Elm Lodge Residential Care Home

Elm Lodge is a residential care home providing personal care to people aged 65 and over. The service can support up to 17 people. Elm Lodge is a converted property. It has communal areas on the ground floor with bedrooms on both the ground and first floor. At the time of the inspection 16 people were living in the home.

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

The provider had taken action to ensure people's care met their needs and preferences. Risk assessments were in place and reflected people’s needs. The home and equipment were clean.

People told us staff were caring and kind and listened. We saw staff interacted with people with warmth. 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 were provided with opportunities to take part in meaningful activities.

Systems of governance were improved since the last inspection. Quality monitoring systems highlighted and addressed shortfalls in the service. People were generally happy with the care provided and felt consulted and valued. An accurate, complete and contemporaneous record was maintained for each person.

Improvements had been made to staff recruitment records to show staff were recruited safely and there were enough staff to meet people’s needs. The provider had continued with their schedule of redecoration and improvement of the building. Staff had received medicines training and we observed a member of staff administering people’s medicines safely.

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 requires improvement (published 15 October 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended the registered provider considered staffing requirements to ensure all aspects of the service were operating in line with good practice guidance. We recommended the provider considered current guidance on medicines management and took action to update their practice accordingly. At this inspection we found the provider had acted on the recommendations made and had made improvements in these areas.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring, Responsive and Well-led which contain those requirements.

For those key question not inspected, we used the rating awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We continued to seek clarification from the provider to validate evidence found.

Elm Lodge is a residential care home providing personal care to 16 people aged 65 and over at the time of the inspection. The service can support up to 17 people.

Elm Lodge is a converted property. It has communal areas on the ground floor with bedrooms on both the ground and first floor.

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

The premises and equipment were not clean. Risk assessments were in place, but these were not always an accurate reflection of people’s needs. Not all staff had refreshed their fire training and the registered manager was unable to evidence all staff had attended a recent drill. Improvements were needed to ensure staff were always recruited safely. Staff had received medicines training and we observed a member of staff administering medicines to people safely. We have made recommendation about staffing at the home and the management of medicines.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

People and relatives told us staff were caring and kind. We saw staff were friendly and caring in their approach to people, but records did not evidence people were supported to bathe at regular intervals. Most staff involved people in making decisions, but this was not always consistently applied. Staff respected people’s right to privacy and took steps to maintain their dignity.

Care plans and daily records lacked detail about peoples likes, preferences and how their care had been provided. We were unable to evidence people were provided with the opportunity to have meaningful social engagement or occupation. The registered provider had recently purchased a ‘pod’ for the garden to enable people to meet family in the garden. There was a system in place to manage complaints.

Systems of governance were ineffective. Quality monitoring systems had not highlighted or addressed where shortfalls in quality or consistency. Despite our findings, relatives were generally happy with the care provided and staff felt supported by the registered manager. Regular meetings were held with staff and people who lived at the home.

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 13 December 2018).

Why we inspected

We received concerns in relation to infection control, person centred care and management oversight. As a result, we undertook a focused inspection to review the key questions of safe, caring, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key question. We therefore did not inspect the key question, effective. Ratings from previous comprehensive inspections for this key question was used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the relevant sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe.

We have identified breaches in relation to person centred care, safe care and treatment and good governance.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good.

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.

Elm Lodge Residential Care home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Elm Lodge Residential Care home can accommodate up to 17 people who require accommodation and personal care. The home is situated over two floors; communal areas are on the ground floor and bedrooms on both floors. In the grounds of the home there is a car park and a patio area. The centre of Horbury and local amenities are several minutes away. At the time of our inspection there were 13 people living in the home.

There was a registered manager employed at Elm Lodge Residential Care home. A registered manager is a person who has registered with the CQC 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.

People told us they felt safe. Staff discussed safety at team meetings and undertook training so they understood their responsibility to safeguard vulnerable adults.

Systems were in place to identify and manage risk. People had assessments that identified potential risks and how they should be managed. People’s care plans covered areas such as personal care, physical well-being, continence, dietary needs, medicines and mobility. These outlined people’s needs and how staff should deliver appropriate care. Care records were reviewed.

Staffing arrangements ensured people were safe. People told us staff were available to assist them when they needed support. Staff received training and support to help them understand how to do their job well.

The provider had systems in place to manage people’s medicines. These were well organised and stored appropriately. Medicine administration records were well-completed. Guidance was in place for most but not all medicines that were prescribed ‘as required’ or ‘as directed’. The registered manager agreed to ensure protocols were in place where required.

People lived in a safe environment. Work to improve the premises was in progress but there was still a lot of work to do before the environment would be pleasant throughout. There was a lack of signage to help navigation around the service. Plans were in place to address the environmental issues.

People told us they were well cared for and our observations confirmed this. People were complimentary about the staff. Visitors were made to feel welcome and told us they were confident the service was caring.

People enjoyed the meals and had opportunity to engage in a range of activities. They accessed services which ensured their health needs were met.

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 although the provider did not consistently assess people’s capacity even though decisions were made on their behalf.

People said they would feel comfortable raising any issues with care workers and management team. The provider investigated and responded appropriately to complaints.

The registered manager was knowledgeable about the service and had a clear vision for development and improvement. People were encouraged to share their views and put forward suggestions. People who used the service and staff attended regular meetings. The provider had effective systems in place to monitor quality and safety.

Our last inspection took place in June 2016 when we rated the service to be ‘Requires Improvement’. At that time we found four breaches of regulation. They were in relation to consent, safe care and treatment, premises and equipment and good governance. On this inspection we found the provider had achieved compliance in relation to consent and premises and equipment but there were outstanding issues in relation to safe care and treatment and good governance.

During the inspection on 20 July 2017 we checked what actions had been taken in relation to these breaches.

Elm Lodge Residential Care home provides accommodation and personal care for up to 17 older people. Respite care is also provided. The home is arranged over two floors with bedrooms on each floor. In the grounds of the home there is a car park and a patio area.

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.

People told us they felt safe and we saw improvements in environmental safety had been made since the last inspection. This included improvements in relation to fire safety and making sure information was in place for staff to follow in the event of an emergency.

We found water temperatures were not high enough to enable people to bathe or wash safely and comfortably.

Staff knew how to recognise and report abuse.

People spoke very highly of the staff and we saw staff were recruited safely and received good training and support.

We were concerned about the availability of sufficient staff to provide people with the care and support they needed and have made a recommendation that the provider reviews staffing levels and deployment of staff.

Accidents and incidents were analysed to look at ways in which they could be avoided in the future and risks to people mitigated.

Medicines management was safe which helped ensure people received their medicines as prescribed.

We found the home was clean and people who lived there told their rooms were kept clean.

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. Staff needed further training to make sure they fully understood the process in relation to best interest decisions.

People said they enjoyed the food at the home but we found it lacked in nutritional value and found staff did not have good knowledge of people’s dietary requirements or provide people with the support they needed with their meals.

People said they felt well cared for and we observed kind and caring interactions from staff.

We saw people were supported to maintain their health and had access to the full range of NHS services. Paper based care plans were in place for people to take to hospital with them if needed.

People did not always receive the support they needed to make sure their privacy and dignity needs were met.

Care plans were in place but varied in quality. Further work was needed to make sure care plans were person centred and individual to the person concerned.

People said they enjoyed the activities provided at the home and felt their families and friends were welcomed. People told us they appreciated the parties staff organised for them.

People said they could speak with staff or management about any concerns they might have. A complaints procedure was in place and was followed as necessary.

Staff, relatives and people who lived at the home all expressed confidence in the registered manager.

Improvements had been made in systems for auditing the safety and quality of the service and whilst we found the improvements were sufficient to achieve compliance with the regulation we have made a recommendation that auditing required further development to make sure all issues affecting the safety, comfort and wellbeing of people living at the home are identified and addressed.

We found the provider was in breach of three regulations. These were in relation to Regulation 10 (Dignity and respect) and Regulation 14 (Meeting nutritional and hydration needs) and there was a further breach in relation to Regulation 12 (Safe care and treatment).

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

Elm Lodge Residential Care home provides accommodation and personal care for up to 17 older people. Respite care is also provided. The home is arranged over two floors with bedrooms on each floor. In the grounds of the home there is a car park and a patio area. The centre of Horbury and local amenities are several minutes away.

The service was last inspected in April 2014 and they were in breach of regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010

Assessing and monitoring the quality of service provision registered person did not protect service users, and others, against the risks of inappropriate or unsafe care and treatment by operating an effective system to regularly assess and monitor the quality of the service provided; and did not operate an effective system to identify, assess and manage risks relating to the health welfare and safety of service users and others. Regulation 10(1)(a) and (b). The registered person did not analyse incidents that resulted in, or had the potential to result in, harm to a service user. Regulation 10(2)(c)(i). At this inspection we found accidents and incidents were monitored and analysed each month to see if any trends were identified. Where needed the relevant people were contacted for example the falls team. The registered manager carried out regular audits. However, none of the audits had picked up on the concerns we raised. Therefore we would question the effectiveness of these audits.

The service had a registered manager. 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 looked around the service and found that where window restrictors were in place these could easily be removed or were broken. One upstairs window had no window restrictor and could be fully opened. We tried to check a window in a person’s room but they became upset and asked us not to touch it as it was broken and the last time someone had tried to open the window it was difficult to fix and they were cold enough. Two people who mainly stayed in their rooms upstairs complained it was cold on the day of inspection. Some windows did have gaps of up to an inch wide which would cause drafts. We pointed these out to the registered manager.

We found issues around the cleanliness of the service. We found some areas could do with a deep clean. The bath also had a large hole around the edge where the side of the bath seemed to have slipped. In one room the carpet had been torn up by placing the bed therefore could not be properly cleaned and posed an infection control issue. In another room there was a hole in the carpet which could present a trip hazard.

A new stair lift had recently been fitted, this obstructed the bannister on the stair case and there was no handrail on the opposite wall. This could prove difficult for people who used the stairs not the stair lift.

Water temperatures were recorded as being too low. The registered manager carried out fire drill scenarios where staff could discuss what could happen. However no actual fire drills took place. We found the Personal Emergency Evacuation Plans (PEEP’s) did not contain enough information and the summary of people who used the service was out of date.

The service had purchased some new sit on weighing scales. However there was no evidence that these had been calibrated.

Staff we spoke with knew how to administer medicines safely and the records we saw showed that medicines were being administered and checked regularly. However the key to the treatment room was hung up outside which meant that everyone had access to it. The keys for the medicine cupboard and controlled drugs cupboard were left in a tub on top of the trolley. This meant that once someone had access to the treatment room they also had access to all the medicines. We highlighted this straight away to the registered manager who removed the key from outside and made sure the keys were kept with the designated person. Temperatures were not taken daily of the room the medicines were stored; therefore we could not guarantee the medicines were stored at the correct temperature which is not above 28 degrees. At the time of our inspection the room felt very warm.

Policies were in place to ensure people’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were protected. Where appropriate, the service had not always worked collaboratively with other professionals to act in the best interests of people who could not make decisions for themselves.

People were supported to maintain their health through access to food and drinks. The majority of people were happy with the food on offer and they were provided with plenty of choice.

Staff we spoke with understood the principles and processes of safeguarding. Staff knew how to identify abuse and act to report it to the appropriate authority. Staff said they would be confident to whistle blow [raise concerns about the service, staff practices or registered provider] if the need ever arose.

The registered provider followed safe processes to help ensure staff were suitable to work with people living in the service.

There were sufficient staff to provide the support needed and staff knew people’s needs well. However staff we spoke with said they found it difficult to provide support to people at teatime when there was no cook on duty.

We saw that all people who used the service had access to an advocate if needed and information was available. An advocate is a person who works with people or a group of people who may need support and encouragement to exercise their rights. At the time of inspection no one was using an advocate.

We found care plans to be person centred. Person centred planning [PCP] provides a way of helping a person plan all aspects of their life and support, focusing on what’s important to the person.

Activities took place between 2:00pm and 4:00pm each afternoon. The service had a file on what activities had taken place and how much people enjoyed them. One to one activities also took place.

The service worked with various healthcare and social care agencies and sought professional advice, to ensure that the individual needs of the people were being met.

The service had an up to date complaints policy. Complaints were properly recorded and fully investigated.

Staff felt supported by the registered manager.

Feedback was sought on a regular basis from people and their relatives on the quality of the service.

Staff and people who used the service had regular meetings.

The registered manager understood their roles and responsibilities, and felt supported by the registered provider.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

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 safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

Since the last inspection a number of safeguarding issues had been identified in relation to incorrect moving and handling procedures and regarding not following healthcare professional advice. The CQC had also received information of concern in relation to the on call system and the management of the home. As a consequence a new management structure had been put in place and staff training in areas such as moving and handling had been undertaken.

The staff we spoke with were aware of the different types of abuse and described how they would respond if abuse was suspected or happening.

Is the service effective?

People told us they were happy with the care provided and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs. One person told us: 'The staff are so kind. You just mention something and they help you.' Another person told us: 'I get on with them. They're good.'

Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We observed staff interacted with people in a polite and respectful way. Staff were patient when supporting people walking throughout the home and worked at a pace to suit the individual.

We spoke with two people who told us they were happy at the home. One person said: 'It's lovely.' Another person commented: 'It's jolly good.' Both people we spoke with told us they had sufficient things to do such as: dancing, arts and crafts, crosswords and bingo. We spoke with one relative who said: 'My relative loves it here. We are always made to feel welcome.'

Is the service responsive?

We looked at two care records and found care planning information included risk assessments in relation to pressure sores, moving and handling and nutrition. Where risks had been identified we saw people had been referred to other healthcare professionals if concerns arose. However, we noted that some care plans lacked sufficient detail. This meant there was a risk that people's care needs may not be met.

Is the service well-led?

People told us they had recently completed a customer satisfaction survey. The deadline for this information to be returned was following the inspection. We have requested a copy of the feedback analysis is sent to the CQC.

Staff told us they were clear about their roles and responsibilities and felt supported by the management team. One member of staff commented: 'Everything has improved at the home. Before it felt like you were on your own.'

The manager acknowledged that because areas such as staff training had been prioritised, there were no recent audits regarding infection control, complaints, safeguarding and accidents. This meant there was a risk that issues would not be picked up at an early stage.

The manager told us the provider contacted her on a daily basis to check whether there were any concerns. However, there was no evidence that the provider carried out audits to assess and monitor the quality of the service. There was no evidence that the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

'I'm quite happy.'

'Staff are nice. They come to help me straight away.'

'Staff are kind and help me.'

The relatives we spoke with told us they were kept updated about their relative's care. One relative commented: 'Staff are very friendly here. My [relative] is more settled here than at the previous home.'

We looked at outcome four to follow up the compliance action we made at the last inspection. We saw that improvements had been made in relation to people's care records since the last inspection. People's care plans were now more detailed and personalised. However, we found some care plans could have benefited from more detailed information to help staff provide appropriate care.

People and relatives made positive comments about the food. One person said; 'The food is good. I don't like sausages and I can choose something else.' We found that although people did have a choice of food at breakfast and dinner, it was not clear from the menu that people had a choice of food for lunch.

We found that the provider had effective systems in place to reduce the risk and spread of infection.

The management team, staff, residents and relatives we spoke with told us there were enough staff to meet people's needs.