Ellacombe

Ellacombe is a residential care home providing care and support to up to 45 people. The service supported people living with dementia. At the time of our inspection there were 34 people using the service.

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

Improvements were required to protect the condition of people’s skin to reduce the risk of developing pressure sores. Changes to the recording of when checks of people’s skin took place needed to be improved.

Where people were meant to have additional calories added to their diets to support weight management, records did not show this was consistently being provided. This was of particular concern where their daily food records showed they had experienced an overall poor intake.

If people smoked, particularly if using flammable creams on their skin, management plans in place to protect them from harm were found not to be consistently followed.

Some people were known to be at risk of accessing other people’s bedrooms, going through drawers and potentially taking items without staff support and supervision. We found drawers containing craft and gardening items, as well as personal cigarette lighters and tobacco, alcohol and items of food that was not found to be stored securely. The assessment of such risks was required to maintain people’s individual safety, particular for people living with dementia.

Some improvements to the management of people’s medicines were required, in relation to the consistent application of creams. Also, in relation to the guidance in place for staff to follow where people received their medicines covertly (hidden in food or drink).

Whilst we identified some areas of improvement still required at the service, we also identified areas of development and changes made as an outcome of findings from our last inspection. Overall, we found a clear intent by the registered manager to support ongoing improvement at the service.

There were sufficient numbers of suitably trained staff available to meet people’s needs. We observed kind and meaningful interactions between people and staff during our inspection. We received mainly positive feedback from people living at the service and their relatives.

We found the registered manager and staff team responsive to our feedback and were keen to make improvements and changes to ensure people received good standards of care. Staff proactively fund raised to support inhouse and external activities, and wanted to ensure people’s wellbeing remained a priority of their care.

Staff morale was observed to be good, and we received positive feedback about working at the service. Staff showed compassion and changes in leadership at the service since our last inspection were supporting a changing culture within the staff team.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 01 February 2020).

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 the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service and in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of relating to the provision of safe care. This inspection examined those risks.

As a result, we undertook a focused inspection to review the key questions of safe 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 remains requires improvement based on the findings of this inspection.

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

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

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.

Ellacombe is a residential care home providing personal care and support for up to 48 people aged over 65 years. Most people were living with dementia. At the time of the inspection, 36 people were living at the service.

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

Environmental risks, maintenance and replacement of certain items of equipment and concerns around medicines management were identified which did not always ensure people’s safety. Leadership and governance arrangements within the service were of concern, as they were not always identifying shortfalls and making changes to address them. There were breaches of regulation impacting on the quality of service provided to people.

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; policies and systems in the service were not always followed to support good practice. We recommended that the service build in checks of corresponding legal paperwork into their care record audits to ensure they consulted with people with the correct legal powers to make decisions on people’s behalf.

We received mixed feedback from people on the levels of activities they were able to access, and to maintain hobbies, interests and social networks. Staff treated people with kindness and were polite, and we received mostly positive feedback from people’s relatives about the care provided.

Management plans were in place for people needing support at the end of their life. The service told us they had good working relationships with health and social care organisations to ensure people received joined up care. The service held an end of life care accreditation.

The registered manager encouraged people and their relatives to give feedback on the service, and areas for improvement through questionnaires and community meetings.

Rating at last inspection: Ellacombe was previously inspected 29 March 2017 and rated as Good overall. The report was published 19 April 2017.

Why we inspected: This was a scheduled, comprehensive inspection, completed in line with our inspection schedule.

Enforcement

We have identified breaches of regulation in relation to safe care and treatment, maintenance of equipment, consent to care and support provided and good governance arrangements. Please see the action we have told the provider to take at the end of this report.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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.

At our last inspection on 10 and 12 May 2016, we found the service required improvements in areas of effective, responsive and well-led. At this inspection, we found that improvements to these areas had been made and these areas were now rated as good.

There had been improvements in staff competence. Staff had received training in areas specific to the people they were supporting and this helped to make sure that people received competent care individual to their needs.

The quality and the choice of food had improved. People’s nutrition and hydration needs were met. People had a choice of freshly cooked meals and a choice of drinks was available to everyone throughout the day.

At the last inspection in May 2016 people did not have enough occupation. At this inspection there were staff dedicated to providing this to people. People were supported to maintain their interests and engage in activities and conversation.

There were improved, effective systems in place to monitor the quality of the service and these were used to develop and improve the service.

The home was safe and staff understood their responsibilities to protect people from harm or abuse and had received relevant safeguarding training. Staff were confident in reporting incidents and accidents should they occur.

There were effective processes in place to minimise risk to individuals. Assessments had taken place regarding people’s individual risks and clear guidance was in place for staff to follow in order to reduce risk.

Staff understood the importance of gaining people’s consent to the care they were providing to enable people to be cared for in the way they wished. The home complied with the requirements of the Mental Capacity Act 2005 (MCA).

People’s privacy and dignity were promoted and they had good relationships with staff who were kind and caring towards them. People were encouraged to be as independent as possible and make their own choices.

Staff had good knowledge about the people they cared for and understood how to meet their needs. People planned their care with staff and relatives, and people were supported to access healthcare wherever necessary and in a timely manner.

The management team was visible throughout the home and people found them approachable. They found the registered manager addressed any concerns. People were encouraged to provide feedback on 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. There was a registered manager in post.

The home was safe and staff understood their responsibilities to protect people from harm or abuse and had received relevant safeguarding training. Staff were confident in reporting incidents and accidents should they occur.

There were effective processes in place to minimise risk to individuals. Assessments had taken place regarding people’s individual risks and clear guidance was in place for staff to follow in order to reduce risk.

Staff had received some training in areas specific to the people they were supporting and this helped to make sure that people received care individual to their needs. However, there were some areas where improvements to staff competence were needed.

Staff understood the importance of gaining people’s consent to the care they were providing to enable people to be cared for in the way they wished. Applications for the lawful deprivation of people’s liberty (Deprivation of Liberty Safeguards) had been made and staff promoted choice where people had variable capacity. The home complied with the requirements of the Mental Capacity Act 2005 (MCA).

People were supported to access healthcare wherever necessary and in a timely manner. People’s nutrition and hydration needs were met, however drinks were not always available to everyone throughout the day.

People’s privacy and dignity were promoted and they had good relationships with staff who were kind and caring towards them. People were encouraged to be as independent as possible and make their own choices. At times people had to wait for a long time for their call bell to be answered, so their needs were not always met in a timely manner.

Staff had good knowledge about the people they cared for and understood how to meet their needs. People planned their care with staff and relatives.

There were not enough hours dedicated to the provision of activities in the home so people were not always supported to maintain any interests.

The management team was visible throughout the home and people found them approachable. They found the registered manager was responsive in addressing any concerns. People were encouraged to provide feedback on the service.

There were some systems in place to monitor the quality of the service and these were used to develop and improve the service, however there were some areas where improvements were needed.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with five people using the service, the manager, four staff supporting them and from looking at records.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, “The staff are very good and kind. “ One person said “staff respond promptly to my call alarm.”

People using the service, their relatives, friends involved with the service completed a satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. There was sufficient moving and handling equipment at the home which had been well maintained and serviced regularly. Staff had received appropriate training and guidance to use the equipment safely.

Records contained detailed assessments of people's needs that had been carried out prior to them moving to the home. Any training needed for staff to support people safely was identified and provided prior to the person moving to the service to ensure that they had the relevant skills and knowledge required to meet the individual’s identified needs.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, staff were able to describe the circumstances when an application should be made and knew how to submit one.

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Staff personnel records contained all the information required by the Health and Social Care Act 2008. This meant the provider demonstrated that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew the people well. One person told us. "The staff are very helpful, if I choose to eat my meal in my room they bring it to me.” Another person said “Living here is like living in a five star hotel and the food is very good. First class - lots of choice.”

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

People’s needs were taken into account with signage and the layout of the service which enabled people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

The training that staff had received equipped them to meet the needs of the people living at the home.

Is the service responsive?

People knew how to make a complaint if they were unhappy. The service held resident and family meetings every two months where people had an opportunity to provide feedback on the service.

We saw that people who used the service and their relatives had raised concerns that there had been significant reduction in the planned social activities within the home following a recent staffing restructure. The manager was reviewing the impact of the staffing changes in relation to the level of activities provided.

People using the service, their relatives and staff completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. This helped to ensure that people received a good quality service at all times.

You can see our judgements on the front page of this report.

We spoke with nine people, one visitor and six members of staff. Staff were clear about their responsibilities and showed a good knowledge and understanding of how to meet people's needs. People who used the service told us that staff were kind and always there if they needed help.

We saw that people were relaxed with staff, who listened to their views and concerns. People told us that they would speak with staff if they had a problem or were worried about anything.

Staff were provided with training appropriate to their roles and they were regularly supervised and appraised.

We found that the provider had implemented robust systems to regularly assess and monitor the quality of the services provided.

People were generally satisfied with the care and support they received from staff at Ellacombe. One person said: "Some of the carers are very good, they're always smiling, it's so nice to have friendly, cheerful people look after you."

People told us that they liked the meals and they got some 'good home cooking' and had plenty of choices from the menu. They said that the care and support they received met their needs, they got their medicines on time and staff asked them regularly if they were comfortable.

One person told us they enjoyed the organised activities and also enjoyed spending some time on their own in their small lounge.

None of the people living there or visiting had any complaints to discuss.