificates for the day to day running of the service and equipment used by people and staff were up to date. However there not enough hoists in place at the service for people who needed them.
The service had a dedicated domestic team who ensured the service was kept clean. On the first day of our inspection there had been an infection control outbreak. We could see that the service followed the procedures necessary to manage this outbreak.
Staff supervision and appraisals were not up to date. This meant staff had not received regular support and guidance to carry out their roles. Mandatory training was up to date, however we found that staff had not received training in living with a learning disability and autism. We also found that staff had not received training in specialist communication methods [Makaton, picture boards, for example] which are appropriate to the people who used the service.
People had enough to eat and drink throughout the day. Menu’s had been created by Bupa which ensured that people received nutritious food. We found that these menus were not always suitable for people who had difficulties with swallowing.
People had regular access with health professionals such as the Dentist and General Practitioner. At the time of our inspection, we saw the Dentist supporting people with their healthcare needs.
We could see from the records and from speaking to people that they were not regularly involved in decisions about the care and support which they received.
Staff provided care which was specific to people’s needs; although records did not always have the detailed needed to provide personalised care and support. Staff who had worked for some time at the service knew the people they cared for, however there was insufficient information to support staff who had just started working at the home.
Staff detailed the steps they took to maintain people’s privacy and dignity. There was evidence of people being given choice during inspection.
There were significant gaps in all records looked at, which the service had failed to improve the quality of record keeping despite measures put in place by the provider and discussion around how to make improvements with commissioners.
A thorough complaints procedure was in place and all staff were aware of their responsibilities if they received a complaint.
Poor systems were in place to monitor and improve the quality of the service.
We found eight breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the premises and equipment and records. You can see what action we told the provider to take at the back of the full version of this report.