Elm House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

At our last inspection we found the provider had not adequately assessed environmental risks. People’s Personal Evacuation Plans (PEEPS) in case of fire were out of date and there was a large amount of rubbish in the back garden which was a hazard. This was a breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found all of these issues had been addressed.

At our last inspection we found potential risks to people's safety were not always reduced and people were placed at an increased risk from the spread of infection. This was a breach of regulation 15 (Premises and Equipment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found this had been addressed.

At our last inspection we found there were not enough staff to adequately support people and maintain their care and wellbeing. This was a breach of Regulation 18(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection this had been addressed.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Incidents and accidents were documented, and staff knew how to report any incidents of concern. The provider ensured learning through discussing any accidents and incidents in staff meetings and staff supervisions. Where necessary, people’s risk assessments were reviewed and updated. The provider had an organisational compliance team who also reviewed any incidents and accidents.

Staff told us they felt there was a culture of openness and learning when any accidents and incidents occurred. The team leader told us people were involved in reviewing accidents and incidents during key working meetings. Keyworking meetings are where a staff member had the responsibility for reviewing a person’s care and they have regular meetings with the person.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People living at Elm House had been there for a number of years. Staff understood their needs and worked well with other healthcare professionals. This ensured people experienced continuity of care.

At the time of the inspection, the home had one vacancy. We asked the Compliance Mentor how they would ensure a safe transition for a new resident. The provider had an admissions manager who worked across all services the provider owned. There was a clear referral process in place which the person was fully involved in. This aimed to ensure the home could meet the person’s care and support needs as well as the person ensuring the home was right for them. Staff used tools to support people with a learning disability to help transition such as, story boards, visits and overnight stays. The home also completed an impact assessment to ensure any new referrals would fit in with existing residents. The Compliance Mentor told us, “The admission manager will do an impact assessment to ensure the person will fit in. For example, age, most of our people here (at Elm House) are in their forties and fifties, so we would not bring in a much younger person.” This would ensure people were compatible with each other in the home and promote better experiences for people.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked well with other agencies to do so.

Staff had training on how to recognize and report abuse, and they knew how to apply it. People and those who matter to them had safeguarding information in a form they could understand, and they knew how and when to raise a safeguarding concern.

The safeguarding policy had been tailored to reflect Elm House. There were specific contacts for safeguarding authorities relating to each person. The safeguarding policy was up to date and provided clear guidance for staff.

People who lacked capacity to make certain decisions for themselves or had fluctuating capacity had decisions made by staff on their behalf in line with the law and supported by effective staff training and supervision. Where people required an advocate, people were supported to access this.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People lived safely and free from unwarranted restrictions because the service assessed, monitored and managed safety well. People, including those unable to make decisions for themselves, had as much freedom, choice and control over their lives as possible because staff managed risks to minimise restrictions.

The service helped keep people safe through formal and informal sharing of information about risks. Staff could recognise signs when people experienced emotional distress and knew how to support them to minimise the need to restrict their freedom to keep them safe. Staff restricted people’s freedom based only on their individual needs and in line with the law. Staff had been trained in restraint techniques but told us they had never used this approach because they knew people well and used other de-escalation techniques.

People’s risk assessments were clear and provided staff with guidance on how to manage and minimise risk.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff regularly checked for environmental hazards and auditing processes showed where issues were identified and addressed. Windows had window restrictors to prevent accidents. There were processes in place to monitor the safety and upkeep of the premises. This included water safety, general buildings checks, fire systems, and gas and electricity safety.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service had enough staff, including for one-to-one support for people to take part in activities and visits how and when they wanted. The Compliance Mentor told us staffing ratios would be assessed and increased when they filled the current vacancy. A staff member told us, “Not bad staffing levels. Mostly there are three people: one senior, one manager and one staff. Night duty one staff member only. This is enough at night.” A relative commented, “I think enough staff to care for people.”

Staff recruitment and induction training processes promoted safety. All background checks were completed prior to staff starting the job.

People were supported by staff who had received relevant training. This included training in the wide range of strengths and impairments people with a learning disability and/ or autistic people may have, mental health needs, communication tools and positive behaviour support. All staff had completed the Oliver McGowan training which is a specialised training for working with people with a learning disability. Updated training and refresher courses helped staff continuously apply best practice.

Staff received support in the form of continual supervision, appraisal and recognition of good practice. The service had clear procedures for team working and peer support that promoted good quality care and support.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The home was clean and smelled fresh. Worn furniture had been replaced and areas of the home redecorated. We identified the floor tiles in the office were still cracked and two toilets were not in a good sate of repair. Following the inspection, we were sent evidence to show the tiles and toilets had been replaced.

The service now used effective infection, prevention and control measures to keep people safe, and staff supported people to follow them. The service had good arrangements for keeping premises clean and hygienic.

Staff used personal protective equipment (PPE) effectively and safely. The service’s infection prevention and control policy was up to date.

The provider made sure that medicines were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People were supported by staff who followed systems and processes to prescribe, administer, record, store and administer medicines safely. This included where there were difficulties in communicating and when assessing risks of people taking medicines themselves.

The service ensured people’s behaviour was not controlled by excessive and inappropriate use of medicines. Staff understood and implemented the principles of STOMP (stopping over-medication of people with a learning disability, autism or both) and ensured that people’s medicines were reviewed by prescribers in line with these principles.

People’s care plans documented how people wanted to take their medicines which met their needs.

'As needed’ medicines are medicines such as pain relief or to help with anxiety. Where people had been prescribed ‘as needed’ medicines, there was information for staff on what the medication was. However, we requested the information was updated to include what actions staff should take before offering these medicines. Specifically relating to medicines to help people feel calmer when agitated. This was provided following the inspection.