Archived: Ella McCambridge Care Home

Ella McCambridge Care Home is a care home which provides residential care for up to 67 people. The service provides support to older people and people living with dementia. At the time of our inspection, 48 people were living at this service.

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

The management team had reviewed and introduced an effective governance system. People found the new management team had made significant improvements to the home. The registered manager had been systematically resolving the issues identified at the last inspection. The management team had increased the support structures and a previous manager who had successfully worked at the home for over 20 years was helping staff to make the required improvements. All of the breaches and registration issues identified at the last inspection had been resolved.

People were happy with the care provided and felt staff went above and beyond in delivering the care. Relatives and people felt the service was delivering holistic and compassionate care, which enabled people to enjoy a good quality of life. Staff were passionate about providing good care outcomes and took ownership of their practice.

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. Staff had received a range of training around the Mental Capacity Act 2005 and work was being completed to ensure all the required capacity and 'best interests' decisions were in place.

Risk assessments were clear and identified how to reduce the risks to people. Staff were familiar with these documents and the actions they needed to take. The management team were in the process of changing to electronic care records and we discussed how enhancements could be made as staff transferred the paper records to the new system. Medicines management was effective and monitored. The registered manager was working with staff to develop a consistent approach to checking how many medicines were left each day. Staff who administered medicines had the appropriate training. Staff adhered to infection control and prevention guidance.

The management team ensured there was always enough staff to support people. Recruitment practices met legal requirements.

People were routinely engaged in a range of activities and found these stimulating. People were provided with nutritious meals and staff routinely monitored people's health and well-being. Visiting healthcare professionals reported staff appropriately contacted them and always sought guidance when needed.

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 inadequate (report published 6 April 2023).

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 inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ella McCambridge Care Home is a care home which provides personal care for up to 67 people, including people living with dementia. Accommodation is provided over two floors. There were 47 people living at the home at the time of our inspection.

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

Risks relating to the environment, people’s care and support and infection control had not been fully assessed to ensure the safety of people, staff and visitors. Records did not always evidence that safe recruitment procedures were followed. Medicines were not managed safely.

People were not supported to have maximum choice and control of their lives and staff did not always 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.

There were gaps in people’s care records which meant we could not be assured care had been carried out as planned. Records did not always evidence how people were supported to eat and drink safely to meet their nutritional and hydration needs. An effective system to ensure staff were suitably skilled and trained was not fully in place. We identified shortfalls in staff knowledge and skills in areas such as care planning, the assessment of risk, medicines management, moving and handling and specialist feeding techniques.

Care plans did not fully reflect people’s needs or provide sufficient detail to describe what actions staff needed to take to make sure people’s needs and preferences were met. We observed bingo and other activities being carried out on the days of our inspection which people enjoyed. However, records and our observations did not always demonstrate how the emotional and social needs of people who were living with dementia were met.

An effective system to monitor the quality and safety of the service and ensure people achieved positive outcomes was not in place. We identified shortfalls in many areas of the service which had not been highlighted by the provider’s quality monitoring system. Records were not available to demonstrate how the provider was meeting their responsibilities under the duty of candour.

There were issues with the provider’s registration. This is being dealt with outside of the inspection process.

The operational director and assistant operational manager were open and honest during the inspection about the improvements that were required and were devising an action plan to address the issues identified.

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 26 September 2019 ). Following this inspection, we carried out two targeted IPC inspections in October 2020 and December 2020. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Why we inspected

The inspection was prompted due to concerns received about people’s care and support, infection control and the management of the home. A decision was made for us to inspect the key questions of safe and well-led and examine those risks.

When we inspected, we found there were shortfalls across the service, so we widened the scope of the inspection to include all five key questions.

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.

Enforcement and Recommendations

We have identified 7 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. These related to safe care and treatment, need for consent, person centred care, staffing in relation to training, fit and proper persons employed, duty of candour and good governance. We also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (notification of other incidents).

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

¿ The provider had implemented effective contingency plans, including occasional use of agency staff, to ensure there were sufficient staff available to meet people’s needs.

¿ The provider had reflected on the challenges presented by an outbreak and put in place additional deputising support for the registered manager.

¿ The registered manager had acted on specialist infection prevention and control advice regarding the disposal of PPE.

¿ Staff and people were tested regularly for COVID-19.

Further information is in the detailed findings below.

Ella McCambridge is a 'care home'. Ella McCambridge provides accommodation for up to 67 people who require support with personal care, some of whom are living with dementia.

We found the following examples of good practice:

• All visitors had to undergo a temperature check and answer a range of relevant questions. There was ample PPE and handwashing facilities available. Staff had introduced additional posters to remind them about the various points they needed to put on and take off PPE. Staff had worked additional hours to ensure the service did not have to rely on agency staff.

• The leadership team continued to work openly and flexibly with external stakeholders and families. They were ready to re-implement visits after the isolation period, should national guidance allow. People were supported to keep in touch with their family members via video or telephone calls.

• The registered manager and deputy had worked with a visiting infection control specialist to improve on areas of practice. They responded quickly and proactively to these requests, and to advice given on inspection.

We found the following examples of good practice:

• Systems were in place to prevent people, staff and visitors from catching and spreading infections. Clear signage and personal protective equipment (PPE) protocols, disclaimers and temperature checks were in place at the front entrance, as well as a mat to disinfect shoes. Additional cleaning of all areas and frequent touch surfaces was in place; the provider had invested in new cleaning equipment to facilitate faster deep cleaning of rooms.

• The service had worked flexibly to safely facilitate outdoor socially distanced visits. They were ready to re-implement visits should national guidance allow. People were supported to keep in touch with their family members via video or telephone calls.

• The registered manager, provider and senior staff valued the commitment and contribution of all staff throughout the pandemic. They regularly and openly communicated with staff.

• Infection control audits were regularly carried out. Additional infection prevention and control training had been delivered. Leadership and staff at all levels shared a common ethos to keep people safe and as connected as practicable with their loved ones.

Further information is in the detailed findings below.

Ella McCambridge Care Home provides personal care and accommodation to up to 67 older people, some of whom were living with dementia, across two floors in one purpose-built home. There were 60 people living at the service at the time of our inspection.

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

People were safe and comfortable in a clean and homely environment they knew well.

Risk assessments contained sufficiently detailed person-centred information. Daily recording information was accurate and up to date. Staff demonstrated a good knowledge and awareness of risks.

The premises and all equipment were well maintained.

Medicines were managed safely, including storage, administration, disposal and all relevant training and competency assessments.

Staff worked proactively with external healthcare professionals to ensure people’s needs were met effectively. Staff were well trained and well supported to provide high standards of care to people.

People were included in the running of the service, for instance in making decisions about meals, décor and activities. Feedback from people, their relatives and a range of external professionals was extremely positive regarding the compassionate, affectionate and sensitive approach of staff. The service felt welcoming and calm as a result.

People ate well and had a choice of meals and snacks. Menus were varied and staff were patient when helping people decide what meals to choose.

The premises were suitable and spacious. The first floor was specifically for people living with dementia and had regard to best practice about dementia friendly environments.

End of life care was a strength of the service. Feedback from external professionals was positive and we saw a range of emotive thankyous from relatives of people who had previously used the service.

A range of group and individual activities were in place. There were good levels of community involvement in place and social isolation was limited wherever possible. Feedback from people and relatives was positive.

The registered manager was well respected in the organisation and further afield. They had a stable staff team who shared a consistent person-centred approach to care. Clear systems were in place for the review and audit of all aspects of the service. The registered manager was responsive to feedback about areas of emerging best practice and how to incorporate this into the service.

People’s capacity was assumed and staff acted in line with the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Best interest decision-making followed best practice guidance.

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 9 February 2019).

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 reinspection programme. If we receive any concerning information we may inspect sooner.

We previously inspected Ella McCambridge Care Home in August 2018, at which time we found the provider to be in breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service requires improvement. There were a number of instances of poor practice in terms of medicines administration and these had not been identified by the auditing and governance systems the provider had in place. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well-Led to at least good.

At this inspection we found the provider had made suitable improvements in all the areas identified and was compliant with the regulations. At this inspection, the service was rated good.

We undertook an unannounced focused inspection of Ella McCambridge Care Home on 23 January 2019. This inspection was done to check that improvements to meet legal requirements planned by the provider after our August 2018 inspection had been made. The team inspected the service against two of the five questions we ask about services: is the service well led and safe? This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvements were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Ella McCambridge 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.

Ella McCambridge accommodates a maximum of 67 older people across two floors. Nursing care is not provided. The first floor supported people with higher levels of dependency. There were 55 people using the service at the time of our inspection, some of whom were living with dementia.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

People were supported by staff who were knowledgeable and competent in the administration of medicines. The administration, storage and disposal of medicines was safe and in line with good practice, with appropriate checks and auditing in place.

Risk assessments were in place and were specific to people’s individual needs and circumstances.

Incidents were reported and acted upon appropriately. The registered manager had ensured lessons were learned after investigations took place.

The building was well maintained and clean throughout, with repairs made in a timely fashion.

Staffing levels were appropriate to the needs of people who used the service and rotas were planned in advance.

The registered manager and all staff we spoke with were passionate about people who used the service receiving high quality care. They had reflected on the improvements required to medicines administration and other areas, and made these promptly.

Auditing of medicines had significantly improved. Auditing at provider level needed to focus more on continual service improvement and strategic objectives. We have made a recommendation about this.

The culture remained one focussed on people’s needs and safety and the registered manager had ensured this was better supported through well planned checks, audits and delegation of duties. The registered manager and deputies received enthusiastic support from the head of operations. Audits completed at this level needed to have a greater focus on the strategic goals of the service.

The registered manager demonstrated a good awareness of areas of recent good practice. They had formed strong external links to ensure they were well place to remain compliant with the regulations on a consistent basis. They were aware of their responsibilities with regard to making appropriate notifications to CQC.

We previously inspected Ella McCambridge Care Home in August 2017, at which time the service was in breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the previous inspection we rated the service as requires improvement. At this inspection, whilst there had been improvements in some areas, the service remained rated requires improvement.

Ella McCambridge 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.

Ella McCambridge accommodates a maximum of 67 older people across two floors. Nursing care is not provided. The first floor supported people with higher levels of dependency. The service supported people, on both floors, living with dementia or a dementia related condition. There were 55 people using the service at the time of our inspection.

A registered manager was in place, with suitable skills and experience. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run. The manager had applied to be registered with CQC and was registered as the manager prior to the completion of this report.

Medicines administration practices required improvement, particularly with regard to topical medicines (creams), patches, and protocols for when people required medicines ‘when required’. The registered manager and deputy managers began improving these processes during the inspection, as well as reviewing how medicines were audited. This was another area identified as requiring improvement.

At the previous inspection we recommended that the provider review guidance regarding dementia friendly environments and make improvements. We found they had done this and the surroundings were in line with dementia-friendly good practice. The premises were suitable for the needs of people who used the service, with ample bathing, communal and outdoor facilities.

Risk assessments were in place, specific to people’s needs and regularly reviewed.

There were sufficient staff in place to keep people safe and meet their needs. Staffing was well planned.

The service was clean throughout with sufficient domestic staff and resources.

All staff were aware of their safeguarding responsibilities.

A range of mandatory and additional training had been delivered to staff or was planned. Staff were knowledgeable in the areas they had been trained in and external professionals confirmed they engaged well and took an interest in new practices.

People received a range of meal options and we observed pleasant mealtime experiences. The use of showing people different plates of food to help them choose was used intermittently and needed to become part of the culture. Feedback about food was consistently positive.

People were supported to have maximum choice and control of their lives in the least restrictive way possible. Staff had received training in the Mental Capacity Act (2005) and were able to answer a range of questions. Consent was sought with regard to day to day interactions throughout the inspection. Some care files needed reviewing to ensure consent was appropriately documented.

Care plans were being reviewed at the time of inspection but contained sufficient person-centred information for staff to understand and act on people’s needs. Staff knowledge of people’s needs was good. Interactions with and advice from external healthcare professionals was well documented.

People who used the service, relatives and external professionals gave consistently positive feedback about the caring, compassionate and patient approach adopted by staff.

The atmosphere was welcoming and communal. People received good continuity of care due to a very low turnover of staff, who knew them extremely well.

Activities were planned by an activities co-ordinator and provided a variety of in-house entertainment. The advertising of these activities would benefit from review in line with the Accessible Information Standard (AIS). The AIS was introduced by the government in 2016 to make sure that people with a disability or sensory loss are given information in a way they can understand.

There had been no recent complaints. All people and their relatives we spoke with knew how to raise any concerns.

Auditing arrangements required review as there was some duplication of work by senior managerial staff, whilst some audits were not effective.

The culture was one focussed on caring for people in a homely environment, with support from a stable and committed staff team. The registered manager and other staff demonstrated a desire to quickly make improvements in the areas we identified.

We have identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection in May 2015 the service was not meeting all of the legal requirements with regard to person centred-care. At this inspection we found improvements had been made and the service was no longer in breach with regard to person-centred care. However, we considered more improvements were required with regard to record keeping.

Ella McCambridge Care Home is registered to provide care and support for up to 67 older people, some of whom may have dementia or a dementia related condition. At the time of inspection 60 people were using the service.

A registered manager was in place. 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.

People said they were safe and staff were kind and approachable. There were sufficient staff to provide safe and individual care to people. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff knew the needs of the people they supported to provide individual care. Care was provided with kindness and people’s privacy and dignity were respected. Records were not all in place that reflected the care that staff provided.

The environment was well-maintained and plans were proposed to promote the orientation and independence of people who lived with dementia. We have made a recommendation the environment should be designed according to best practice guidelines for people who live with dementia. Activities and entertainment were available to keep people engaged and stimulated.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. People had the opportunity to give their views about the service. There was regular consultation with people and/ or family members and their views were used to improve the service. People had access to an advocate if required.

The home had a quality assurance programme to check the quality of care provided. However, the systems used to assess the quality of the service had not identified the issues that we found during the inspection with regard to people’s dining experience, environmental design and record keeping.

Staff and relatives said the management team were approachable. Communication was effective to ensure staff and relatives were kept up to date about any changes in people’s care and support needs and the running of the service.

Appropriate training was provided and staff were supervised and supported. Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People received a varied and balanced diet to meet their nutritional needs.

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

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way.

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

We found the provider had undertaken a review of the home's audit systems to make them more effective in order to identify gaps in care and medication reords.