Archived: Elm Bank Care Home

Elm Bank is a residential care home registered for 48 places but has 42 bedrooms, some of which were previously used as shared rooms. At the time of this inspection there were 37 people accommodated, including people who were living with dementia.

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

People and relatives were positive about the care, kindness and friendliness of staff. They said staff were respectful, patient and helped people to maintain their dignity.

People and relatives said this was a safe place to live. There were enough staff to meet people’s needs. Staff knew how to report any concerns and said these would be acted upon. The home was clean, warm and comfortable.

People’s needs were assessed to make sure their care could be provided. Some parts of the home were not adapted to support people who were living with dementia. We have made a recommendation about this.

People said the meals were good and there were plenty of choices. Staff worked with other care professionals to support people’s health needs.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service upheld this practice.

People received personalised support that matched their individual preferences. There were enough activities and engagement with the local community to help people’s social inclusion.

People and relatives commented positively on the open culture in the home and the approachability of the registered manager and staff. Staff said that morale had improved and they felt supported.

The provider checked the quality and safety of the service. Overall, the effectiveness of these checks had improved.

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 7 December 2019) and there were two 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Elm Bank is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Elm Bank is registered for 48 places but has 42 bedrooms (some of which were previously used as shared rooms). At the time of this inspection there were 38 people accommodated, including people who were living with dementia. The home was set over three floors, each of which had separate facilities.

There was a registered manager in post. They were not present at the time of the inspection. A ‘Resident Experience’ support manager was managing the service so we have referred to them as acting manager throughout this report. 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.

The provider’s governance systems had not always been rigorously or effectively applied. This meant several shortfalls in the standard of the service had not been identified by the quality audit processes. This is a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 - good governance.

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

Prior to the inspection there were concerns that potential safeguarding incidents had not been acted upon and had not always been reported to the safeguarding authority. Also, unwitnessed falls and injuries had not been reported in line with local safeguarding protocols. This meant people had not always been protected from potential risk of harm. Recently, the acting manager had made sure that accidents and incidents were acted on, reported and appropriate preventative measure were put in place to reduce the risk of further harm.

Staffing levels were based on people’s assessed dependencies but the dependency assessment records were not up to date. Call bells were not always answered in a timely way so sometimes people had to wait for assistance. We have made a recommendation about this.

People said they felt safe and comfortable at the home. Risk assessments were in place about people’s safety and about the premises. The home was comfortable and maintained. There were some areas that needed attention to make them more easily cleanable. Medicines were managed in a safe way but there were some shortfalls in relation to medicine recording.

People who could express a view told us they received a “good service”. Before they moved to the home their needs were assessed to check if the home could provide the right care for them. Staff had opportunities for relevant training, although the induction of new staff and agency staff did not always show they were supported into their new role.

The assessments about some people’s capacity to make their own decisions was not always clear. Staff were going to have more training to help them understand the Mental Capacity Act 2005.

People now received the right support with their nutrition and hydration needs. Risks to people’s nutritional well-being were now assessed and managed. People said they enjoyed the meals and the quality of food was very good.

People and relatives told us staff were kind and caring. Staff were respectful and helpful when supporting people. There were friendly relationships between staff and the people who lived there.

There was a welcoming atmosphere in the home. Staff supported people to make their own individual choices and communicated with them clearly and sensitively.

Following concerns by the local authority about care records being out of date, senior staff were now reviewing and updating everyone’s care records. The records that had been updated were recorded in a personalised and clear way. This work was still on-going during the inspection.

There were activities provided each day and the people who took part said these were enjoyable.

There was not always much interaction with people who spent time in their bedrooms and little to demonstrate their engagement in activities. We have made a recommendation about this.

People were asked for their views in surveys and at meetings. They had information about how to make a complaint and concerns that people had raised were acted upon. Staff felt they could talk with the acting manager and said they were approachable.

Staff told us that the atmosphere improved. They enjoyed working at the home. Staff said they had more direction and guidance now. Communication between management and the staff team had improved. This was evident from the morning briefings held by senior staff and the acting manager.

We last inspected the service on 21 August 2015 where we found two breaches of Health and Social Care Act (Regulated Activities) Regulations 2014. These related to staffing and good governance. We also made four recommendations that best practice should be followed in relation to the management of medicines, the application of the Mental Capacity Act 2005 [MCA], the provision of a varied and balanced diet, and the décor and design of the service, particularly in relation to supporting people living with dementia. We asked the provider to take action to make improvements in these areas and this action has been completed.

Elm Bank Care Home provides accommodation and personal care for up to 43 older people, some of whom were living with dementia. Respite care and a day care service were also provided. The day care service is not regulated by Care Quality Commission (CQC) because it is out of scope of the regulations. There were 41 people using the service at the time of the inspection.

A registered manager was 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 the last inspection, we found that there were insufficient staff to meet the needs of people, particularly those living with dementia. We found that staffing levels had been increased and we observed that care was unhurried and people told us they were attended to promptly.

At the last inspection we found that governance arrangements in place had not identified all the shortfalls we found during our inspection. During this inspection we found that improvements had been made in all areas we had identified. There were improvements to the safety of the premises and equipment, and the home had been refurbished and redecorated, taking into account 'dementia friendly' design best practice. Feedback had been taken on board and acted upon.

Following our recommendation at the last inspection, we found that medicines were managed safely. Records were accurate and complete, and there were safe systems in place for the ordering, receipt, storage and administration of medicines. Quantities of medicines we checked were correct, meaning stock levels were accurate.

Risks to people and the environment had been assessed, and were regularly reviewed. We found that the staff and registered manager were not sufficiently aware of the status of a pressure ulcer of one person, who was being attended to by a district nurse. We made a recommendation that best practice should be followed in relation to the monitoring of skin integrity.

Staff had received training in the safeguarding of vulnerable adults and were aware of what to do in the event of concerns. Suitable recruitment practices were in place which supported safer recruitment decisions and helped to protect people from abuse.

The premises were clean and well maintained. Infection control procedures were followed by staff. Some unsuitable flip top bins we saw on the first day of the inspection, were replaced. There were no widespread malodours, and any issues with odours were addressed at the time they occurred.

Staff received regular training, supervision and appraisals. Recently introduced training in supporting people living with dementia had proven popular with staff who described to us the impact it had had on their approach, and the increase in empathy they felt towards people.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. it also ensures unlawful restrictions are not placed on people in care homes and hospitals.

The service was working within the principles of the MCA. Capacity assessments had been carried out and specific decisions taken in people's best interests were appropriately recorded. Applications to deprive people of their liberty had been made to the local authority in line with legal requirements. This had improved since the last inspection.

Following our recommendation regarding meals at the last inspection, new menus had been developed and all people we spoke with told us the food was good. People were consulted about additions to the menu and their satisfaction with meals was checked on a regular basis. Staff supported people well with eating and drinking. Where people had lost weight or had difficulties swallowing, appropriate professional advice was sought. Special diets were accommodated.

We observed that staff were very kind and attentive in their interactions with people. Relatives and visiting professionals told us staff were caring and we observed that people displayed warmth and humour towards staff with whom they clearly enjoyed good relationships. The privacy and dignity of people was maintained. Staff provided compassionate end of life care which was complimented by visiting professionals.

Care plans had improved since the last inspection. Following the introduction of a "dementia framework" these were more person centred and individualised. There was a greater emphasis on life story work to ensure care and activities could be tailored to meet individual interests and preferences.

The range of activities available had improved. We observed people enjoying group activities, and some people did individual activities such as painting. There were some concerns expressed, and we observed, that people who spent a lot of time in their rooms, or were unable to initiate contact with staff had fewer opportunities for engagement. We have made a recommendation about this.

A complaints procedure was in place. There had been no recent complaints and people were aware of how to complain if they needed to do so. Electronic surveys were available to all people, staff, and visitors to enable them to comment upon the quality and safety of the service. This provided real time feedback which could be responded to straight away by the manager. People were asked about their experience of the service on a regular basis.

The registered manager completed a number of quality and safety checks. We found an overall improvement in these since the last inspection. They had responded positively to the last inspection and had put a number of improvements in place. Staff and relatives told us the registered manager was helpful and approachable. There were systems in place within the wider organisation to monitor the quality and safety of the service.

We found before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person said, 'They always ask before doing anything, we work as a team.'

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. One person told us, 'We have a very honest decent time here, they care very effectively.'

We received mixed opinions from people and staff about whether there were enough staff to look after people. One person said, 'Sometimes there are not enough staff but we are never left in the lurch.' We found that there were enough qualified, skilled and experienced staff to meet people's needs.

There was a system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service. We found that records were kept securely and could be located promptly when needed.