Archived: Elmbridge Residential Home Limited

We found the following examples of good practice.

¿ The provider had ensured that policies and procedures relevant to infection, prevention and control were up to date. COVID-19 guidance was also kept updated for staff to reference.

¿ Infection control audits were completed so that any shortfalls could be identified and addressed. On-going monitoring of staffs’ usage of personal protection equipment (PPE) ensured this was used in line with current national guidance.

¿ Cleaning records were maintained and the environment looked clean and bedrooms and communal rooms had been decluttered to support easier cleaning. Refurbishment of the lounge had included new and wipeable armchairs.

¿ Designated family members had been supported to visit their relative safely. An area within the home had been used for visiting and cleaned after each visit. Relatives were supported to wear appropriate PPE and meet hand hygiene requirements. Arrangements were in place to keep relatives informed about necessary changes in visitor guidance. Support had continued to be in place to enable a family member to support their relative at the end of their life.

¿ Admissions to the home were only accepted if staff were confident they could safely support a person, following their admission and in line with relevant COVID-19 guidance. People had to have a negative COVID-19 test result before admission and be able to self-isolate, with support, for 14 days after admission.

¿ All people and staff were tested in accordance with current COVID-19 national guidance for care home testing. People were given reassurance during the time of testing and only tested at the time they were able to agree to this.

¿ Staff monitored people closely to be able to identify any changes in wellbeing which may indicate potential infection. Staff knew who to contact if they suspected a person had signs of infection.

¿ Social distancing had proved difficult to maintain when supporting people in their everyday activities. Action had been taken to reduce people’s risk of becoming infected because of this. This included a one hundred percent uptake in testing staff and people in line with national guidance for care homes. Staff avoided the use of public transport when travelling to work and they limited their social interactions outside of work. Staff wore appropriate PPE when in close proximity to people and agency staff were not used. A whole home Flu vaccination program was almost completed.

¿ People’s end of life wishes and their treatment preferences had been reviewed, with them and their representative/s in light of the COVID-19 pandemic. Where decisions had been made on people’s behalf and in their best interests, this had involved both relatives, staff and the person’s GP.

Further information is in the detailed findings below.

Elmbridge Residential Home Limited is a residential care home providing personal care and accommodation to 16 people who live with dementia and mental health needs. At the time of the inspection 15 people were receiving support in one adapted building.

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

People were supported to remain safe and they told us they felt safe. Arrangements were in place to protect people from potential abuse and discrimination. Risks to people’s health and from the environment around them were identified and action taken to reduce or mitigate these risks. People’s medicines were managed safely, and people given support to take their medicines as prescribed. The home was staffed in such a way so that people’s needs, and the needs of the home generally were met. Staff were provided with support and training to be able to look after people appropriately and safely.

We recommended that staff be updated in relation to two areas of current best practice and guidance. The registered manager responded to this recommendation by seeking information about additional learning for staff.

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 who lacked mental capacity to make decisions regarding their care and accommodation were protected against unlawful care as staff adhered to the Mental Capacity Act and Deprivation of Liberty Safeguards.

People had access to social care and health care professionals; specialist support and advice was sought when needed to support people’s wellbeing. Collaborative working with healthcare professionals also ensured people’s health needs were reassessed as required. People received appropriate help to eat and drink and specific risks associated with people’s nutrition were identified and acted on.

People’s care was delivered in a caring way by a staff team who knew people’s needs, behaviours, likes and dislikes well. People’s privacy and dignity was maintained. Staff supported people’s independence when it was safe and appropriate to do so by weighing up the risks and benefits to people in different circumstances. Staff provided personalised care to people. Family and friends were welcomed, and staff valued the positive additional support this could bring to people’s lives.

Care plans outlined people’s care support needs, and these were reviewed regularly to ensure the care planned for people remained relevant to their needs.

There were arrangements in place for people, their relatives and other visitors to the home such as professionals to raise a complaint and have this responded to. Thought was being given to how best make people and their relatives more aware of the home’s complaints procedure. Ideas included within a home brochure, to be given on admission. Complaint guidance was however on display in the front hall.

People were supported to take part in activities when they felt able to do this. These were predominantly on a one to one basis although some group activities and social events were enjoyed. Opportunities for people to get out and enjoy the wider community had increased in 2019 and this had improved people’s wellbeing.

The service was well managed by a registered manager who was registered with the Care Quality Commission. Regulatory requirements were met, and staff were aware of their individual responsibilities. The registered manager monitored the quality of the service provided to people to ensure the standard of care and working culture met with their expectations. Staff worked as a team and reflected on practice and situations to identify areas for further learning and improvement. There were arrangements in place for people, their relatives and other visitors to the home to feedback their views, ideas and suggestions. Plans were in place to formally gather feedback from these groups as part of the service’s quality monitoring action for 2019.

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 (last report published 7 March 2018).

Why we inspected

The inspection was prompted in part due to concerns received about one person’s care; this person no longer lived at the home. A decision was made for us to inspect and examine the care of other people who lived at the home to ensure they were in receipt of safe and appropriate care.

We found no evidence during this inspection that people were at risk of harm. Please see Is the service safe, effective, caring, responsive and well-led? sections of this full report.

Follow up

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

Elmbridge Residential Home Limited 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. The home can accommodate 16 people in one adapted building. During this inspection 15 people lived there. The home specialised in the care of older people who lived with dementia or who had mental health needs.

The home provided people with accommodation which comprised of 14 single bedrooms and one shared bedroom. People had the use of communal toilets, a bathroom and a shower room, as well as a lounge, conservatory and dining room. A garden to the back of the home provided people with a safe space outside to enjoy. Limited car parking was provided but car parking was possible in the surrounding area. There was disabled access into the home. Inside a stair-lift supported access to the second floor.

A registered manager was in place. 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 on 2 and 6 February 2017 we rated the service Requires Improvement and asked the provider to take action to make improvements. These were to ensure people received their medicines as prescribed, that systems were in place to assess, monitor and improve the quality and safety of the service and to ensure accurate records were held with regard to people’s care and treatment. The provider was required to submit a monthly written report (to CQC) with the results of their quality monitoring and the improvements they had made to the service. We found the above necessary improvements had been made. Improvements to the key questions, is the service safe, effective, responsive and well-led? had also been made in order for the rating of these, as well as the service’s overall rating, to improve to Good. The rating for the key question, is the service caring? was previously rated a Good and has remained Good.

During this inspection we made two recommendations to further improve the provider’s good practice in relation to the managing of environmental risk and gaining additional professional support. There were arrangements to keep people safe. Risks were identified and action taken to reduce these. People were protected against potential abuse and staff worked with other agencies to safeguard people. There was zero tolerance of any form of discrimination. Staff were recruited safely and there were enough staff on duty to meet people’s physical and emotional needs. People received their medicines as prescribed and safely. The home was kept clean and arrangements were in place to prevent the spread of potential infections. The kitchen had been refitted and the home had been recently awarded the highest rating possible by the Food Standards Agency.

People’s needs were assessed and staff worked closely with other professionals to ensure people received the care they required. Staff had received training and people’s diverse needs were met safely and skilfully. Staff understood and adhered to the principles of the Mental Capacity Act 2005. 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. People had a choice in what they ate and their nutritional wellbeing was monitored. Some adaptations had been made to the home to support people’s independence and to help them receive safe care.

People’s care was planned with their involvement and the involvement of their relatives. Care was personalised around people’s likes, dislikes, preferences and wishes. Daily and social activities brought a quality to people’s lives and helped them retain skills. A complaints process was in place but open and transparent communication with relatives and others meant complaints were rarely received. People at the end of their life were supported to have a comfortable and dignified death. Relatives were provided with support at this point.

The registered manager provided strong leadership. They were fully aware of what was going on in the service and they communicated effectively with their staff. They were fully committed to ensuring the service provided a high quality of care. The arrangements by which the service was monitored had improved. A new electronic quality monitoring assessment tool had been chosen. This was to be started soon to help the registered manager assess the service’s on-going level of compliance with necessary regulations. Feedback had been sought in a proactive way from relatives and the management and staff were open to suggestions and ideas. The staff did not belong to, or attend, professional forums which supported best practice. These could provide the service with support and new ideas. The registered manager told us they were open to exploring some of these.

People were supported to use the local community and there were longstanding links with a local church. The registered manager was open to exploring further ideas and suggestions with regard to links with local community groups.

There was a registered manager in post. 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.

We last inspected in October 2015 and found that the provider was not meeting a number of the regulations. We found that people did not consistently receive safe care and treatment, because staff had not always administered their medicines as prescribed. Following our inspection the registered manager told us immediate actions would be taken to ensure people would receive their medicines as prescribed.

Whilst the registered manager had taken some action, including reducing the stock of people’s prescribed medicines and ensuring care staff had received further management of medicine training, people were still at risk of not receiving their medicines as prescribed. Care staff did not always keep an accurate record of when they had assisted people with their medicines. Care staff had signed to say they had administered some people’s medicines; however these medicines had not been given to the person.

The registered manager had implemented systems to monitor and improve the quality of service people received, however these systems were not always effective. The registered manager did not have formal systems to monitor the skills and competency of staff. Additionally there were not clear structured formal systems to seek the views of people’s relatives or visitors.

People and their relatives were generally positive about the home. People felt safe and looked after. People told us they enjoyed the food they received in the home and had access to food and drink. People told us there was not always something for them to do at Elmbridge Residential Home; however they enjoyed living at the home. People benefitted from positive caring relationships with care staff.

People’s care and risk assessments were often person centred and reflective of their needs. Care assessments give care staff and nurses clear information in relation to people’s needs. The risks associated with people’s care was not always clearly documented, however care staff knew how to meet people’s needs and protect them from risk.

Staff were deployed effectively to ensure people’s basic needs were met and kept safe. All staff felt they had received the training they needed meet people’s healthcare needs. Staff felt supported, by the registered manager.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulation 2009. You can see what actions we told the provider to take at the back of the full version of this report.

Is the service safe?

People had been cared for in an environment that was safe. There were enough staff on duty to meet the needs of the people living at the home and the manager was always available in emergencies. Staff had received appropriate training and knew the needs of all the people who used the service very well.

Is the service effective?

We saw feedback from relatives of people who used the service. This feedback was very positive about the care their relatives received. It was clear from what we saw and from speaking with staff that they understood people's care and support needs. They knew each person who used the service very well.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and encouraged the people who used the service.

Is the service responsive?

People's needs had been assessed. Records confirmed people's preferences, interests, aspirations and diverse needs had been considered and acted on. Care had been provided to meet their needs. People had access to activities that were important to them.

Is the service well-led?

Staff had a good understanding of the home and the people who used the service. Relatives told us that they felt comfortable approaching any member of staff if there was any problems. The manager was present in the home on a regular basis and spoke to people who used the service and their relatives on a regular basis.

However, the arrangements which the provider had told us had been put in place to maintain a good standard of cleanliness and hygiene, in relation to the environment, had not been put in place. After inspecting areas of the care home we found evidence of inadequate cleaning arrangements. The arrangements for monitoring, identifying and then addressing these shortfalls were also not effective.

There were good arrangements in place for preventing the spread of infection.

Each person required a lot of support to ensure their preferences were identified and met. Staff had a good understanding of each person's ability and supported them to make simple choices on a daily basis. People's care was planned on an individual basis making sure their meeds were met. There was evidence to show that people's rights were upheld. Staff made sure people had access to specialist health care professionals when needed. People's medicines were managed well, although the arrangements for demonstrating that staffs' knowledge was updated needed improvement.

Risks to people were monitored and arrangements made to ensure these were managed. Close communication with members of the local mental health team took place if risks related to people's behaviour or mental wellbeing.

Some areas of the environment were not clean and there was a foreseeable risk that people would be exposed to infection. This was despite there being some good infection control systems in place. People were given guidance on how to raise a concern/complaint within the service or externally. Robust recruitment processes were adopted in order to protect people.

We looked at the care records of three people and these demonstrated that people's needs were being assessed and their care was being planned. They showed that alterations were being made to people's care and treatment as required. There was evidence to show that the service worked alongside external professionals and agencies in order to meet people's health care needs. There were arrangements in place to safeguard people against potential abuse, to ensure their rights were upheld and to make sure they were not discriminated against. Potential and actual risks were being effectively identified and managed.

Staff were being trained and supported to perform their jobs safely and competently. We observed a couple of shortfalls in practice that indicated that staff may not always be applying their training in their practice.

There were systems in place to monitor the service and actions were being taken as a result of this monitoring, but the monitoring process and actions were not always being recorded.