Archived: Elmhurst Nursing Home

Elmhurst Nursing Home is registered to provide accommodation with nursing care for up to a maximum of 37 people. There were 25 people living at the home at the time of our inspection, some of whom were living with dementia.

There was no registered manager in post at the time of our inspection. The service is required to have a registered manager. During our inspection, we met with the home manager who had applied to become registered manager of the service. 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.

When we undertook our last inspection in January2017 we had concerns about the staffing arrangements and we issued a warning notice which required the provider to make the necessary improvements to improve people's quality of life. They submitted an action plan and we continued to monitor this. At this inspection we reviewed whether the provider had made the necessary improvements and we were assured they had.

At our last inspection January 2017, we found breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. We gave the service an overall rating of ‘requires improvement’. These breaches related to the provider's failure to provide person centred care; to deploy enough suitably trained staff; to ensure decisions made on people's behalf were made in their best interests and a lack of robust systems to drive improvements in the service . We asked the provider to make improvements and to send us an action plan of how they intended to address the shortfalls in care.

At this inspection, we found that provider had made significant improvements and was no longer in breach of the regulations.

There were enough staff effectively deployed to meet people’s health and social needs in an unhurried manner. The provider had safe recruitment processes in place to ensure potential new staff were suitable to work at the home before they started work there.

People felt safe living at the home as staff were available to support them when they needed help. Staff were aware to the risks associated with people’s needs and how to minimise them. Staff were knowledgeable about the different signs of abuse and would not hesitate to report their concerns.

People were supported to take their medicine as prescribed. Only staff who had received training in the safe administration of medicines and assessed as competent were able to give people their medicines. Staff monitored people’s health needs and arranged health care appointments as necessary.

People received care from staff that had the skills and knowledge to meet their individual needs. New staff received a structured induction and were supported by a mentor. Staff felt training opportunities offered were good and relevant to their roles and development needs.

Staff and management understood the principles of the Mental Capacity Act and supported people to make decisions about their own care. Where people were unable to make specific decisions themselves, these were made in their best interest to ensure their rights were protected.

People’s nutritional needs were routinely assessed, monitored and reviewed. People enjoyed the food and were supported to eat and drink enough to maintain their health.

People found staff to be kind and caring. Staff treated people with dignity and respect and enabled them to remain as independent as possible.

People were given choice and felt listened to. People received care that was individual to them and responsive to their changing needs. Staff knew people well and supported them to take part in things they enjoyed doing.

People felt confident and able to raise any concerns they had with staff or management. Complaints were dealt with in line with the provider’s complaints procedures. The provider encouraged feedback from people, their relatives and health care professionals to drive improvements in the service.

There was a positive working culture at the home where staff and management worked together as a team to deliver the vision for the service.

The provider had a range of checks in place to drive improvements in the service.

Elmhurst Nursing Home is registered to provide accommodation with nursing care for up to a maximum of 37 people. There were 29 people living at the home at the time of our inspection, some of whom were living with dementia.

There was no registered manager in post at the time of our inspection. The service is required to have a registered manager. During our inspection, we met with the home manager who had applied to become registered manager of the service. 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.

At our last inspection April 2016, we found breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. We gave the service an overall rating of requires improvement. These breaches related to the provider’s failure to provide person centred care, provide safe care and treatment, deploy enough suitably trained staff and to ensure decisions made on people’s behalf were made in their best interests. We asked the provider to make improvements and to send us an action plan of how they intended to address the shortfalls in care.

At this inspection, we found that provider had not achieved all the improvements required since our last inspection.

There were not enough suitably trained staff to ensure that people received safe care and support that was tailored to their individual needs. Staff were frustrated that they could not always provide person centred care due to a lack of time to do so. Checks were completed on potential new staff to ensure they were suitable to work with people living at the home.

Staff were not always aware of the risks associated with people’s needs and lacked guidance on how to minimise these. It was unclear if people’s prescribed creams had been applied in line with guidance from the prescriber.

The provider had not consistently worked in accordance with the principles of the Mental Capacity Act to protect people’s rights. Staff sought people’s consent before supporting them and provided information in a way they could understand to help them make decisions.

People were satisfied with the quality of the food but had limited choice in what they ate. People’s dietary needs were assessed and associated risks were managed. Where necessary, people were supported to eat in a patient and caring manner. Staff monitored people’s health and sought appropriate medical advice and treatment as necessary.

People’s private space and surrounding environment were not always respected. People’s dignity was not always maintained. People felt staff were kind and caring. People were supported to make choices about their day-to-day care. People felt happy and safe with the care provided to them.

Staff had access to an ongoing programme of training. Staff were supported by their seniors and colleagues who were able to give guidance and advice when needed.

People and their relatives were given opportunities to provide their views on the development of the service. People and their relatives felt able to approach staff or management with any concerns they may have. The provider had a complaints procedure, but this was not consistently followed.

The systems the provider had in place to monitor the quality and safety of the service were ineffective in identifying all the shortfalls we had found. The manager was working towards improving the service, but this had not been sustained due to insufficient resources.

The manager had a clear vision for the service that both staff and management worked towards.

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

Elmhurst Nursing Home is registered to provide accommodation with nursing care for up to a maximum of 37 people. There were 30 people living at the home during our inspection and some people were living with dementia.

There was no registered manager in post. The service is required to have a registered manager. There was a temporary manager in post who was present during the inspection. 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.

At our last inspection 10 February 2015 the service was given an overall rating of requires improvement. We found that the provider was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. The breach related to not enough staff being on duty at night. This meant people did not get the care and supported they required when they needed it. We asked the provider to make improvements and to send us an action plan of how they intended to address the shortfalls in care.

The previous provider went into administration on 3 February 2016 and a temporary provider had been brought in to manage the service on behalf of the administrators. A temporary manager was appointed and had been in post eight days on the first day of our inspection. The provider and manager had completed a number of checks and had found a number of improvements were required to ensure people’s safety and wellbeing. They had a clear vision for the service and were keen to address the identified risk. They had secured additional management resources to bring about timely change and improvement.

At this inspection we found that there were still concerns about the level and deployment of suitably trained staff. People told us they often had to wait for support and this sometimes compromised their dignity. Staff felt overwhelmed by their workloads and frustrated that they did not have time to spend with people other than when they were assisting them with personal care and meals.

Some people did not receive their medicine as prescribed as staff had to prioritise the needs of people who required their medicines at specific times. The morning medicine round often did not finish until late morning and this affected when people could be given their next medicine. Some people’s medicine records were inaccurate and did not reflect the treatment staff were giving to them.

People were cared for by staff who did not have consistent support and supervision to undertake their roles. Staff did not have the appropriate training to enable them to understand and support people living with dementia or other specific illnesses. Staff felt communication was poor and did not feel listened to or supported by the provider.

People’s ability to make their own decisions had not been appropriately assessed. Where decisions had been made on people’s behalf there were no records to show why these decisions were in their best interests. People were always asked before support was given and their wishes were respected. We saw that people were given choice about day to day decisions such as what they would like to wear and where they would like to sit.

People were not always involved in decisions about their care and treatment. People’s care plans were not always tailored to their individual needs and had not been reviewed.

People’s nutritional needs had been properly assessed and monitored. Where people had lost weight they had been referred to the doctor to establish why. People were offered a choice of what they wanted to eat and drink.

People were supported by staff who knew how to keep them safe and how to report concerns should they witness or become aware of abuse taking place. Staff were aware of the support people needed to reduce the risk of harm. Staff knew how to deal with accident and incidents and there were systems in place to reduce the risk of reoccurrence. Appropriate checks had been made to ensure that staff were suitable to work at the home. Staff received a structured induction to ensure that they were competent and confident to support people safely

People were treated with kindness and compassion. Staff had good working relationships with people. They were aware of their likes and dislikes and how they preferred their care and support to be provided. People were treated with dignity and respect and were supported to remain as independent as possible.

People and their relatives were happy to speak to management if they had any concerns or complaints. Where people had complained their concerns had been dealt with appropriately. The provider did not have an up to date complaints procedure. The provider did not have system for gathering people’s opinions on the development of the service.

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

Two inspectors carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with people who used the service, a relative, staff, acting manager and the Head of Business Development. We also reviewed records relating to people's care.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Prior to this inspection we had received a number of concerns that alleged there were insufficient staffing levels during the night time to meet people's needs. We carried out this inspection at 7.40pm, so we had the opportunity to talk with both the day and night staff. Discussions with people who used the service, staff and our observations confirmed that there were insufficient staffing levels during the night to meet people's needs in a timely and safe manner. People who used the service told us that the staff were very nice but sometimes they had to wait a while before they received the support they required. However, people told us that they felt safe. One person said, 'I feel safe and the staff are very nice.' We saw that staff spoke with people in kind and gentle manner.

We found that the nurse who was in charge of the day shift was unaware of how many people were in residence. This meant that in the event of an emergency some people may not be accounted for.

Discussions with the nurse in charge of the night shift confirmed that there were 36 people in residence. They said that 34 people required two care staff to assist them with their mobility and personal care needs. We met with the provider on 13 October 2014. They told us that on the evening of our inspection only 26 people required two staff to support them with their care needs. On the evening of our inspection we saw one nurse and two care staff on duty. Discussions with staff confirmed that they did their utmost to meet people's needs but expressed that this was difficult because of inadequate staffing levels. All the people we spoke with said that the staff were kind but they sometimes had to wait a while to receive support.

While the nurse carried out the drug round, the two care staff on duty assisted one person at a time to go to bed. This meant that the remaining people were left without supervision and support. People who required two to one support received care sequentially. One person who used the service said, "The drug round could take up to an hour."

One person who used the service told us that they required one care staff to assist them with their personal care needs. They told us that sometimes they had to do this them self because there were not enough staff. They told us this was difficult and caused pain and discomfort. Another person who used the service told us, 'There is never enough staff on.' This meant that people were at risk of inadequate care and support. We shared these concerns with the Head of Business Development. On 23 July 2014, we received written correspondence from them to confirm that staffing levels during the night time had been increased.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, staff confirmed that proper policies and procedures were in place.

Is the service effective?

We saw that one person had a large bruise on their arm. They told us they had sustained this whilst being hoisted. This information had not been recorded and the acting manager acknowledged this. The acting manager was unaware of the person's injury. This meant that appropriate measures had not been taken to reduce further risk of injury.

Is the service caring?

One person who used the service said, "The staff are very good, they take a long time to come but I just wait."

Another person told us, "I get the help I need, sometimes I have to wait a while but the staff are nice to me."

We spoke with a relative of a person who used the service. They told us, "I am happy with the care and support X receives."

Is the service responsive?

We observed that staff were busy attending to people's care needs and they did this in a respectful and dignified manner. However, the staff we spoke with acknowledged that the delivery of care was not always carried out in a timely manner due to insufficient staffing levels. The people we spoke with were complimentary about the care they had received but said they sometimes had to wait a while for support.

Discussions with the acting manager confirmed that fluid monitoring charts were in place for all the people who used the service. Records told staff how much fluids the individual required over a 24 hour period. However, these charts showed that people did not receive sufficient amounts of fluids. This meant that appropriate measures were not in place to reduce the risk of dehydration.

Is the service well-led?

There was no registered manager in place at the time of our inspection. The provider has a legal obligation as part of their condition of registration to appoint a registered manager. An acting manager had recently been appointed and they assured us that they would complete an application for registration.

We found that records were being completed accurately and reliably ensuring that healthcare professionals could make clinical judgements based on reliable information.

People told us that their views were being listened to. One person told us, 'They asked me all about what I want and that's what they do ' just how I like it'.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, 'The staff take good care of me' and another said, 'The staff are very caring'.

Generally people were well looked after but some of the procedures that made sure of this were not always being followed.

We talked with people who said that they were well looked after. They said the staff always asked them how they would like things to be done, were always mindful of their privacy and treated them with respect. They told us staff talked to them about how they would like their support to be provided.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said 'You will not find better staff anywhere' and another said 'I like it here'.

People said their comments were listened to. The home's management held regular meetings with the people who use the service to find out what people thought about how their care was delivered.