Elm House

Updated 27 April 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of 1 inspector and 1 Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Elm House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Elm House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the inspection visit, we spoke with 3 people living at the service and 1 relative. We spent time in the communal areas observing the care and support people received. In addition, we spoke with the registered manager, 1 care staff and the compliance manager.

We reviewed 3 people’s care records which included care plans, risk assessments and medicines records. We reviewed 2 staff recruitment records and other documents related to the running of the service which included staff rotas, audits, surveys, meetings and quality assurance records.

After the site visit, we spoke with 4 family members and sought feedback from health and social care professionals.

Updated 27 April 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Elm House is a residential care home providing personal care for up to 5 people. At the time of the inspection, 5 people were using the service.

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

Right Support:

People did not consistently receive safe care at the home. Environmental risks had not always been identified and resolved to limit unnecessary risk to people. People were placed at increased risk from the spread of infection.

People's medicines were being managed safely.

People had their own rooms which had been personalised. People were able to use communal areas as they wished.

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.

Right Care:

People were not always consulted on planning the food menu and had limited choice around what they wanted to eat. Staff did not ensure people using the service had a fulfilling and meaningful everyday life.

Staff were polite with people, but they did not always help them follow their interests.

The home was not clean, needed decorating and items replaced.

People were treated with kindness and staff respected their privacy. Staff were appropriately skilled to meet people's needs.

Right Culture:

The provider was not effectively assessing the quality of the care at the home or considering the quality of people's experiences.

The service did not always ensure risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

Based on our review of safe, effective and well led, the service was not able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

The provider took immediate action to seek support to address leadership and governance concerns and implemented an urgent action plan to mitigate risks to people's safety and quality of life.

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 03 May 2019).

Why we inspected

We received concerns in relation to poor care, staff training and lack of management oversight. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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.

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

Enforcement

We have identified breaches in relation to safe care and treatment, premises and equipment, staff deployment, nutrition and hydration and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.