Archived: Elmbank Residential Care Home

Updated 28 March 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, to check the provider had taken action to address the concerns identified at our last inspection and to provide a rating for the service under the Care Act 2014.

We carried out this unannounced inspection across two visits. The first visit took place on 7 October 2016 and was carried out by two inspectors. The second visit took place on 7 November 2016 and was carried out by three inspectors.

Before the inspection we reviewed the action plan submitted by the provider, which set out how they planned to become compliant with the breaches of regulations identified at our last inspection. We also reviewed records held by the Care Quality Commission which included notifications, complaints and any safeguarding concerns. A notification is information about important events which the service is required to send us by law. This enabled us to ensure we were addressing potential areas of concern at the inspection.

The provider had completed a Provider Information Return (PIR) prior to our inspection in July 2015. This is a form that asks the provider to give some key information about the home, what the home does well and improvements they plan to make. We did not ask for another PIR to be completed as we were following up on action taken in response to the concerns found at the last inspection.

During the inspection we spoke to six people, three relatives, the registered manager, the deputy manager, four care staff and the cook. Where people were unable to communicate their experience verbally, we observed the care and support they received. We checked four people’s care records and other records related to the running of the home, including recruitment records, complaints and quality monitoring audits.

Updated 28 March 2017

Elmbank Residential Care Home provides accommodation and personal care for up to 14 people. At the time of our visit there were 13 people living at the home, some of whom were living with dementia.

This inspection took place on 7 October 2016 and 7 November 2016. Both visits were unannounced.

The registered provider is also the registered manager of 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.

.At our previous inspection in July 2015 we found breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found shortfalls in relation to the management of medicines and the governance of the home. Following our inspection, the provider sent us an action plan and provided timescales by which time the regulations would be met.

At this inspection we found the management of medicines and some aspects of governance had improved. However we found that the home was still not well-led and we identified further concerns and breaches of the regulations in other areas.

There were not always enough staff deployed to meet people’s needs safely. People were at risk because there were not always enough staff in all parts of the home to provide the support they needed. People were not protected by the provider’s recruitment procedures. The provider had not obtained all necessary information when prospective staff applied for work.

People were at risk of harm because the provider had not taken action to mitigate known risks. For example some people had been identified as at risk of poor nutrition. No referrals had been made to professionals, which meant there was no guidance in place for staff about how to meet these people’s needs and keep them safe. Accidents were recorded but no action was taken following these events to reduce the risk of them happening again.

People were not adequately protected against the risk of infection as staff were not working within current guidelines on the prevention and control of infections. Some parts of the home were not adequately clean or well maintained. The environment was not designed or adapted to meet the needs of people living with dementia.

People’s care was not being provided in line with the Mental Capacity Act (2005). Decisions had been taken on behalf of people without their consent or establishing whether or not they had the capacity to make decisions for themselves.

Care was not responsive to people’s changing needs. Some people were consistently losing weight but no action had been taken to address this. Care records did not contain all the information necessary to ensure people received the support they needed. Where people had specific behavioural needs, there was no guidance for staff about how to manage this behaviour or provide appropriate support.

Some of the terminology used by staff to describe people and aspects of their care was inappropriate, which did not promote dignity or respect. People were not receiving a service or care that was responsive to their needs, wishes or preferences. Some aspects of care were institutionalised and did not take account of people’s individual preferences. People did not always receive the support they wanted at the time they preferred.

People had access to activities but these did not always reflect their wishes and preferences, particularly in relation to going out. People who stayed in their room had little company apart form when staff delivered basic care and were at risk of social isolation.

The assessment of the quality of care was insufficient to identify shortfalls and make improvements. Accidents and incidents were recorded but there was no evidence of learning from these events or that action had been taken to prevent a recurrence. Records were not always maintained appropriately to demonstrate that people were receiving effective care.

People told us they felt safe at the home and with the staff who provided their care. Staff had attended safeguarding training and were clear about their role in keeping people safe.

The provider carried out health and safety checks and maintained appropriate standards of fire safety. There were plans in place to minimise the impact on people’s care in the event of an emergency.

The provider had submitted applications for DoLS authorisations where restrictions were imposed upon people to keep them safe.

Staff had received appropriate training and attended an induction when they started work, which included shadowing an experienced colleague.

People were supported to access medical treatment when they needed it, although their health was not effectively monitored.

People were cared for by kind and friendly staff. People were supported to maintain relationships with their friends and families. Relatives were consulted about their family members’ care and had opportunities to give their views.

The registered provider had a written complaints procedure and the one complaint received in the previous 12 months had been managed appropriately.

People told us they would feel comfortable raising a concern with the management team if necessary. Relatives told us the management team were approachable and available.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.