Elmstead Care Home

Elmstead Care Home provides accommodation and personal care support for up to 41 older people. The home is situated within the London borough of Bromley and is spread out over three floors. Care provided includes respite services, day care facilities and care for people recovering from illness. At the time of our inspection there were 37 people living at the service.

People's experience of using this service and what we found

Risk were managed and reviewed on a regular basis to protect people from possible harm. People were protected from the risk of abuse, because staff were aware of the action to take to ensure people’s safety and well-being. Medicines were managed, administered and stored safely. There were robust systems in place to ensure people were protected from the risk of infection and home was clean and hygienic with sufficient stocks of personal protective equipment which staff used in line with national guidance. Accidents and incidents were recorded, monitored and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff to meet people’s needs in a timely manner.

People’s needs and preferences continued to be met by appropriately skilled staff with the right knowledge and experience. Staff received training, supervision and appraisals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were supported to eat a healthy, well-balanced diet and people told us they enjoyed the meals on offer at the home.

People were empowered and supported to maintain relationships with people that were important to them. People and their relatives told us that staff were kind and caring. People were supported to express their views and were involved in decisions about their care. Their privacy and dignity was respected and maintained, and staff supported people to retain their independence.

People received outstanding responsive personalised care and support. Staff had outstanding skills and knowledge in meeting people’s diverse needs. Staff were provided with up to date training in line with best practice that was tailored to meeting people's individual needs and choices. People continued to be empowered and supported to live an active and fulfilling lives.

People received individualised care and support that was exceptionally responsive to their needs and wishes. Responsive partnerships with professionals were maintained to ensure people received high standards of care. Activity provision was outstandingly responsive to people’s needs, person-centred and innovative.

There were suitable arrangements in place to respond to people's concerns and complaints appropriately. The home had an open and inclusive culture and staff spoke positively about the registered manager. There were effective and well-led governance systems in place to monitor, assess and improve the quality of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for this service was good (published 26 September 2018).

Why we inspected

This was a planned inspection based on the previous rating.

We also looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

At the time of our inspection there were 35 people living at the service.

We found the following examples of good practice.

The provider had modified a lounge area to accommodate visitors by adding an intercom and screen. People were supported to speak to their families on the phone or via video call. The provider had introduced virtual consultations to reduce the need for external visitors to the home.

The provider had arrangements in place to test both people and staff for COVID-19, in line with the current guidelines on testing.

The provider had clear protocols for people who were infected with Covid-19, and for people who had been admitted to the home from hospital or the community. Staff were adhering to PPE and social distancing guidance.

Staff who were more vulnerable to Covid-19 were supported and risk assessed to ensure staff and people remained safe.

Elmstead Care Home provides accommodation and personal care support for up to 49 older people. The home is situated within the London borough of Bromley and is spread out over three floors. The middle floor has been designed for people living with dementia. Care provided within the home ranges from respite services, day care facilities for people who enjoy socialising or their informal carer is unavailable or requires a break, residential care and dementia and convalescent care for people recovering from surgery or illness. At the time of our inspection there were 39 people living at the service.

The service continued to have a long standing experienced registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager was aware of their legal requirement to display their current CQC rating which we saw was on display within the home and on the provider’s website.

At our last inspection of the service on 5 and 6 July 2016 we rated the service overall as 'Good'. At this inspection we found evidence that not only continued to support the rating of good, but we also found for the key question 'is the service Responsive?' the service had improved to 'Outstanding'. There was no evidence or information from our inspection and on-going monitoring that demonstrated any risks or concerns.

Risk were managed positively in the least restrictive way to protect people from possible harm. Medicines were managed, administered and stored safely. People were protected from the risk of abuse, because staff were aware of the types of abuse and the action to take to ensure peoples safety and well-being. There were systems in place to ensure people were protected from the risk of infection and the home environment was clean and well maintained. Accidents and incidents were recorded, monitored and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff to meet people’s needs in a timely manner.

People’s needs and preferences were met by suitably skilled staff with the right knowledge and experience. There were systems in place to ensure staff were inducted into the service appropriately. Staff received training, supervision and appraisals. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s physical, mental and social needs were holistically assessed before they moved into the home to ensure staff and the home environment could meet their needs safely and appropriately.

The home environment was suitably maintained and adapted to meet people’s needs. People were supported to eat a healthy, well-balanced diet and people told us they enjoyed the meals on offer at the home. People were supported to maintain their health and well-being.

People were proactively supported and encouraged to maintain relationships with people that were important to them. People and their relatives told us that staff were caring. There were well established and affectionate relationships between staff, people and their relatives which was promoted by the stable longstanding staffing team. People were able to express their views, were involved in decisions about their day to day care and were provided with information about the service. People's privacy and dignity was respected and maintained and staff supported people to retain their independence.

People received outstanding responsive personalised care and support. People and their relatives told us that staff had outstanding skills and excellent knowledge and understanding of their diverse needs and how best to support them. Staff had excellent understanding of people's needs and preferences. They were skilled and knowledgeable about initiatives and best practice when supporting people living with dementia. Staff were provided with up to date training in line with best practice that was tailored to meeting people's individual needs and choices.

People, and those with permission to act on their behalf, were involved in planning, developing and reviewing their care and support. People received individualised care and support that was exceptionally responsive to their needs and wishes. People’s diverse needs and human rights were supported, encouraged and respected. People received outstanding care based on their individual needs because staff worked extremely well with health and social care professionals to ensure their needs and preferences were met. Responsive partnerships with other professionals and agencies were formed and the home worked innovatively to ensure people received high standards of care. People were supported to live an active and fulfilling life as arrangements in place for social activities were innovative and excelled at meeting people’s individual needs. The home takes an active key role in the local community and is actively involved in building further links. Activity provision was outstandingly responsive to people’s needs, person-centred and innovative. There were suitable arrangements in place to respond to people's concerns and complaints appropriately.

The service was particularly well-managed and staff had an accurate mix of skills and knowledge. There was a clear chain of management in place with a distinct line of responsibility and accountability within the staffing team. People and their relatives spoke highly and enthusiastically about the management, staff and running of the home. The home had an open and inclusive culture and staff spoke positively about the registered manager describing them as a visible presence within the home who offered them support and leadership. There were systems in place to recognise and acknowledge excellence in the work place.

There were sustained positive links and partnerships in place with other agencies, charities, community initiatives and professionals to ensure people received appropriate levels of care and support to meet their needs and information and best practice was shared between agencies when appropriate. There were systems in place which continuously sought ways in which the home could be improved upon and which encouraged people and their relatives to participate. There were effective and well-led governance arrangements in place to monitor, assess and improve the quality of the service.

Elmstead Care Home provides accommodation and personal care support for up to 49 older people. The home is situated within the London borough of Bromley and is spread out over three floors. The middle floor has been designed for people who have dementia. Care provided within the home ranges from respite services, day care facilities, residential, dementia and convalescent care.

At the time of our inspection there were 34 people using the service. There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.

The provider failed to support staff through regular supervision and appraisals of their practice and performance in line with the provider’s policy. Although there were plans in place to address these shortfalls, we were unable to check them at the time of our inspection but will check them at our next inspection of the service. This required improvement.

Risks to the health and safety of people using the service were identified, assessed and reviewed in line with the provider's policy. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies. There were safeguarding adult’s policies and procedures in place to protect people from possible abuse and harm. Accidents and incidents were recorded and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff were deployed throughout the home to meet people’s needs.

There were processes in place to ensure staff new to the home were inducted into the service appropriately. Staff received training that enabled them to fulfil their roles effectively and meet people’s needs. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with respect and were consulted about their care and support needs. Staff respected people’s dignity and privacy. People were supported to maintain relationships with relatives and friends. People’s support needs and risks were identified, assessed and documented within their care plan. People’s needs were reviewed and monitored on a regular basis. People were provided with information on how to make a complaint. The service worked with health and social care professionals to ensure people’s needs were met.

There were systems and processes in place to monitor and evaluate the service provided. People’s views about the service were sought and considered through residents meetings and satisfaction surveys.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and from examining records. If you want to see the detailed evidence supporting our summary please read the full report.

At the time of our inspection there were 34 people residing at Elmstead Residential Home. We used different methods to help us understand the experiences of people who use the service as not everyone who lived at the home was able to communicate verbally with us in a significant way. We used our Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care provided which helps us to understand the experiences of people who could not talk with us.

Is the service caring?

People expressed their views and were involved in making decisions about their care and treatment. People who use the service were given appropriate information and understood the care and support choices available to them. People using the service who we spoke with told us they were very much a part of the planning of their care and had been given choices about their support and how it was delivered. One person told us 'I like living here, the staff are great and I am supported to be as independent as possible'. Another person told us 'This is the best place. The staff are wonderful and the food is good. I have support when I need it and staff know me well'.

We spoke with relatives and friends of people using the service who visited the home on the day of our inspection. Comments included 'The home is lovely', 'It's always cheerful and friendly here', 'Staff are ready to have a laugh and joke with people to brighten their day' and 'The staff and management are great, nothing is too much trouble'. Relatives and friends of people using the service told us they were always kept informed of any changes to their relative's health and communication with the home was good.

Is the service responsive?

We spoke with the registered manager who told us the home holds residents and relatives meetings every quarter. They said that they discussed all issues related to the home and care provided including the building, housekeeping, catering, activities, care plans and staffing. Records we looked at confirmed this. The registered manager also told us the home produces a quarterly residents and relative's newsletter which informs them of any news related to the home and up and coming events or days out that the home organises. People we spoke with using the service told us that they found the meetings useful and that they felt involved and included and their views were taken seriously.

Is the service safe?

We spoke with several members of staff. They understood the types of abuse that could occur, the signs they should look for and what to do if they thought someone was at risk of abuse or harm including who to report this to. They told us they had attended training on safeguarding adults from abuse. Staff told us they were aware of the organisations whistle blowing policy and procedures and were able to explain how to use this process. We spoke with the registered manager who told us of the provider's policy called 'Speak Up'. They informed us that this was introduced into the home to enhance staff awareness of safeguarding and whistleblowing.

Is the service effective?

During our tour of the home we visited the middle floor which was designed for people with dementia. We noted there were clear and suitable pictorial signs displayed on walls or above doorways to remind people of which room they were approaching. We saw that memory boxes were being introduced at people's bedroom doors with familiar things displayed in them like pictures or badges to help remind them of the location of their room.

People were provided with a choice of suitable and nutritious food and drink. Comments from people living at the home about the meals provided included, " You can't beat the food here it is really first class' and 'There is always plenty of it. It is freshly cooked and I always enjoy it ". People told us that when they did not like the meal choice on offer they were provided with an alternative of their choice. During the lunch time meal we observed people being offered alternative meals to those on the menu. One person explained, "Sometimes I don't always like the choices on offer but staff will always give you something else that you like".

Is the service well-led?

There were effective recruitment and selection processes in place. Staff we spoke with told us they had been recruited by completing an application form and attending an interview where they were asked questions which were relevant to their role and qualifications gained were checked. One person told us 'The recruitment process was robust and my induction period was very helpful to me when learning the job'. The registered manager confirmed staff were recruited by an application process followed by an interview using competency based questions.

We spoke with the registered manager who told us that the provider also conducts internal quality reviews called 'Quality Metric Reports'. We looked at the last report which was conducted in March 2014. The results of this quality report demonstrated the homes performance against four key themes which included the quality of care, quality of life, quality of leadership and management and quality of the environment. The registered manager explained that the results of these reports would enable them to make necessary improvements to the home and the service provided.

However we found that people's individual risk assessments were not all correctly calculated and action was not always taken where risks were identified.