Archived: Elmbank Residential Care Home

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.

We spoke with the manager and provider during this inspection who confirmed they had changed the application form and made sure all the information was now available in the staff members' recruitment folders.

Our inspection team was made up of one inspector. We asked our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

From our observations we saw people were treated with respect and dignity by the staff.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The provider reported safeguarding alerts to the local authority and notified CQC. This reduced the risks to people and helped the service to continually improve.

The service was safe, clean and hygienic.

We looked at the recruitment of new staff. This showed that some required recruitment checks were not being followed. This could put people at risk of being supported by staff without the appropriate checks in place.

Is the service effective?

People's health and care needs were assessed with them and their families. We saw that people and their relatives had been encouraged to be involved in writing their plans of care.

Specialist dietary, mobility and equipment needs had been identified in care plans where required.

The premises had been adapted to meet the needs of people with physical impairments. The provider told us that people were assessed prior to being admitted and that only people who were able walk or transfer easily were admitted due to the layout of the building.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences and interests had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People benefitted from some activities in and outside the service regularly arranged by staff.

We looked at the complaints record and found there had been no complaints made to the provider. We saw the complaints policy displayed on the notice board. People could be assured that if a complaint had been received there was a system in place which would ensure their complaint would be investigated and appropriate action taken.

Is the service well-led?

The service worked well with the local authorities that had placed people at the home. This ensured people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and that quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We spoke with three people informally. They told us they were happy living at the home. One person told us the problems they were having with their legs but staff were looking after her well. One person told us they enjoyed watching films and hoped they would be available at the home.

The provider had developed care plans to ensure the care provided met people's needs. We saw that risks had been identified but had not been fully managed to protect the welfare and safety of people.

Staff had knowledge and had received training in safeguarding vulnerable adults.

We looked around the home and identified some shortfalls with the cleanliness and decoration. We also identified areas where liquid hand wash were not available for staff and equipment, such as sinks and toilets was soiled and dirty.

Staff received regular training and supervision. This meant they had up to date skills to be able to support the people who lived there.

The people that we spoke with told us they were happy at the home. They told us they felt safe and liked the food. All the family members we spoke with were complimentary about the care their relatives received.

We saw that staff consulted with people who used the service. This was to ensure they gained consent prior to personal care or treatments being carried out.

We looked at the nutrition for people who used the service. We found shortfalls as recordings of people's nutrition at weekends had not taken place. Also menus were not being followed and recorded. There was no cook at weekends and food was warmed by the carers that had been prepared on Friday.

Shortfalls had been identified in the providers safeguarding adults procedures. Incidents had not been recorded and sent to us.

Staff had received some training but some shortfalls were identified.

Family members that we spoke with knew how to raise a complaint should they need to do so. We did not find a complaints policy displayed in the home.