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Archived: Elmsleigh Care Home Inadequate

The provider of this service changed - see old profile

Reports


Inspection carried out on 25 October 2016

During a routine inspection

Elmsleigh is a care home that provides nursing care for up to 48 older people, some of whom had a diagnosis of dementia or other mental health conditions. On the day of the inspection there were 45 people living at Elmsleigh. Thirty-three people lived in the main house and 12 people lived in the adjoining annex (called the bungalow).

The service is required to have a registered manager and at the time of our inspection a registered manager was not in post. The manager who was in charge of the day-to-day running of the service had applied to become the registered manager. At the time of this inspection their application was being processed. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

We carried out this unannounced inspection of Elmsleigh Care Home on 25 October 2016. At this comprehensive inspection we checked to see if the service had made the required improvements identified at the inspection of 14 June 2016.

In June 2016 we found the premises and equipment were not properly maintained. There were two shower rooms, where the showers had been removed, and the floors were stained and dirty. There were three bathrooms that were not in full working order, including water that was too hot to be safely used by people living at the service. An unlocked boiler room, accessed through a bathroom, put people at risk of harm because the room had hot pipes and electrical equipment. There was broken equipment stored around the premises, including in areas identified at a previous inspection in September 2015.

At this inspection while we found some improvements had been made to the premises and the environment there were still areas of concern. There were communal bathrooms and en-suite bathrooms that either did not have hot water or had water that was too hot with the risk of scalding people. One shower room had a wall mounted electric bar heater approximately three feet immediately opposite the shower which meant water could come in contact with the heater. There was no hot water available in the kitchen on the day of the inspection. While the door to the boiler room, accessed through a communal bathroom, was locked the door leading into the boiler room in a corridor was not locked. Three bedroom self closing fire doors were seen wedged open by furniture and a suitcase in one case. These issues put people at risk of harm.

Most of the broken equipment that had previously been stored around the building had been removed. However, we did find an unused pressure mattress, unnamed continence pads and a ladder stored in the entrance area to a toilet used by people. The premises were warm throughout the inspection, except for one corridor which was cooler than the rest of the building. The communal areas were clean and odour free. However, some people’s bedrooms were not clean and had strong incontinence odours. Several toilets and bathrooms did not have paper towels, soap or waste bins to enable effective hand washing and infection control. All of the above created an environment that was not homely or pleasing for people to live in.

In June 2016 we had concerns about the safety of two people living at the service who had been assessed as being at high risk of falls and ‘unsafe if left unobserved’. At this inspection we found action had been taken to help reduce the risk of harm for these two people. One person’s health had deteriorated and they were less mobile than they had been. They had also been provided with head protection, to protect their head if they did fall. The other person had been given funding to have individual care. While this had helped to reduce their falls this person could still suddenly get up and attempt to walk. However, there was no risk assessm

Inspection carried out on 14 June 2016

During a routine inspection

Elmsleigh is a care home that provides nursing care for up to 48 older people, some of whom had a diagnosis of dementia or other mental health conditions. On the day of the inspection there were 44 people living at Elmsleigh. 32 people lived in the main house and 12 people lived in the adjoining annex (called the bungalow).

The service is required to have a registered manager and at the time of our inspection a registered manager was not in post. The manager in charge of the day to day running of the service had submitted an application to CQC for the registered manager position. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

We carried out this unannounced inspection of Elmsleigh Care Home on 14 June 2016. At this comprehensive inspection we checked to see if the service had made the required improvements identified at the inspection of 8 September 2015. In September 2015 we found the premises and equipment were not properly maintained. Some areas of the building did not have hot water due to problems with the boiler. There was broken equipment stored around the building, including in areas used by people such as lounges and bathrooms. There were two dirty shower rooms where the showers had been removed and the space was being used to store broken equipment. Toilet facilities in both these shower rooms were being used by people.

We also found there were not enough working hoists and wheelchairs to meet people’s needs. There were insufficient adaptations to the premises to support people with dementia.

At this inspection we found that signage to help people with dementia to orientate independently around the building was in place. Additional hoists and wheelchairs were available in the service and staff told us there was enough suitable equipment to meet people’s needs. The two shower rooms, identified at the inspection in September 2015 as being dirty, had been partially re-decorated although the floors where the showers had been were still dirty and stained.

There was still broken equipment stored around the premises, including in the two shower rooms identified at the last inspection. There were three bathrooms where water was either at the incorrect temperature or taps that were not working. An unlocked boiler room put people at risk of harm because the room had hot pipes and electrical equipment. During the afternoon we found the heating along one corridor of the premises was not working. After we advised the deputy manager, the thermostat was altered, and by end of the inspection heating had been restored to that area. These concerns potentially put people at risk of harm and created an environment that was not homely or pleasing for people to live in.

We had concerns about the safety of two people living at the service who had been assessed as being at high risk of falls and ‘unsafe if left unobserved’. Both people had moved from other services where they had been funded for individual support. The funding for additional staff had not transferred with them and managers had not put any additional staff on duty each day. The numbers of staff on duty were not enough to provide individual care for each of these people. Records showed that both persons A and B had fallen on a number of occasions. At the time of our inspection one person was in hospital and the other person had recently returned from hospital. Both had been admitted to hospital with injuries from falls at the service. Insufficient action had been taken to mitigate the risk of harm to these two people.

Advice was sought from external healthcare professionals but not always acted upon. For example, records for one person showed that in February 2016 a discussion took place between the servi

Inspection carried out on 8 September 2015

During a routine inspection

We carried out this unannounced comprehensive inspection of Elmsleigh Care Home on 8 September 2015. Elmsleigh is a care home that provides nursing care for up to 48 older people. On the day of the inspection there were 37 people living in Elmsleigh. 25 people lived in the main house and 12 people lived in the adjoining annex (called the bungalow). Some of the people at the time of our visit had mental frailty due to a diagnosis of dementia or other mental health conditions.

The service was last inspected in February 2015 to follow up concerns from a comprehensive inspection in November 2014. At the inspection in February 2014 we found improvements had been made and the provider had met the legal requirements outstanding from November 2014.

The service is required to have a registered manager and at the time of our inspection a registered manager was not in post. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

We found that the premises and equipment were not properly maintained. On the day of the inspection there was no hot water in the main house due to problems with the boiler. There was a broken freezer and blast chiller in the kitchen that needed to be disposed of. However, the freezer had been broken for five months and the blast chiller for twelve months and arrangements had not been made for their removal. There was substantial water damage to the worktop around the tap in the sink in the kitchen.

There were two shower rooms where the showers had been removed and the space was being used to store broken equipment. Dirt had collected in gaps where the showers and shower trays had been disconnected. Both these rooms were in regular use as they provided toilet facilities for people in the nearby bedrooms. However, judging from the level of dust and dirt that had accumulated, and from speaking with staff, it appeared that these showers had been unusable for some time. This meant people had been using toilet facilities in rooms that were dirty and unsuitable to use.

Staff told us there were not enough working hoists or wheelchairs to meet people’s needs. In the main house there was one hoist for staff to use to support five people daily and another four people, who were cared for in bed, on some days. There were only three working wheelchairs. The provider advised us that they had hoists and wheelchairs in the organisation‘s central store and these would be supplied to this service.

We found there were insufficient adaptations to the premises to support people with dementia to orientate independently around the building. For example there was a lack of appropriate signage to help people with dementia identify their bedroom or different areas of the premises.

People told us they felt safe living at the home and with the staff who supported them. People told us, “I feel safe” and “Staff are always here”. Staff had received training in safeguarding adults and had a good understanding of what may constitute abuse and how to report it. All were confident that any allegations would be fully investigated and action would be taken to make sure people were safe.

Staff asked people for their consent before delivering care or treatment and they respected people’s choice to refuse care and support. Staff supported people to make decisions about their daily lives. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

The service had safe arrangements for the management and administration of medicines. Care plans were personalised to the individual and gave clear details about each person’s specific needs and how they liked to be supported. These were reviewed monthly or as people’s needs changed.

Recruitment processes were robust and appropriate pre-employment checks had been completed to help ensure people’s safety. There were enough skilled and experienced staff to help ensure the safety of people who used the service.

Staff interaction with people was kind and staff treated people with dignity and respect. People told us they were able to choose what time they got up, when they went to bed and how they spent their day.

Staff supported people to maintain a balanced diet appropriate to their dietary needs and preferences. People were able to choose where they wanted to eat their meals, in either a lounge, dining room or in their bedroom. People were seen to enjoy their meals on the day of our visit.

There were temporary management arrangements in place that provided effective leadership and support for staff. There was a positive culture within the staff team. However, there were concerns about the lack of consistent leadership as there had been two changes in managers since our inspection in February 2015.

People and their families were given information about how to complain. Details of the complaints procedure were displayed in the main entrance to the service. There were systems in place to monitor the quality of the service provided. However, the provider’s response to requests for new equipment was not always carried out in a timely manner.

We identified a breach of the Health and Social Care Act regulations. The actions we have asked the provider to take are detailed at the back of the full version of the report.

Inspection carried out on 13 November 2014 and 23 February 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 13 November 2014. Breaches of legal requirements were found. As a result we undertook a focused inspection on 23 February 2015 to follow up on whether action had been taken to deal with the breaches.

You can read a summary of our findings from both inspections below.

Comprehensive inspection of 13 November 2014

Elmsleigh Care Home is a care home that provides nursing care for up to 48 older people. On the day of the inspection there were 47 people living in Elmsleigh Care Home. 33 people lived in the main house and 14 people lived in the adjoining annex (called Willow House, formerly the bungalow). Some of the people at the time of our visit had mental frailty due to a diagnosis of dementia or other mental health conditions.

The service is required to have a registered manager and at the time of our inspection a registered manager was not in post. However, the manager who was in overall charge of the day-to-day running of the home had made an application to the Care Quality Commission (CQC) and this application was being processed. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

At this visit we checked what action the provider had taken in relation to concerns raised at our last inspection on 1 May 2014. These concerns related to a lack of individualised detail in people’s care plans to ensure their needs were met, concerns about medicines management and concerns about staffing levels. At this inspection we found improvements had been made in relation to medicines management and staffing levels and the provider had met the relevant legal requirements in these areas.

However, we found improvements had not been made in relation to the level of detail in people’s care plans to ensure staff had clear guidance about how to meet people’s individual needs. In addition we found the provider had failed to plan and deliver care that reflected people’s needs and wishes, particularly in relation to their social and emotional needs. There was a lack of meaningful activities to meet people’s individual needs. We also found the provider did not have a robust system in place for auditing care plans to ensure care records accurately reflected people’s needs.

The provider had not notified the Care Quality Commission of allegations of abuse in relation to people who used the service, as required by law.

People and their families were given information about how to complain. Records showed the home had not received any complaints in the last year. We had been advised by a relative, prior to our visit, that they had raised a compliant. The manager was aware of this complaint and told us about how they had dealt with it. However, it is important that the service records all complaints, their investigation and how they are resolved.

The actions we have asked the provider to take are detailed at the back of the full version of the report.

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and they were confident that any allegations made would be fully investigated to help ensure people were protected.

Staff were well trained; there were good opportunities for on-going training and for them to obtain additional qualifications. There were enough skilled and experienced staff to ensure the safety of people who lived at the home.

People told us they felt safe living in the home. Visitors also said they felt the home was a safe place for their relatives to live. We saw people received care and support in a timely manner. People, who were able to use a call bell, had one to alert staff if they required any assistance.

People told us staff were very caring and looked after them well. Visitors told us “staff are lovely” and “can’t fault the staff, friendly and lovely.” When staff talked with us about individuals in the home they spoke about them in a caring and compassionate manner. Staff demonstrated a good knowledge of the people they supported.

Staff demonstrated a good understanding of how they cared for each individual to ensure they received effective care and support. People told us they were satisfied the staff team were well trained. All the visitors spoke well of staff and their ability to meet the needs of people. One visitor told us about how staff cared for their relative “They are very good with my wife”.

Staff supported people to maintain a balanced diet appropriate to their dietary needs and preferences. People were able to choose where they wanted to eat their meals, in either a lounge, dining room or in their bedroom. People were seen to enjoy their meals on the day of our visit.

Staff supported people to be involved in and make decisions about their daily lives. Where people did not have the capacity to make certain decisions the home acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Focused inspection of 23 February 2015

Following the inspection of 13 November 2014 the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches. We carried out this unannounced focused inspection to check what action the provider had taken in relation to concerns raised at our last inspection.

We found people’s care plans had been updated to give staff clear guidance about how to meet people’s individual needs. This included how people’s social and emotional needs could be met. The service had employed a ‘recreational therapist’ to facilitate a programme of meaningful activities to meet people’s individual needs. There was a robust system in place for auditing care plans to ensure care records accurately reflected people’s needs.

We found the service recorded all complaints, their investigation and how they were resolved. The service had notified the Care Quality Commission of allegations of abuse in relation to people who used the service, as required by law. This meant legal requirements had been met.

There was no system in place to monitor the quality of the service provided at the provider level. There was no external auditing process or any opportunities to share good practice across the organisation. This meant there were no standard governance arrangements to help ensure a consistent quality of service across the group’s homes.

Inspection carried out on 13 November 2014

During a routine inspection

Elmsleigh Care Home is a care home that provides nursing care for up to 48 older people. On the day of the inspection there were 47 people living in Elmsleigh Care Home.  33 people lived in the main house and 14 people lived in the adjoining annex (called the bungalow). Some of the people at the time of our visit had mental frailty due to a diagnosis of dementia or other mental health conditions.

The service is required to have a registered manager and at the time of our inspection  a registered manager was not in post. However, the manager who was in overall charge of the day-to-day running of the home had made an application to the Care Quality Commission (CQC) and this application was being processed. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

We carried out this unannounced inspection of Elmsleigh Care Home on 13 November 2014. At this visit we checked what action the provider had taken in relation to concerns raised at our last inspection on 1 May 2014. These concerns related to a lack of individualised detail in people’s care plans to ensure their needs were met, concerns about medicines management and concerns about staffing levels.  At this inspection we found improvements had been made in relation to medicines management and staffing levels and the provider had met the relevant legal requirements in these areas.

However, we found improvements had not been made in relation to the level of detail in people’s care plans to ensure staff had clear guidance about how to meet people’s individual needs. In addition we found the provider had failed to plan and deliver care that reflected people’s needs and wishes, particularly in relation to their social and emotional needs. There was a lack of meaningful activities to meet people’s individual needs. We also found the provider did not have a robust system in place for auditing care plans to ensure care records accurately reflected people’s needs.

The provider had not notified the Care Quality Commission of  allegations of abuse in relation to people who used the service, as required by law.

People and their families were given information about how to complain. Records showed the home had not received any complaints in the last year. We had been advised by a relative, prior to our visit, that they had raised a compliant. The manager was aware of this complaint and told us about how they had dealt with it. However, it is important that the service records all complaints, their investigation and how they are resolved.

The actions we have asked the provider to take are detailed at the back of the full version of the report.

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and they were confident that any allegations made would be fully investigated to help ensure people were protected.

Staff were well trained; there were good opportunities for on-going training and for them to obtain additional qualifications.  There were enough skilled and experienced staff to ensure the safety of people who lived at the home.

People told us they felt safe living in the home. Visitors also said they felt the home was a safe place for their relatives to live. We saw people received care and support in a timely manner. People, who were able to use a call bell, had one to alert staff if they required any assistance.

People told us staff were very caring and looked after them well. Visitors told us “staff are lovely” and “can’t fault the staff, friendly and lovely.” When staff talked with us about individuals in the home they spoke about them in a caring and compassionate manner. Staff demonstrated a good knowledge of the people they supported.

Staff demonstrated a good understanding of how they cared for each individual to ensure they received effective care and support. People told us they were satisfied the staff team were well trained.  All the visitors spoke well of staff and their ability to meet the needs of people. One visitor told us about how staff cared for their relative “They are very good with my wife”.

Staff supported people to maintain a balanced diet appropriate to their dietary needs and preferences. People were able to choose where they wanted to eat their meals, in either a lounge, dining room or in their bedroom. People were seen to enjoy their meals on the day of our visit.

Staff supported people to be involved in and make decisions about their daily lives. Where people did not have the capacity to make certain decisions the home acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Inspection carried out on 1 May 2014

During a routine inspection

During our inspection of this service we considered our findings to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence to support our summary please read the full report.

Is the service safe?

People were treated with dignity and respect by staff. We spoke with six people living in the home and they told us they felt safe living there.

Elmsleigh Nursing Home had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). There was evidence the home considered the impact of any restrictions put in place for people that might need to be authorised under the Deprivation of Liberty Safeguards.

People were protected from the risk of infection because appropriate guidance had been followed. People were cared for in an environment that was safe, clean and hygienic. Incidents and accidents were recorded and learning from these events was used to change practice to reduce the risk of harm to people.

People’s needs were not always met because care records did not accurately reflect their current needs. Vital information for staff to follow to ensure people’s safety and welfare was not always recorded in care records. There was not always enough staff on duty to meet the needs of the people living at the home.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. People did not always receive their medicines at the time they needed them.

We have asked the provider to tell us what actions they intend to take to meet the requirements of the law in relation to people’s care, staffing levels and medicines.

Is the service effective?

During our inspection we observed staff caring for people. It was clear from our observations and from speaking with people that staff had a good understanding of people’s needs.

People’s health and care needs were assessed and mobility and equipment needs had been identified where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

Is the service caring?

People’s individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. We saw staff provided support in accordance with people’s wishes.

During our inspection we spoke with six people who used the service and observed staff interaction with people. People we spoke with told us staff were caring and attentive to their needs. We observed staff responding to people in a kind and caring manner.

Is the service responsive?

The home provided some regular group activities such as arts and crafts, singing sessions and exercises. Most people we spoke with did not express a view about the activities on offer.

Elmsleigh gave clear information to people about how to complain. We looked at the home’s complaints policy and saw a copy of the complaints procedure in the home. At the time of our inspection the home had not received any complaints.

Is the service well-led?

The home worked with external health professionals to ensure people’s health needs were met.

The provider had an effective system to regularly assess and monitor the quality of service that people received. The provider asked people who used the service, their families and professionals for their views about their care and treatment and used any feedback to improve the service.

Inspection carried out on 10 June 2013

During a routine inspection

This was the first inspection of Elmsleigh since the new provider took over in November 2012. There were 40 people living in the home on the day we visited. During our inspection we spoke with the provider, manager and the clinical nurse lead about the care and support they provided.

We observed staff helping people in a discreet manner and speaking to people with respect. We saw call bells were answered very promptly.

We saw care plans were detailed and directed staff as to the care and support people needed. They had been regularly reviewed. We saw a range of activities were available.

We saw meals were well presented and care workers were available to assist people as required. We saw the four week rolling menu and saw there were always choices available at each meal.

Medicines were handled appropriately, kept safely, safely administered and were disposed of appropriately.

Staff told us training was provided, and records confirmed they had received supervision. The manager told us annual appraisals were not yet in place but were planned.

The home was spread over two floors. At the time of the inspection the first floor was not accessible to people using the service as the whole floor was being refurbished