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Archived: ELMS in Waltham Forest Requires improvement

Reports


Inspection carried out on 20 October 2017

During a routine inspection

The inspection took place on 20 and 23 October 2017, the first day of inspection was unannounced. At our last inspection on 8 October 2015 we found the provider was in breach of Regulation 12 safe care and treatment. At this inspection we found some improvements had been made, but further improvements were required to ensure that risk assessments were more comprehensive and detailed actions for how risks would be mitigated.

ELMS in Waltham Forest is a three bedded care home. The home specialises in providing support for people with mental health conditions and working towards them developing their independence. There were three people using the service at the time of our inspection. Each person had their own room and shared communal areas such as bathroom, lounge, kitchen and the garden.

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.

Medicines were stored safely, however we found gaps in medicine administration records.

People were protected from the risk of abuse because staff knew what to do and how to report any suspicions to their manager and the relevant authority.

The service operated within the legal framework of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Risk assessments identified areas of risks, however they did not include guidance for staff on how these risks should be mitigated.

The registered manager told us that staffing levels were sufficient to meet people’s needs. We found staff were not deployed appropriately to ensure that people were safe.

Staff recruitment procedures were in place, however we found gaps in records relating to staff references and disclosure and barring checks.

Care plans were detailed and provided staff with guidance on how to support people. People received support in line with their plan of care. However, care plans were not written in a person-centred manner.

Staff felt supported by the registered manager and felt able to approach them at any time with their concerns. Some staff had not completed training in specialist areas such as diabetes.

Systems in place to audit the service were not effective as they had not identified the gaps we found on the day of our inspection.

We made recommendations in relation to care plans, staff deployment and staff training.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, staff recruitment and governance. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 8 October 2015

During a routine inspection

The inspection took place on 8 October 2015 and was announced. The service was last inspected in May 2014 and was found to be fully compliant with all the standards we looked at during that inspection.

ELMS in Waltham Forest is a three bedded care home. The home specialises in providing support for people with mental health conditions and working towards them developing their independence. There were three people using the service at the time of our inspection.

The service had two registered managers 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.’

Comprehensive risk assessments were not always in place which meant guidance was not always available to staff about how to support people in a safe manner.

People told us they felt safe using the service. There were enough staff to meet people’s needs and robust staff recruitment practices were in place. Staff had a good understanding of issues relating to safeguarding adults. Medicines were managed in a safe manner.

Staff received regular training and one to one supervision. People were free to make choices about their daily lives and consented to the care and support they received. People were able to make choices about what they ate and the service supported people to eat healthily. The service supported people to access relevant healthcare professionals.

People told us they were treated with respect by staff and we saw staff interacted with people in a way that was caring and sensitive.

People told us the service supported them to meet their needs. Care plans were in place which were subject to review. The service had a complaints procedure in place and people knew how to make a complaint.

People that used the service and staff told us they found senior staff to be approachable and helpful. The service had various quality assurance and monitoring systems in place, some of which included seeking the views of people that used the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

Inspection carried out on 14 May 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

People who used the service told us they felt safe. Risk assessments were in place which provided information about how to support people in a safe manner. The service had a safeguarding vulnerable adults' procedure in place and staff had undertaken training about this. Staff had also undertaken training about the safe administration of medication. Medications were stored safely.

Is the service effective?

Care plans were in place which set out how to meet people's assessed needs. Staff we spoke with had a good understanding of the individual needs of people. People said they were supported by the service with their health care needs. One person told us "they make appointments with the GP for me and I see the psychiatrist about once every six months."

Is the service caring?

People told us that staff treated them with dignity and respect. We observed staff interacting with people in a caring and sensitive manner. The service had a robust staff recruitment procedure in place to help ensure staff were of suitable character to work with vulnerable adults.

Is the service responsive?

People's needs were assessed before they began using the service. People told us that care plans were in line with their needs and that they had been involved in developing them. One person told us "I've got my care plan. They talk to me about it. It's got my activities and stuff in it." Systems were in place to support people to take their prescribed medication.

Is the service well-led?

The service had a registered manager in place and a clear management structure. Staff told us that they found management to be approachable. The service had regular staff meetings and staff could request a one to one meeting with their manager at any time. The service had systems in place for seeking the views of people who used the service. One person told us "every Monday we have a meeting. We can talk about what we like."

Inspection carried out on 8 August 2013

During a routine inspection

We spoke to three people who used the service and two members of staff.

People spoke positively about staff and the service, saying "I'm quite happy here" and "the staff are nice people." We observed staff interacting with people using the service, offering support and guidance in a respectful manner.

There were procedures in place to ensure people's consent was sought before care was carried out and people told us staff would not do anything without their consent.

We found people's care was planned and delivered in line with care plans. People told us they were involved in domestic activities and day trips. People said "I do my own washing" and "there could be more activities." Clinical risks were assessed and care plans took these into account, although risk was not formally assessed around individual activities.

There were infection control policies and cleaning schedules, which staff followed. Precautions had been taken to reduce the risk of infection and the premises mostly appeared clean and tidy although kitchen cupboards needed cleaning. People said "staff keep everything nice and clean" and "I help with washing up."

Staff received individual and group supervision and were supported to attain further qualifications and training relevant to their roles.

We found that accurate, complete and up-to-date records were kept about people using the service and staff.

Inspection carried out on 7 December 2012

During a routine inspection

We spoke to three people at the home. One person told us "I feel safe here" and "I like to walk to the shops to get the paper."

We also spoke to three members of staff including the registered manager at the home. Staff were knowledgeable of people's needs and were friendly and professional in their approach. There were systems in place to assess new people who were joining the home and how to support them.

Each person knew who their key worker was and we could see from the daily records that they worked closely with them. People's views were regularly sought through group meetings and individual meetings with their key workers. We saw a copy of the provider's newsletter "Day by Day" where people at the home were told of upcoming activities and contributed to the newsletter. We saw a person at the home had written a positive review about how they were happy with how staff had supported them when they needed it.

We observed that people were offered support to cook for themselves which encouraged independence.

Reports under our old system of regulation (including those from before CQC was created)