Archived: Elliott House Care Home

Elliott House provides personal care and accommodation for a maximum of 70 older people. Some people are living with dementia. The accommodation is across three floors and there is a separate part of the home for people with dementia, called Poppy unit. Elliott House is a large home set in extensive grounds. There is parking along the drive at the front of the home. At the time of the inspection 56 people were living at the service.

At our last inspection in June 2016, the home was in breach of one of the regulations regarding safe staff recruitment and there were some improvements needed to meet this. The provider sent us an action plan outlining how they would make the improvements. At this inspection improvements had been made to staff recruitment and there were no breaches.

At this inspection some other improvements were needed. In Poppy unit staff were responsive to people’s choices and when a person became unwell but this left insufficient staff support for people in the dining room to make sure they ate their lunch well and in a dignified way. The registered managers found a solution immediately we brought this to their attention by changing some of the staffing arrangements. Some of the language the staff used was not person centred and this needed improvement. The registered managers were aware of this training need and were addressing it.

People and their relatives were complimentary of the service and the registered managers. A person’s relative told us, “If I have to go in a care home, this one is one of the best.” Feedback we received from health and social care professionals was all positive.

There were two registered managers in post who worked together sharing the role between them and both were present at this inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 told us that they felt safe living at Elliott House. Staff understood how to protect people from the risk of abuse and the action they needed to take to report any concerns in order to keep people safe. Staff were confident to whistle-blow to the registered managers if they had any concerns and were confident appropriate action would be taken.

There were enough staff to keep people safe. Staff were checked before they started working with people to make sure they were of good character and had the necessary skills and experience to support people effectively.

Staff were trained to support people’s health and wellbeing, including specialist training to support people’s changing needs. Staff met regularly with the registered managers to discuss their training and development needs and the registered managers worked alongside staff some of the time. The registered managers addressed any issues if staff were not working as they should so that the staff team worked together effectively.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered managers and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments had been carried out to determine people’s level of capacity to make decisions in their day to day lives and for more complex decisions when needed. DoLS authorisations were in place, and applications had been made for renewal, for people who needed constant supervision to keep them safe. There were no unnecessary restrictions to people’s lifestyles.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Each person had a care plan that included their preferences and all the information necessary to meet their individual needs. Risks to people were assessed and managed without restricting people. People were involved in the assessments and planning and staff had a good understanding of making sure people had the right support to make decisions and give consent to care.

People were supported to have a nutritious diet. If people were not eating or drinking enough their food and fluid intake was monitored. Referrals were made to health care professionals, such as dieticians, when required.

People were supported to keep well and healthy and if they became unwell the staff responded promptly and made sure that people accessed the appropriate services. People received their medicines safely and when they needed them, by staff who were trained and competent.

There were a variety of activities available to keep people occupied. People were enthusiastically joining in with a music and movement session, playing ball games or quietly reading, playing dominoes or colouring. Some people were not doing anything although they said they were quite happy. Another activities coordinator had been employed and they were in the process of developing the activities on offer, including arranging outings and outside entertainment.

People, staff and relatives told us that the service was well led and that the registered managers and staff team were supportive and approachable and that there was a culture of openness within the service. People were treated with kindness, patience and respect. People were given the right support to maintain their independence as much as possible.

The registered managers had created a clear direction for the home and improvements were on-going. There was a good quality monitoring system that was based on feedback from people, their relatives and representatives and feedback was requested from visitors including health professionals. The registered managers carried out checks and audits of the service and had an improvement and development plan for the services based on the feedback and outcome of their audits.

People and their visitors told us that if they had a concern they would speak to the registered managers or any of the staff. There was a clear complaints procedure and opportunities for people to share their views and experiences of the service.

Checks on the equipment and the environment were carried out and emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

Services that provide health and social care to people are required to inform the Care Quality Commission, (the CQC), of important events that happen in the service. This is so we could check that appropriate action had been taken. The registered managers were aware that they had to inform CQC of significant events in a timely way. Notifiable events that had occurred at the service had been reported. Records were stored safely and securely.

Elliott House provides personal care and accommodation for a maximum of 70 older people, some people are living with dementia. The accommodation is across three floors and there is a separate part of the home for people with dementia, called Poppy unit. Elliott House is a large home set in extensive grounds. There is parking along the drive at the front of the home.

At our last inspection in October 2015, the service was in breach of some of the regulations. The provider sent us an action plan outlining how they would rectify those breaches.

At this inspection there were two registered managers in post who worked together sharing the role between them and both were present at the inspection. 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 and visitors were complimentary of the service and said that their experience of the management of the service had improved. A visitor commented, "There has been a good improvement in the place and my kids also tell me it is nice to be here now, whereas before they said it was really smelly. There is no sign of that now".

The registered managers had a list of improvements that they were working through to meet the regulations and had made considerable progress. There were some areas that were still a work in progress and needed improvement but enough progress had been made to meet the regulations that were in breach at the last inspection.

At this inspection the recruitment process needed improvement. There was a robust staff recruitment procedure but this had not been followed. References, gaps in employment history and issues on the police checks had not been followed up properly to make sure staff were suitable to work with vulnerable adults. This was a breach in the regulations and the registered managers were asked to take action with this.

The staffing level had been reviewed and more staff were being recruited. The registered managers were developing a dependency tool to make sure they were able to assess the staffing level needed and respond to people’s changing needs. Staff had given feedback in a staff meeting about the need for increased staff at particular times in the day and this had been responded to. Agency staff were supporting the team to increase numbers until appropriate staff had been employed and trained. A person commented, "There are usually enough people around and anyone will always help you if you need it".

One of the lifts was out of action and had been for some time. The provider had requested quotes to get this repaired. Changes to the times of the main meals had reduced the need for everyone to use the lift at the same time but there were still periods of time when people had to wait. This was an area for improvement. A visitor commented, "If we need the lift to go downstairs we do have to wait our turn".

The quality monitoring system was based on responding to feedback and issues identified. There was a good system of auditing and analysing the feedback received. There was no overall development plan for the service to structure the projects the registered managers were focusing on, so that it was clear to people what they were working on and what the priorities were. This was an area for improvement.

Visitors and staff said that the registered managers had worked hard and that the service had greatly improved. Visitors said they felt listened to if they had a concern and that the managers had an open door, so that they felt confident to approach them. Staff said they felt well supported by the registered managers and were clear about their role and what was expected of them.

The registered managers understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. All staff were receiving training in the principles of the MCA and the DoLS and were becoming more confident about the requirements of the legislation. Work was on going with the assessments but many were already in place for essential things like whether people were able to consent to taking their medicines and if they wanted to have the flu injection.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLS authorisations had been obtained from the local authority. Some further applications had been made and DoLS assessors had been involved.

A variety of training courses were provided and some new courses were being organised to make sure staff had the skills and knowledge they needed for their role. New staff received induction training and supervision from the registered managers until they were confident. There was a plan to introduce the Care Certificate so that staff had up to date training for current good practice. (This is the new minimum standard for new care staff.)

People were supported to have a healthy diet. Their nutritional needs were monitored and appropriate referrals to health care professionals, such as dieticians, were made when required. Care and consideration was taken by staff to make sure that people had enough time to enjoy their meals. Some people said they had to wait for their meal. Some people said the meals were not as hot and as tasty as they could be. The organisation of meal times was being reviewed, to make sure people did not have to wait too long for their meal to be served and so that it was served at the right temperature. At the time of the visit there were three different sitting and serving times, an additional member of staff had been allocated to the dining room where most people needed support and an additional cook had been employed. People said this had improved things.

People were supported to keep well and healthy and if they became unwell the staff responded promptly and made sure that people accessed the appropriate services. Visiting health professionals including district nurses and doctors were involved in supporting people’s health and wellbeing as needed.

Staff were attentive and responsive when people called for them or indicated that they needed some help. We saw staff behaved respectfully and were accommodating if people wanted drinks and snacks at different times; and if people wanted to go to the toilet, staff responded straight away. A visitor commented, "I am always made welcome when I come in".

People received their medicines safely and when they needed them. They were monitored for any side effects. Staff were trained in the safe administration of medicines and kept relevant records that were accurate. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. All medicines were stored safely and all records were completed. The registered managers carried out medicines audits and picked up any issues.

People said they felt safe in the service. Staff understood how to protect people from the risk of abuse and the action they needed to take to report any concerns in order to keep people safe. Staff were confident to whistle-blow to the registered managers if they had any concerns and were confident appropriate action would be taken.

Risks to people’s safety were assessed and managed appropriately. The risk assessments identified people’s specific needs, and showed how risks could be minimised. Staff understood people’s individual needs and had good relationships with them. People looked settled, happy and contented.

The needs of people living with dementia had been considered when the lounge/dining rooms had been redecorated, including plain floors and clear signs. The registered managers were working on picture and easy read documents to help people express their wishes and if they had concerns. This was a work in progress.

Before people decided to move into the service their support needs were assessed by the registered managers to make sure the service would be able to offer them the care they needed.

People’s privacy was respected and they were able to make choices about their day to day lives. Staff were respectful and caring when they were supporting people. People were comfortable and at ease with the staff. Staff encouraged and involved people in conversation as they went about their work, smiling and chatting to people as they went by.

Staff spent time with people and found different ways to occupy people. There was a checklist to make sure people were not left in the lounge unattended for too long. When people became anxious staff took time to sit and talk with them until they became settled. When people could not communicate verbally staff anticipated or interpreted what they wanted and responded quickly.

Visiting entertainers and activities coordinators provided some activities each week and there was equipment for the staff to entertain people. The registered managers were in the process of recruiting a new activities coordinator who would be based in the home. Structured activities were carried out by the staff in Poppy unit and visitors were complimentary of the care provided.

A visitor commented, “I think this is a lovely home and everyone seems happy to be here. The staff are very kind and nothing is too much trouble. I would certainly recommend this home to a relative or friend.”

Staff were familiar with people’s life stories and were very knowledgeable about people’s likes, d

Three inspectors, a pharmacy inspector and an expert by experience visited the home over the course of three days.

We spoke with the people who used the service, people's friends and relatives, visiting professionals, the registered manager, duty manager, care manager and care staff. We also observed staff supporting people with their daily activities.

Elliott House Care Home can provide accommodation for up to 71 older people. There were 52 people using the service at the time of our inspection.

We considered our inspection findings to answer questions we always ask:

' 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. This summary is based on our observations during the inspection, discussions with people using the service, staff supporting people and the management team and the records we looked at.

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

Is the service safe?

There were systems in place to make sure that the staff learned from accidents and incidents. Checks of accidents, such as falls, were completed. Action taken had been successful in reducing the number of falls people had.

Assessments were undertaken and care was planned to ensure that people received safe and appropriate care. Care plans detailed each person's individual needs. When risks to a person were identified the home carried out a risk assessment. However, more information was required in some risk assessments to support staff to provide safe and consistent care.

Recruitment procedures had been improved since our last inspection. All staff employed had been the subject of criminal records checks and potential risks had been assessed when staff had cautions or criminal convictions. However, the provider had not taken action to check every candidate's full employment history and why any previous employment providing services to vulnerable adults had ended.

There were now effective systems to reduce the risks posed to people from the spread of infection and ensure that the service was clean and hygienic.

Is the service effective?

People's care and support plans were individualised and had been regularly reviewed to ensure they remained current.

Staff knew people well, they responded to people's requests and offered them choices. Staff knew what people were able to do for themselves and supported them to remain independent.

The provider operated an effective system to regularly assess and monitor the quality of the service provided. This included regular monitoring of the environment and the service provided. There was a structured system in place to ask people using the service, their relatives and staff for their views about the service and act upon them.

Training was planned and delivered to ensure that staff developed the skills and knowledge they required to meet people's needs safely and to an appropriate standard.

Is the service caring?

People were supported by kind and attentive staff. Staff showed patience and gave encouragement when supporting people. People we spoke with said they felt staff respected their privacy and dignity and said that staff were polite and caring. People we spoke with said they liked the staff.

People were supported to attend health appointments, such as, doctors or dentists. The service worked closely with health and social care professionals to maintain and improve people's health and well-being.

We saw positive interactions from staff when supporting people throughout our inspection.

Is the service responsive?

The service had taken action to become compliant and improve the service people received since our last inspection.

People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of the people's care and support needs.

Staff were attentive to people using the service and responded promptly when needed.

The service had a complaints process in place and information had been given to people about how to make a complaint. Complaints received had been acted on and action had been taken to address people's concerns.

Is the service well-led?

Since our last inspection a new management team was in place who had implement changes to address the shortfalls.

There was an effective system to regularly assess and monitor the quality of the service to protect people's health, safety and welfare.

Audits of the care plans and other systems were completed to assess the quality of the care being provided. Where shortfalls had been found action had been taken to protect people using the service.

Staff told us they were clear about their roles and responsibilities and that they felt supported by the management team.

At the time of our inspection there were 68 people receiving a service from Elliott House. We spoke with some of the people using the service and the relatives. We observed staff providing care to people and saw that they spoke with people about the care they were receiving.

The provider had taken action to plan care to meet people's needs, however, care was not consistently risk assessed and delivered in response to people's needs.

Action had been taken to improve the way medicines were managed. However, records demonstrated that risks to people associated with the unsafe use and management of medicine remained.

The provider had employed new staff since our last inspection; however they did not have an effective process in place to check that staff were safe to work with vulnerable people and were of good character.

We saw that at times there were not enough staff available to meet people's needs in a timely way.

We found that many of the staff did not have the skills, experience and qualifications to meet people's needs and the provider had not taken action to support staff to develop these skills.

The provider did not operate an effective process to assess the quality of the service people received.

We found that people were not able to make choices about their care and support and were not involved in planning their care. One person we spoke with said, 'I'd like to see my care plan to make sure it's accurate'.

The provider had not taken action to ensure each person's care was safe and met their needs. Care was not consistently planned and delivered in response to people's changing needs.

We saw that areas of the building were not clean and there was a strong odour in some areas. The layout of the building did not support people living with dementia to move around independently.

Medicine administration was not managed in a way that ensured people received their medicine safely.

We found that there were not enough staff available to meet people's needs and they were not always met in a consistent or timely way.

The provider did not operate an effective process assess the quality of the service people received.