Archived: The Elms @ Kimblesworth

Updated 5 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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.

The inspection was prompted after we received a number of whistle blowing concerns from people who had experience of working in the service. We decided to carry out a focused inspection. However on initiating the inspection we found continued breaches and carried out a comprehensive inspection.

This unannounced inspection site visit activity started on 28 March 2018 and ended on 29 March 2018. It included speaking to people who used the service and staff working in the home. We visited the home to see the manager and the staff, speak to people who used the service and to review care records and policies and procedures.

The inspection team consisted of two adult social care inspectors.

Prior to the inspection we checked the information we held about this location and the service provider, for example we looked at the inspection history, safeguarding notifications and complaints. A notification is information about important events which the service is required to send to the Commission by law.

During our inspection we spoke with five people who used the service and 12 staff members including the area manager, the manager, nurses and care staff, kitchen, domestic and maintenance staff. We looked at six people’s care records as well as medicine administration records, maintenance records and audits carried out by the service. We looked around the home and its gardens to check people were safe living in the home. We also looked at records concerned with the day to day running of the service.

Updated 5 June 2018

This inspection took place on 28 and 29 March 2018. We planned to undertake an unannounced focused inspection as a result of receiving information of concern about the running of the service. This inspection was carried out to check to see if the concerns were accurate, and also to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection in August 2017 had been made. We intended to inspect the service against the key questions – is the service safe, is it effective and is it well–led. As continued concerns were found across the five key questions we changed the inspection to a comprehensive inspection.

At our last inspection in August 2017 we found breaches of regulations 11, 12, 13, 17, 18 and 19. The breaches related to the provider failing to meet the requirements of the Mental Capacity Act, ensuring people were cared for in a safe manner, staff were provided with the necessary support to carry out their roles and they had been appropriately vetted before they began working in the home. We also found the provider had failed to ensure there were sufficient and robust governance arrangements in place. The manager provided us with an action plan to show us what actions they were taking to continue with the improvements. At this inspection we found improvements had been made although we found there were continued breaches of Regulations 12, 17 and 18.

The Elms @ Kimblesworth 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. At the time of the inspection there were 14 people living in the home.

At the time of our inspection a new manager who subsequently became the registered manager had begun to make improvements. They provided us with an action plan to show us what actions they were taking to continue those improvements. 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.

Security of the building needed to improve. Inspectors were able to access the building and people’s personal information undetected at 6.30am. The manager told us they would issue new guidance to staff which ensured greater security.

People were given their medicines in a safe manner. However we found improvements were required in the home to support people who had been prescribed topical medicines (creams applied to the skin).

During our last inspection we found a breach of Regulation 18 as staff had not received appropriate support through induction, training supervision and appraisal. At this inspection staff records showed there was a continued regulatory breach. Staff had not received supervision and training in topics relevant to their work.

Audits to measure the quality of the service failed to identify the deficits we found during our inspection and monitor the service across regulatory requirements. The service had yet to reach the stage where the outcomes of surveys, complaints and compliments drove improvements to the care provided to people.

Work had been carried out to make improvements to the cleanliness of the building and reduce the risks of cross infection. Further work was required to the home to complete this task.

The fire risk assessment had been updated and there were regular checks carried out on, for example, firefighting equipment and alarms. However we found a number of concerns about fire safety and asked the local fire safety officer to visit the home. The fire safety officer reported they had found a number of deficits and the area manager and the manager had agreed to address these.

At our last inspection we recommended the provider develop a strategy which took into consideration national guidance on caring for people with learning disabilities. To date this had not been carried out and the service had begun to admit people with learning disabilities. The newly appointed manager agreed to explore this area of work.

Kitchen staff were aware of people’s dietary needs and how people managed their health conditions. People told us they enjoyed the food at The Elms and described it as, “Lovely.” Staff had put in place food and fluid charts for people who needed additional support. However we found these records had not been accurately maintained. Improvements had been made to other records to increase accuracy and bring them up to date. We found further work was required to ensure all records were up to date.

Appropriate checks had been undertaken before staff began working for the service. Disclosure and Barring Service (DBS) checks were carried out and at least two written references were obtained, including one from the staff member's previous employer. Staff provided information about their skills and experience on an application form. We found there were sufficient staff on duty to meet the needs of the people using the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Not every person had signed their care plans. The area manager devised a consent form during our inspection to seek people’s consent for living in the home.

People were protected from the risk of abuse because the staff in the home understood their responsibility to keep people safe and the actions to take if they were concerned a person may be at risk of harm. Staff told us they would be comfortable in raising concerns with the newly appointed manager.

Staff were caring and kind toward people who used the service. They knew people well and were able to describe their preferences, their likes and dislikes. They were able to respond to people with compassion and respected people’s privacy. We saw in people’s care records staff had sought advice from other professionals on the best ways to provide people’s care.

Staff promoted people’s independence and encouraged them to do things for themselves. Systems were in place to assess and monitor people who wished to independently take their own medicines.

The provider had a complaints process in place. We found two people had made a complaint to a member of staff who had documented the issues they had raised. The area manager was unaware of the complaints and agreed to look into people’s concerns.

The area manager and the manager told us a new activities coordinator had recently been appointed and was due to start work in the service. Staff had continued to engage people in activities of their choice.

You can see what action we told the provider to take at the back of the full version of the report.