Archived: The Elms Care Home

The Elms Care Home is a care home that provides personal and nursing care for up to 37 people living with dementia. The home is in one adapted building over two floors. At the time of our inspection there were 29 people receiving the service.

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

The service was not well-led. The registered manager and provider failed to carry out their regulatory responsibilities. Quality assurance processes were ineffective, this meant people were exposed to unnecessary risk of harm. The provider failed to deliver safe and effective care and had not always taken the action they said they would to improve the service people received.

People were not always protected from harm because staff did not always ensure they received care and treatment in a safe and effective way. People did not always receive their medicines as prescribed. Staff did not always seek prompt medical advice after medicines errors occurred.

People's needs were not effectively assessed or reviewed, and their care was not always planned in line with best practice guidance. People’s health conditions were not monitored in line with guidance and necessary referrals were not always made to external healthcare professionals. People were not effectively supported at the end of life. People were not always supported to make informed decisions about end of life care in a person-centred or timely way.

Staff did not always safeguard people from harm and had not referred all potential safeguarding events to the local authority in line with the local authority’s protocols.

People experienced delays in receiving care and staff felt rushed when providing care. The provider was highly reliant on the use of agency workers and resulted in people not receiving consistent care. There was no reliable record of the staff who had worked in the home. We therefore could not be confident of who provided care or was present in the home on any given date.

People's fluid and food intake was inconsistently managed. Despite the provider’s assurances, we continued to find these records were not satisfactorily completed and we therefore could not be confident people were receiving sufficient fluids.

Staff received an induction when they were first employed at the service. However, they did not always receive an induction when they were promoted into new roles within the senior team. This meant staff did not always know and understand the provider’s systems or their responsibilities. Not all staff had completed relevant training within the provider’s expected timeframe. The registered manager was addressing this and had written to staff with short timescales for completion. Staff did not feel well supported by management.

People were not consistently 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 support this practice.

People were not always treated with dignity and respect or their independence promoted.

People told us they liked the food and were given choice at mealtimes. Some people told us they could make decisions about their day to day lives, such as when they got up and went to bed and how they spent their day.

People who were able to access communal areas told us they had opportunities to pursue interests and join in communal activities. Some people told us they liked the staff. They described staff as good and kind.

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 (report published 20 September 2019).

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. The rating has changed to inadequate.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and 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.

Enforcement and Recommendations

We have identified continued breaches in relation to safe care and treatment, and good governance at this inspection. We have identified new breaches at this inspection in relation to safeguarding people from abuse, staffing, person-centred care, nutrition and hydration, and dignity and respect.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

All visitors to the service had their temperature checked, undertook a rapid COVID-19 test, completed a health questionnaire and were provided with personal protective equipment (PPE).

Only essential visits were being facilitated at the time of our inspection such as for end of life care.

The provider had developed policies and procedures in response to the COVID-19 pandemic. Risks to people and staff in relation to their health, safety and wellbeing had been thoroughly assessed.

PPE was placed throughout the service, with ample supplies available. Staff were seen to be adhering to the PPE guidance and protective measures in place.

The service was clean and hygienic. Cleaning schedules were in place. People's rooms and areas frequently touched by people and staff such as door handles were cleaned regularly.

The Elms Care Home was providing personal and nursing care to 29 people older people and people living with dementia at the time of the inspection. The service can support up to 37 people in one adapted building over two floors.

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

Staff had been trained in the administration of medicines. However, some people had not received their medicines in line with the prescriber’s instructions. Also, detailed guidance was not in place for the management of creams. Records did not state when creams where and when creams were to be applied.

Care records did not always fully reflect peoples care needs, including peoples nutritional and hydration needs. Peoples care needs were not always met in a timely way.

The provider had a quality auditing system, but this has failed to identify some of the areas we identified that needed improvement.

People were positive about the caring nature of staff. We observed positive interactions between staff and people using the service. One person said, “Staff definitely know how to look after me.” People were supported by external health and social care professionals and staff supported people to attend appointments as needed.

Staff received an induction when starting at the service. Regular training, specific to their role, was delivered and refreshed when needed. Staff received supervision and felt supported by the management team.

A complaints procedure in place. Formal complaints were recorded although they did not always show the action that had been taken.

People were offered opportunities to take part in regular activities. One person told us, “The activities are very good. Kids come and play which is nice.” People were supported by staff who respected their diversity and cared about them. People made decisions about their everyday care and support and staff respected people's privacy and dignity. A relative told us, “The staff are very patient. They look after [family member] very well.”

Accidents and incidents were reviewed, and action taken as needed.

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

The last rating for this service was good (published 7 March 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staff responding to call bells, repositioning, hydration, poor medicine management, staffing levels and cleanliness of the service. A decision was made for us to inspect and examine those risks. We found some evidence during this inspection that people were at risk from these concerns. Please see each section of this full report.

Enforcement

We have identified breaches in relation to the management of medicines and how quality and safety of the service is monitored, and improvements are made. Please see the action we have told the provider to take at the end of this report.

Follow up

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.

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

The service is registered to provide accommodation for up to 37 people, including older people, some of whom may be living with dementia. The accommodation is provided over two floors

We inspected the service on 30 January 2018. Our inspection was unannounced. There were 27 people living in the care service. This is the first inspection since the location was registered in January 2017 with a new provider.

The service had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’) 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 were enough staff to keep people safe and meet their care and support needs in a timely way. Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively. Staff provided end of life care in a sensitive and person-centred way. Pre-employment checks were completed on staff before they were assessed to be suitable to look after people who used the service.

People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm. There was evidence of organisational learning from significant incidents and events.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. Systems were in place to ensure effective infection prevention and control.

Staff were kind and patient. People were provided with food and drink that met their individual needs and preferences. People were provided with a varied activity programme including visiting the local town.

Staff were able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

The registered manager were well known to everyone connected to the service. A range of audits was in place to monitor the quality and safety of service provision and action was taken where improvements were identified.

People were involved in the running of the service. Regular meetings were held for the people and their relatives so that they could discuss any issues or make recommendations for improvements to how the service was run.