Background to this inspection
Updated
6 November 2018
The inspection: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team: The inspection was carried out by one inspector.
Service and service type: The Elms Care Home with Nursing is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
A registered manager was in post; they had been registered to manage the home in September 2017. 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.
Notice of inspection: This inspection was unannounced.
What we did: Before the inspection, we reviewed information we held about the service including notifications. A notification is a report about important events which the service is required to send us by law. We used information the registered manager sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. The provider had informed CQC that from 06 December 2017, nursing care was not being provided at the home.
Throughout the inspection we observed the support being provided to people. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with three people who use the service and four relatives. We reviewed four people's care files which included pre-admission assessments, care plans and risk assessments. We checked medicines records for four people and observed a staff member administering medicines. We reviewed the processes in place for managing medicines, including the use of 'as required' medicines.
We spoke with the provider's area operations manager and the registered manager, three members of the care staff team and the maintenance person. We spoke with four health and social care professionals. We looked at staff training records and rotas, accident and incident records, maintenance records and reviewed provider policies and quality assurance systems.
Updated
6 November 2018
What life is like for people using this service: Following our previous inspection the provider had made the decision to retire. At the time of our inspection staff were anticipating a change in ownership and we found the provider had been open and transparent with people and staff about the anticipated changes.
At this inspection we identified shortfalls in both ‘Is the service Safe’ and ‘Is the service Well-led’ key questions and have rated the service ‘Requires Improvement’ overall.
Staff were committed to providing good quality care but the service was not consistently safe. We found people’s needs had not always been comprehensively assessed and staff did not always have the information they needed to understand how to support people to remain safe. We found people who required moving and handling support and those who required support to manage their behaviour did not always receive care in accordance with current best practice guidelines.
The provider and registered manager continuously worked to improve the service. Following our inspection feedback the provider took immediate action to increase staffing in the afternoons so that people could have staff support when they needed it. Additional staff training had also been arranged.
The provider had reviewed their internal quality assurance systems to ensure a more comprehensive audit of the service was completed. The audits had effectively identified most of the shortfalls we found prior to our inspection. However, progress against the provider’s action plan had been slow and the provider’s area operation manager was working alongside the registered manager to make the required improvements.
More information can be found in the Detailed Findings below.
Rating at last inspection: Good (Report published on 4 April 2017)
About the service: The Elms Care Home with Nursing accommodates up to 22 older people in one adapted building. 13 people were using the service at the time of this inspection. Some people using the service were living with dementia, physical disability and/or sensory impairment.
Why we inspected: This inspection was prompted by concerns raised by a health professional regarding people's safe care and treatment. The information shared with CQC indicated potential concerns about the management of risk relating to safeguarding, response to deterioration in people’s physical health and safe moving and handling techniques. This inspection examined those risks.
This was the second concern raised to CQC about the service within the last 12 months. In December 2017, similar concerns had been raised by a health professional and relatives, relating to one person’s care and treatment. This concern was shared with the Local Authority who found action had been taken by the registered manager to address shortfalls in the care provided.
We inspected the service against two of the five questions we ask about services: Is the service safe? and Is the service well-led? No risks, concerns or significant improvement were identified in the remaining three Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.
Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure the provider improves the rating of the service to at least Good. We will revisit the service in the future to check if improvements have been made.