Archived: Elliscombe House Nursing Home

People were not always treated with consideration and respect and their privacy was not always maintained. For example, staff focus was not always on the person they were supporting as staff spoke with people other than the person they were supporting with their meal.

Care was not always delivered to meet people's needs. For example, one person's risk assessment indicated that they were at risk of becoming entangled in their call bell and did not have the ability to use it. However, we saw that this person was provided with a call bell which may have placed them at risk. People's care records did not always contain accurate information. For example, people's food and drink was not always recorded accurately.

People's medicines were managed safely.

The home had policies which provided information and guidance to staff as to how to recognise and report actual or suspected abuse and staff were aware of these policies. However, staff did not have knowledge of the Deprivation of Liberty Safeguards.

The provider had made a number of improvements to the environment. For example, the installation of clear signage to indicate when there was a change in floor level and hand rails were present which were painted in a bright contrasting colour to assist people with sensory impairments. However, these improvements were not sufficient. For example, a fan heater in a shower room could be touched by the shower head. This placed people at risk as the heater could easily be splashed by water.

Staff were not always available to meet people's needs and there was not always clear leadership or on going supervision of staff. The provider did not operate effective quality monitoring of the service.

We inspected in November 2012 to follow up the warning notices. The provider remained in enforcement action as they had not made the improvements to demonstrate compliance.

At our inspection in January 2013 we found that people's preferences were not always respected, they were not always involved in planning their care and people remained at risk of receiving inappropriate and unsafe care. Staff did not have suitable skills and experience to care for people and people's care records were not always accurate or appropriately maintained. We returned in March 2013 and found that the provider was non compliant because people were not protected against the risks associated with medicines.

During this inspection we found that people were not always treated with consideration or respect, their preferences were not always respected and people remained at risk of receiving inappropriate and unsafe care. Quality audits did not identify issues raised at our inspection and records were not always accurate or complete. The provider had made some improvements to the premises.

Accurate records were not kept of the application of people's prescribed creams and ointments. Insufficient information was available for staff about the use of some medicines that had been prescribed for people to be given 'when required'. This meant that people were at risk of not receiving their medicines in a safe and consistent way.

The dose instructions for some people's medicines had been changed following verbal instructions from a healthcare professional. This information had not been confirmed in writing. This increased the risk of mistakes being made.

We also found the home non compliant because people's views and experiences were not taken into account in the way the service was provided and delivered. The provider had a system to assess and monitor the quality of service that people received however issues identified were not always acted upon to improve the quality of the service provided. People were not protected from the risks of unsafe or inappropriate care and treatment because records were not completed. The provider sent us an action plan and told us they were compliant.

We inspected on 12 November 2012 to follow up the warning notices. The provider remained in enforcement action as they had not made the improvements to demonstrate compliance.

During this inspection we found that people's preferences were not always respected, they were not always involved in planning their care and people remained at risk of receiving inappropriate and unsafe care. Staff did not have suitable skills and experience to care for people and people's care records were not always accurate or appropriately maintained.

People were, at times involved in their care. One example was a person who was enabled to go out for a cigarette when they wanted to. The staff would assist the person outside so that they could meet this need. However, one person told us that they preferred female staff to assist them with their personal care needs but they had not been asked so at times, a male member of staff assisted them with their personal care.

People told us that there were one or two members of staff had 'terrible attitudes' and another person told us that a member of staff had shouted at them. People had told staff that members of staff had been rude to them and although staff had a good understanding of safeguarding and whistle blowing, no one had made a whistle blowing or safeguarding alert.

We observed people being assisted up towards the early afternoon and people did not always get their lunch in a timely manner.

People told us that they had to wait some time for call bells to be answered. One person told us that on the morning of our visit, they had been left on the toilet for some time without a call bell and subsequently were very uncomfortable.

During this inspection people told us that sometimes they had to wait for their call bells to be answered but we did observed that people were getting their meals in a timely manner.

Staff had a good understanding of safeguarding and how to report concerns but there were still concerns that staff may shout or be abrupt with people.

People told us they did not feel there were enough staff. The home had increased its numbers of registered nurses in the morning but we saw that there were still times when people were not being assisted to get up until the late morning or early afternoon.

The provider remained non compliant with the warning notices and we have asked the provider to submit a strategic action plan and to voluntarily agree not to admit any more persons until the service is compliant with the regulations. The provider had five working days to submit this action plan.