Elsenham House Nursing Home

Updated 10 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors, a medicines inspector, an advanced nurse practitioner, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Elsenham House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Elsenham House Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with nine people who used the service and one relative. We observed care and support provided in communal areas. We spoke with eight staff, this included three nurses, the cook, care and kitchen assistant, the administrator and deputy administrator. We also spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We looked at eight people's care and support records and 16 people's medicine records, as well as a sample of medicines. We looked at three staff files, training records and records relating to the management of the service such as audits, policies, and meeting minutes.

Updated 10 November 2022

About the service

Elsenham House Nursing Home is a residential care home providing personal and nursing care to up to 36 people living with complex mental health conditions. The service also provides support to people who have a dual diagnosis of a mental health condition and a learning disability and/or autism. At the time of our inspection there were 26 people using the service. People living in the service were accommodated over five houses contained in two separate blocks. There were several communal kitchens, bathrooms, living and dining areas, the outside garden space was not separated and could be accessed from each block.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location predominantly supported people living with a mental health condition. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support: People did not receive the right support with medicines. This was because medicines were not always managed safely. Further improvements were needed to protect people from the risk of infection and with the management of people’s monies. Incidents that had occurred were not always reported. This meant it was difficult to be certain people and staff got the right support after an incident had occurred. People were supported by staff who knew them well and supported them to make choices. Staff took a positive approach to risk taking which helped maximise people’s control and independence. There was enough staff to support people and this helped ensure people could engage in the community. People lived in a clean environment although we noted some improvements were needed to the décor.

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.

Right Care: Best practice in supporting people with a learning disability and/or mental health condition had not been implemented. People’s care records did not always contain accurate or complete information. People were supported by competent and trained staff who understood people’s conditions and needs. People were supported to think about how to manage their health conditions and their nutritional needs were met.

Right Culture: Improvements were still required for the governance of the service. The systems in place had not been effective in identifying and improving areas of concern. Further work was needed to strengthen the systems used to support person-centred care. The provider was open and honest about where it needed to improve. They had engaged support to help them do this from external professionals.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 January 2021). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last four consecutive inspections.

We imposed conditions on the provider’s registration following the last inspection.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of Safe, Effective, and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elsenham House Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicines management and good governance. We have made a recommendation that the provider seeks reputable advice and guidance on implementing recognised models of support to meet the needs of the people using the service.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.