New Elmcroft

New Elmcroft is one of a group of homes owned by a national provider, Shaw Healthcare Limited. It is a residential 'care home' which can accommodate up to 60 people in one adapted building. The care home provides accommodation and nursing care for people living with a range of healthcare needs and disabilities associated with older age and frailty, including people living with dementia. There were 46 people living at the home at the time of our inspection.

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

People did not always receive care in line with their assessed needs and plans of care. People did not consistently receive safe wound care as guidance from health professionals was not always followed to ensure risks to people’s health and safety were mitigated. People were not always monitored for changes to their health following a fall as staff had not always followed the provider's processes to keep people safe. Staff did not always have all the risk information required to ensure potential risks associated with people’s health conditions were managed effectively.

Systems to monitor the quality and safety of the service were not robust enough to identify shortfalls in people’s care, communication or records relied upon to demonstrate the care people had received. The service had a new manager who had begun to implement changes to improve the standard of care and overall governance of the home. However, these changes were not yet embedded or sustained and required more time to embed them in everyday practice and monitor their overall effectiveness to improve people’s care.

People’s and most relative's experience of using the service was positive. People told us they felt safe and were cared for by staff who knew them well and understood their needs. Staff understood their safeguarding responsibilities and knew how to escalate concerns. There were enough staff to meet people’s needs and changes made to the skill mix and deployment of staff, meant nurses had more time to provide care for people.

People and their relatives thought the home was clean and hygienic and people were protected from the risk of infection. Comments included, “The home seems clean and [person’s] room is well maintained”, and, “The home was clean when I visited before and staff were all wearing PPE, as did we as visitors.”

People received care that was responsive to their needs. People were offered choice and their preferences respected. 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’s communication needs were assessed, and people had access to information in the way they preferred when needed. People were offered a range of activities which would promote their emotional wellbeing and reduce the risk of isolation. People were supported to maintain contact with their loved ones and this continued if the home was closed due to COVID-19. One person’s relative told us, “The home arranged video calls at times when we couldn't visit.”

People received care and support at the end of their lives which was in line with their wishes and preferences. The managers acted on feedback and had taken action to enhance the quality of care people received at the end of their lives.

The managers of the service promoted a positive and person-centred culture which aimed to achieve good outcomes for people. Most feedback received was complimentary about the way the home was managed and the care people received. One person told us, “I enjoy it here, it is different from anywhere else and you know you'll have a good time. The staff are very good really, I have no problems at all.”

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

Rating at last inspection

The last rating for this service was Good (published 23 August 2018).

Why we inspected

We received concerns in relation to wound care, end of life care and infection prevention and control. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well led sections of this full report.

During and after the inspection, the provider took appropriate action to ensure any potential risks to people’s health and safety were mitigated. The manager provided assurance that concerns identified during the inspection, and others identified through their own quality assurance processes, would be addressed and actions taken to make the required improvements.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

New Elmcroft is situated in Shoreham, West Sussex and is one of a group of homes owned by a national provided, Shaw Healthcare Limited. New Elmcroft accommodates 60 people across separate units, each of which have separate bedrooms with ensuite shower facilities, a communal dining room and lounge. There were also gardens for people to use and a hairdressing room. The home provides accommodation for older people, those living with dementia and people who require support with their nursing needs. At the time of the inspection there were 49 people living at the home. The home had a registered manager. 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 the last inspection the home was rated as Good. At this inspection we found the evidence continued to support the rating of Good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Most risks were assessed and managed well. There had been several incidents whereby people had accessed areas of the home that had the potential to cause them harm. Preventative measures had immediately been put in place, such as installation of locks to the doors. One of the doors to the sluice toom, which had a key pad lock installed, had not been closed. There was a potential that a person could access the room and cause themselves harm.

External healthcare advice had not always been implemented by staff. Two people had been assessed as needing to have their drinks thickened to minimise the risk of choking. Neither of the people were provided with thickened drinks. One of these people began to cough on an un-thickened drink and there was a potential that they could have come to harm as there were no staff with the person when this occurred. These incidents were immediately fed back to staff who ensured that the people’s drinks were thickened.

People told us that staff made them feel safe. They felt that there was sufficient staff, that they were well-trained and knowledgeable to meet their needs and assure their safety. People and staff were aware of the importance of raising concerns about people’s wellbeing and safety. People were protected from abuse and made aware of their right to complain. Incidents had been reflected on and practice changed in response.

People were protected from the spread of infection. Registered nurses and external healthcare professionals ensured that people’s heath was maintained. Medicines were provided when people required them. People told us that they were confident that staff would summon assistance if their health condition deteriorated. There was a coordinated approach to people’s healthcare. People received good need of life care.

People had a positive dining experience. They told us that they were happy with the food and had access to drinks and snacks throughout the day and night. One person told us, “Food is okay, helpings are fine, it is enough for me”.

People were asked their consent before being supported and were involved in their care. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Staff demonstrated respect. People’s privacy and dignity were maintained and they were supported by staff in a sensitive and dignified way. People told us that they felt well-cared for. They spoke fondly of the staff and person-centred practice was evident. One person told us, “I get on well with all the staff. They are nice”.

The environment provided spaces for people to enjoy time on their own or with others. There was a fun, lively and welcoming atmosphere. People had access to a varied range of stimulation. Activities, external events and entertainment was available for people to enjoy. One person told us, “There are lots of entertainers that come in. We have quite a bit to do”.

People and relatives were complimentary about the leadership and management of the home. They told us that the home was well-organised and that the registered manager listened and acted upon their ideas and suggestions. Systems were monitored to ensure they were effective. Staff were appropriately supported and involved in decisions that affected their work. Partnership working with external organisations and healthcare professionals ensured that good practice was shared.

Further information is in the detailed findings below.

During this inspection, we looked at the outcomes relating to the consent to care, care and welfare of people, safeguarding people from abuse, medicines management, staffing and the process for assessing and monitoring the quality of service.

We considered the evidence we had gathered under the outcomes we inspected. We spoke with 11 people who use the service, six relatives and visitors to the service, the manager and 12 staff. We reviewed six care plans and associated records and records relating to the management of the service.

We used the information to answer the five 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:

Is the service safe?

The service was not safe because the arrangement for the effective management of people's medicines was not adequate. This may put them at risk of not receiving their medicines safely and consistently and according to their needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.

The provider had arrangements in place to ensure there were sufficient staff with the right skills to meet people's needs. People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had received appropriate training in safeguarding vulnerable adults and we found the manager had responded appropriately to incidents of potential abuse.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service had policies and procedures in place in relation to MCA and DoLS. There was one person who was subject of a DoLS authorisation and they were receiving appropriate monitoring and support.

Is the service effective?

There was a system in place whereby risk assessments were carried out and care plans developed to show how people's assessed needs would be met. The care plans contained detailed information about people's care and staff were knowledgeable about the people they cared for. They included appropriate information to enable staff to provide support with food and fluids to meet people's nutritional needs. Equipment was in place to support people's mobility and to maintain their independence.

Is the service caring?

We saw people were supported in a caring and compassionate way. Staff and people using the service had developed good relationships and people were treated with respect. One person told us the staff were "really good" and a visitor told us their friend was always well dressed and 'he seems to be happy living here'. People told us they were able to exercise their choices and staff listened to them. People we spoke with were complimentary about the care and support they received. Comments included 'they treat you very well' and 'the staff are very nice'.

Is the service responsive?

Most aspects of the service were responsive. People told us told us they were satisfied with the care and support they were receiving. We saw people were supported to access external healthcare facilities as needed. Two visitors told us the staff 'always make sure a doctor is called out' if their relatives were unwell. The staff also kept them informed of any new changes. However, care plans were not always reviewed to reflect any changes in people's needs.

Is the service well-led?

Some aspects of the service were not well-led. Systems were in place to regularly assess and monitor the quality of service provided. However these were not always effective as shortfalls were not identified and action taken. The quality improvement system did not evidence how improvements would be embedded in practice.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation assessing the quality of the service provision and monitoring the outcomes for people.

There was a complaints process in place to support people to raise their concerns and information was available to people.

We shadowed a member of staff administering medicines to people cared for by the service, they administered medicines to people in a manner which suited the individual. We sampled the administration records and supporting information, the records were in the main complete, however most supporting information lacked sufficient detail to ensure staff less familiar with the people would administer the medicines in a consistent manner

We spoke to a number of people cared by the service who told us that they 'get their medicines when required'.

People's care needs were assessed and care was planned and delivered to meet those needs with regard to their personal preferences. People's health was monitored appropriately. One person told us, 'I think the staff are very patient; I am very well treated.' A relative said, 'I'm completely satisfied with the way they are handling my wife's care.'

We found there were efficient systems for ordering, storing and accounting for medicines. People were supported to take their medicines on time and with kindness when help was needed.

We found there were sufficient staff with the right qualifications skills and experience to meet people's needs. However, there were occasions when late notice absence could not be covered although the home had systems to manage staffing shortfalls. A team leader said 'Nothing is left intentionally.' A typical comment from a person who used the service was, 'They can get very short handed.'

The provider had systems for gathering feedback from people who used the service, their families and from staff. There were systems of audit and risk assessment to ensure the service was safe.

There was an effective complaints system that was well publicised. The provider investigated and responded to complaints.