Elton Hall Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to governance at the service.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. People, relatives and staff told us they felt people were kept safe and any concerns in the home were listened to and acted on. A person told us, “I am as safe as I can be.” The manager conducted reviews of safety incidents to look at areas of learning and shared these with staff.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, however they did not always manage or monitor people’s safety. They made sure there was continuity of care, including when people moved between different services.

Systems did not consistently support safe practice. Some records needed updating to ensure people received safe and continuous care. Information was shared with other services to ensure smooth transitions.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. People told us they felt safe living at the home and that they felt staff would act on any concerns raised.

The provider did not always work well with people to understand and manage risks. Staff provided care to meet people’s needs that was safe and supportive, but this was not always effectively and consistently planned or recorded. Some risks to people were well explored in individual risk assessments and people were helped to understand these. However, there were other risks present in the service that had not been fully explored. These included risks due to the recording of medicines, and in the environment, that had either not been identified or addressed.

The provider did not always detect and control potential risks in the care environment. Several areas of the home required redecoration or maintenance, and there were areas of the home and gardens that posed potential risks to people’s safety. People could access these areas freely, and unobserved by staff, because doors were left unlocked and open. These included areas of the garden with uneven paving and rubble and an upper floor of the home used for storage. This upper floor also presented a potential fire risk.

Safety equipment such as window restrictors and emergency pull cords were in place but did not comply with current health and safety guidance. These were changed prior to us returning to the home for a second visit.

The provider had already planned to make improvements to the environment and had an action plan to address redecoration and maintenance. The manager took immediate action following our feedback.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision, and development. They worked together well to provide safe care that met people’s individual needs.

Safe recruitment processes were followed; relevant checks were completed before people started working at the home. New staff completed a range of training and an induction into the home; this included a period of shadowing experienced staff. Staff received training to ensure they were able to safely meet the needs of people living in the home. Staff told us they felt supported in their roles.

There were enough staff to support people safely and in line with their preferences. Dependency needs were assessed and reviewed regularly to ensure staffing levels remained safe and appropriate to meet people’s needs. There had been recent recruitment to several key roles in the home and a reduction in the use of agency staff to support consistency. Most people, relatives and staff spoke positively about staffing. A person told us, “There is always someone around, staff are around and keep an eye on me."

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading. In several areas of the home, including bathrooms and shower rooms, there was a need for redecoration and repair making effective cleaning more difficult. Several chairs and carpets also needed to be replaced because they were worn, stained or were not easy to keep clean.

Some personal items were stored in bathrooms, such as towels and toiletries, which can pose an infection prevention and control risk. These were removed when we highlighted this to the manager.

There was a regular schedule of cleaning, and we received positive feedback about the general cleanliness of the home. The manager had already identified the need for improvement, and an environmental improvement plan was in place. They had also proactively asked for an external IPC audit to help them identify and address issues.

The provider did not always ensure medicines were safely managed and administered. Medication management required improvement. We identified shortfalls in the records and care plans for medicines. Records were not always clear or fully completed, one person received an incorrect medicine dose for Nebules. The manager had implemented a new system for medicines; however not all discrepancies were escalated for investigation. Guidance and recording for PRN (when required), variable-dose medicines, topical creams and patches were incomplete. Medication care plans needed further information or updating when changes occurred. Medicines were stored securely, but some fridge temperatures were outside the recommended range.

Audits by the provider and a local NHS care home support team had picked up some of the issues we found, an action plan was provided following the inspection to address the issues that had not been resolved.