Archived: Elswick Hall Care Home

We last inspected Elswick Hall Care Home in September 2014. At that inspection we found the service was meeting the legal requirements in force at the time.

The home provides nursing care and support for up to 47 people, some of whom may have mental health needs or live with dementia and associated conditions. The 'neuro-disability' suite, located on the ground floor, provides nursing care to 18 people with various neurological conditions, as well as people with acquired brain injuries.

A registered manager was in place. 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 said they felt safe. We had concerns however that there were not enough staff on duty to provide timely and individual care to people. Care was provided with kindness and people's privacy and dignity were respected. However, we saw staff were busy and did not always have time to interact and talk with people except when they were carrying out care tasks.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support. Appropriate training was provided and staff were supervised and supported.

Elswick Hall Care Home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff had received training and had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People had access to health care professionals to make sure they received appropriate care and treatment. Systems were in place for people to receive their medicines in a safe way.

Communication was effective, ensuring people, their relatives and other relevant agencies were kept up to date about any changes in people's care and support needs and the running of the service.

Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for.

Limited activities were available for people and the activities and entertainment programme required expansion to ensure it met people's interests. We have made a recommendation about more activities provision across the home.

The environment was mostly well-maintained but some bedrooms were showing signs of wear and tear.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. People had the opportunity to give their views about the service. There was regular consultation with people or family members and their views were used to improve the service. The provider undertook a range of audits to check on the quality of care provided.

You can see what action we told the provider to take at the back of the full version of the report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

Risk assessments were in place. All risks to people living in the home, their relatives and staff were regularly assessed and appropriate steps taken to minimise such risks. People were supported and encouraged to maintain their independence and this was balanced with the risk to the person. Systems were in place for checking safety equipment and systems such as fire alarms, lifts and hot water temperatures.

Audits were carried out to look at accidents and incidents and the necessary action was taken to keep people safe. Information was available to show that the service worked with other agencies to help ensure people's health needs were met and to prevent admissions to hospital wherever possible.

Staffing levels were in place to ensure all the needs of the people who lived at the service were met in a timely way and to ensure their safety. A member of the management team was available on call in case of emergencies. One person commented; 'I trust the staff, I am very safe here.'

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told the necessary applications had been submitted and three people were subject to Deprivation of Liberty orders. We saw proper policies and procedures were in place.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well as individuals. Relatives we spoke with told us that the service kept them up to date with what was happening with their relative's care and they felt able to ask any questions. One relative commented; "Yes I am aware and the plan is regularly reviewed." Another person said; "I am kept I informed of any changes to my relative's care."

Staff had received regular training to meet the needs of the people who used the service.

Is the service caring?

People were supported by kind and attentive staff, who showed patience and gave encouragement when supporting people. People commented how helpful and friendly staff were. One person commented; 'The staff encourage me to be as independent as I can be.' Another person commented; "I am always told in plenty of time if I have a hospital appointment, a member of staff always comes with me.' And; "I feel involved in my care.'

Is the service responsive?

People's needs had been carefully assessed before they moved into the home. People told us they had been asked for their views and these had been recorded. Records confirmed people's preferences, interests and needs had been recorded and care and support had been provided in accordance with people's wishes. Comments included; "I can do most things I want to, I get up when I want and go to bed when I want. The staff always listen to what I say,' Another person said; "I can do anything I want to.' People had been supported to maintain personal relationships with their friends and relatives. People spoken with commented there was a lack of activities. One person commented; "We don't do anything these days.'

Is the service well-led?

The home had a registered manager in post. Staff told us they were clear about their roles and responsibilities. They said they felt supported by the manager and advice and support was available from the management team. Staff had an understanding of the ethos of the home and a range of effective quality assurance processes were in place. People who used the service were asked for their views about their care and treatment in regular meetings and their views were acted upon. One person commented; "I am aware of the complaints procedure but have never needed to use it. I am very confident in the ability of the staff.'

We found staffing levels had increased which ensured there were enough qualified, skilled and experienced staff to meet people's needs.

The premises were better maintained so people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We saw the provider had an effective system to regularly assess and monitor the quality of service that people received.

Records showed care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We told the provider at the time of inspection urgent action that needed to be taken to ensure the safety and welfare of people who lived in the home. This was with regard to increasing staffing levels and, the provision of adequate ventilation and hydration for the benefit of people in the home. We received confirmation from the regional manager that action had been taken immediately. This stated an Ebac and fans had been obtained. An extra member of staff was to start work immediately.

We observed a tray of drinks was prepared and left available in the dining room for people to help themselves.

We used a number of different methods which included observation to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We saw staff were very busy as they provided care and support to people who used the service. We spoke to three people who lived at the home and one relative who told us staff were kind and helpful but they were kept very busy. One person we spoke with said there wasn't much to do in the way of activities.

We observed staff were rushed as they tried to provide individual care to each person. Due to the low staff numbers on duty and the high dependency of many people care and support was not provided in a timely way as people had to wait for staff support. At times they were at risk due to inadequate observation.

We found the building was not well maintained or suitably designed for the needs of people with dementia as the top floor was not decorated to help maintain the orientation and independence of the person. Also due to some baths being out of order people were unable to bath if they wished.

People experienced care, treatment and support that met their needs and protected their rights, however not all care records reflected people's care needs accurately.

We saw the provider did not have effective systems in place to regularly assess and monitor the quality of service people received.

People who used the service said they were pleased with the care and support provided by the home. Nothing was too much trouble for the staff who were always polite and cheerful. They also said they were kind and caring.

We found people were given appropriate information and were involved in making decisions about their care and treatment. People told us staff treated them with respect and courtesy. One person said, "They always ask me my opinion and explain what is happening."

People told us they were well cared for. One person said, "The staff are very good, nothing is too much trouble." We found that care was planned and delivered in a way that ensured people's safety and welfare.

Staff received professional development and people told us staff were well trained.

We saw the provider had systems in place to gather feedback from people who used the service, and to regularly assess and monitor the quality of service people received.