Background to this inspection
Updated
9 February 2015
The inspection team consisted of an inspector and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before we visited, we reviewed the information we held about the service including a provider information return (PIR), which we asked the home to submit. This is a form that asks the provider to give some key information about its service, how it is meeting the five questions, and what improvements they plan to make. We reviewed reports from Age Concern Dignity in Care visits. We also looked at previous inspection reports. At our last inspection in October 2013, the service was judged to be meeting all the standards inspected.
At this visit, we spoke with sixteen people who used the service and two visitors of people who used the service, nine care staff, the chef and the registered manager. We observed care being carried out and we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We used pathway tracking, which means looking at how the service works with people from before they start using the service through to the present or the end of their care package. We looked at five people’s care plans and also reviewed five staff files. We looked at other records relating to the management of the service.
Updated
9 February 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
This inspection was unannounced. At our previous inspection in October 2013, we judged that the service was meeting all the standards we inspected.
Eltandia Hall Care Centre provides care and support for up to 83 people and at the time of our visit, 70 people were using the service. It has two residential units on the first floor and two units offering nursing care on the ground floor. Three of the units provide care for older people and one unit provides nursing care for younger adults with physical disabilities. The service has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.
People felt safe using the service and there were arrangements in place to safeguard people from abuse. Staff were aware of the requirements of the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS), which care homes are required to meet. The service acted within legal requirements when determining whether people needed to be deprived of their liberty to keep them safe.
People had individual risk assessments detailing the risks to their health and safety, based on assessments of their needs. Staff were familiar with risks relating to people and what measures were in place to keep them safe whilst promoting their independence.
People and their relatives felt there were enough staff to keep people safe and robust recruitment procedures were in place so that only suitable staff were recruited. Staff were visible in communal areas and attending to people’s needs in a timely manner.
People received effective care from staff who were appropriately trained. The service sought specialist guidance on best practice. The service took action to address gaps in the specialist knowledge of staff. Staff had regular supervision to ensure they were delivering consistent, evidence-based care.
People were supported to have a choice of enough suitable food and fluids to meet their needs, including cultural needs. Staff ensured that people drank plenty of fluids in hot weather and people at risk of malnutrition were monitored.
People were supported to access healthcare professionals when they needed to and they were regularly visited by dentists and chiropodists. People were able to access specialist services if they needed to.
The home was adapted to meet the needs of people using the service, including people who used wheelchairs or other mobility equipment. There was information displayed, which was designed to meet the needs of people living with dementia. We found that the home was in need of refurbishment, although it was fit for purpose.
People and their relatives had positive relationships with staff. Staff understood and responded to people’s diverse individual needs and were familiar with their histories, preferences and routines. Staff interacted with people in a caring manner and respected their privacy, dignity and independence. There was a ‘dignity champion’ who shared information on specialist guidance and best practice to staff. The service worked with experts to promote the dignity of people living with dementia. People were involved in decisions about their care and support and this involvement was tailored to people’s individual communication needs.
The home used specialist guidance to ensure that when people were dying they had a comfortable and dignified death. They worked with a palliative care team, doctors and with people and their families. However, end of life care plans were not filled in and so there was a risk that people’s end of life wishes might not be carried out because the information was not available.
People’s care was planned and delivered in accordance with their individual needs gathered at assessment and regularly reviewed with people to reflect their changing needs. The service promoted diversity and held cultural celebrations to help ensure that everyone felt included. The service promoted community involvement and encouraged contact with family and friends. A variety of activities and outings was provided, although the activities on offer did not suit everybody who used the service.
There was an accessible complaints procedure and the service responded appropriately to people’s concerns and complaints. People who used the service knew how to complain and felt their concerns were listened to, although some people did not know whom to report concerns to.
Leadership was visible and the manager had an ‘open door’ policy. People knew who the manager was and had a friendly relationship with them. Staff felt supported by managers and were able to raise concerns and ideas. Achievements of staff and people who used the service were celebrated. The home used surveys and meetings to gather people’s views and improve the service, but some people did not have the opportunity to be involved in developing the service.
The service had mechanisms to measure and monitor the quality of the service and learn from accidents and incidents. Action was taken promptly to address shortfalls in the safety or quality of the service so there was a focus on maintaining high quality care.