Elm House Care Home

Elm House Care Home is a residential care home providing personal care to up to 34 people. The service provides support to older people, people with a physical disability and people with a sensory impairment. At the time of our inspection there were 29 people using the service. The home is set over 2 floors with communal areas and a garden for people and their relatives to use.

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

Systems needed improving to make sure people were adequately protected from the risk of abuse and to make sure lessons were learned following mistakes. Risks to people’s health and wellbeing were not always assessed and mitigated effectively. Staff were not always recruited using safe processes. Although staff were experienced, they did not receive regular training to update their knowledge and skills, which we have made a recommendation about.

We found gaps in the governance processes of the service although this had been identified by the registered manager and provider prior to the inspection, and plans were being made to address.

People and relatives gave positive feedback, one relative said, “[My relative] is comfortable in Elm House, I can rest knowing they are being looked after.”

People were supported to take their medicines safely. The home was kept clean, tidy and comfortable.

People were supported to eat and drink healthily, and people commented that they enjoyed the meals. A relative said, “The food is very good,” another relative said, “My relative loves the meals and eats better than they did at home.”

The home had a comfortable atmosphere and people could decorate their rooms according to their personal preference.

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

People and their relatives spoke highly of the managers and felt that any concerns would be dealt with effectively and in good time. Staff enjoyed their jobs, one person supported said, “The staff are brilliant, they are kind and caring and like to have a good laugh.”

The registered manager had plans to further his own knowledge and skills and worked well with external agencies.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 20 July 2021).

Why we inspected

We received concerns in relation to managing people’s needs effectively should their health deteriorate, and staff training. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe section of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and recommendations

We have identified breaches in relation to monitoring risks to be able to improve the service, assessing risks to people’s health and wellbeing and staff recruitment.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Elm House Care Home is a residential care home providing personal care and support for up to 34 older people, including those with physical disability and sensory impairment. At the time of the inspection there were 28 people living in the home.

Elm House Care Home is a purpose-built home with accommodation provided over two floors.

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

People and their relatives were happy with the service they received. People felt safe and said staff were kind, patient and caring and they were treated well. Staff understood how to protect people from abuse and recruitment processes ensured new staff were suitable. There were enough staff to meet people's needs and to ensure their safety. The management of people’s medicines had improved. People received their medicines when they needed them from staff who had been trained and had their competency checked. We discussed areas for improvement such as ensuring medicines for disposal and handwritten directions were consistently recorded. The management of any risks to people had improved. Risk assessments enabled people to retain their independence and receive support with minimum risk to themselves or others. Infection control was well managed, and the home was clean and free from odours and hazards.

People's care and support needs were assessed prior to them using the service to ensure their needs could be met. They were supported to live healthy, active and interesting lives and had access to health and social care professionals, a well-trained staff team and a choice of a nutritious diet. People's wishes were respected, and care was arranged around their preferences and requirements. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The environment was clean, comfortable, safe and well maintained and had been developed with people’s needs in mind.

Management and staff had developed friendly, caring and respectful relationships with people and their families. People told us the registered manager and deputy manager were visible around the service and they spoke very highly of them. The registered manager and staff demonstrated a high commitment to providing person-centred care and to ensure people received good quality care. People were treated as individuals and their equality and diversity was respected. Staff understood the importance of giving people their time and the importance of encouraging people to maintain their independence.

The information in people’s care records had improved. People's care was tailored to their needs, routines and preferences and staff knew people well; good relationships had developed. People had access to a wide range of activities which they enjoyed. Safe visiting processes were in place to ensure people could see their visitors when they wished and could maintain relationships that were important to them. People did not have any complaints about the service but were confident they could raise any issues and be listened to.

People, visitors to the home and staff told us the service was managed well. They told us this was a good home and they would recommend the home to others. Staff felt valued, enjoyed working at the home and genuinely cared about the people in their care. Systems to assess and monitor the quality of the service and the practice of staff had improved. People's views and opinions of the service were sought and acted on.

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 16 August 2019). We found multiple 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

We carried out an unannounced comprehensive inspection on 1 and 22 July 2019. Breaches of legal requirements were found in relation to the management of medicines, risk management, systems to safeguard people, record keeping and failing to establish and operate systems effectively. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-Led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elm House Care Home on our website at www.cqc.org.uk.

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 house care home is a residential care home providing accommodation with personal care in one purpose built building for up to 34 older people, including those with physical disability and sensory impairment. On the first day of the inspection 17 people were living at the service and 16 on the second day.

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

Peoples medicines were not managed safely. Individual and environmental risk assessments required improvements to ensure they reflected individual risk and included measures to manage these safely. Systems to record and act on safeguarding concerns required improvement. All people told us they felt safe in the service and raised no concerns. Staff recruitment was ongoing to cover some vacant night shifts. Staffing levels were on the whole satisfactory; however no staffing analysis was undertaken.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Systems had not been established that ensured capacity assessments and best interest decision had been completed with people. Staff received training to support them in their role. Evidence that professionals were involved in people’s health and care needs was seen. People were happy with the meals provided to them.

The feedback from all people was positive about the care they received. People were treated with dignity; respect and their individual needs were met. A policy was in place for equality and diversity; however this only related to the staff in the home and not in relation to people who used the service. People were seen being involved in decisions.

Care plans were in place, however more information about how to support people’s individual needs was required. A range of activities were provided, we observed people enjoying an activity with a small animals’ company. Family and visitors were encouraged to visit the home. A range of positive feedback had been received. Where complaints had been recorded we could see no evidence of the investigation or actions taken because of them.

We received positive feedback about the leadership and management of the service. The registered manager was looking at introducing champion roles to support improvements in the care people received. Meetings with people who used the service and staff were taking place, the records from these were brief. Feedback was received from surveys and questionnaires. Audits and quality monitoring were undertaken. These would benefit from a review of how the findings were recorded. A number of concerns were identified in relation to assessing and management of risk, the safe management of medicines, records and record keeping, safeguarding and good governance.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 10/07/2018 and this is the first inspection.

Why we inspected

This was a planned inspection.

Enforcement

Following the first day of our inspection we asked the registered manager to take immediate actions to improve the standards of quality and safety. The registered manager provided confirmation of actions taken. We checked these on day two of our inspection.

We have identified breaches in relation to the assessment and management of risks, the safe management of medicines, safeguarding people from abuse, protecting people from unlawful restrictions, records and record keeping and good governance.

We have made recommendations about staffing levels, polices for equality and diversity and complaints.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.