Archived: Elsinor Residential Home

Elsinor Residential Home is a residential care home that is registered to provide accommodation and personal care for up to 35 adults and people living with dementia. At the time of the inspection there were 16 people living at the service.

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

People Living at Elsinor Residential home did not receive a safe, well led service. Infection control procedures were not followed, and people were exposed to this risk of infection due to the poor infection control practices of staff.

Care plans and risk assessments did not contain information to provide the safe care and support people required. Risk management was not in place for some people who were at high risk of developing a pressure ulcer. Where risk assessments were completed, they had not been updated in over six months, despite the person’s needs changing.

Systems were not always implemented to ensure the effective management of medicines. Staff who were administering medication were not trained and did not have their competencies checked to ensure correct procedures were followed.

Incidents were not always escalated appropriately by the registered manager or reported to the safeguarding authority. A number of safeguarding concerns, relating to pressure area care and delays in requesting professional intervention, were identified by the local authority.

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.

The registered manager was not present at the service. The provider had a lack of oversight of people’s basic care needs and the governance of the service. Systems or processes were not established and operated effectively to ensure compliance with regulations.

A registered manager from another service within the provider group was providing support to the service. They failed to monitor and assess the quality and safety of the service or the welfare of people. Staff did not receive effective support from the management team and lacked understanding of their roles and the principles of providing high-quality care. The lack of robust management meant there was no consistent oversight of the service.

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

Rating at last inspection

The last rating for this service was requires improvement (published 31 October 2019) and there were two breaches of regulation. The service has been rated requires improvement for five consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to poor management of infection control, pressure area care, and weight management, poor record keeping and the overall management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. 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 Elsinor Residential home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to managing risks, staff training and support, meeting people’s care needs and improving the quality of the service at this inspection.

Because of the serious concerns relating to people’s welfare and safety we have taken enforcement action to prevent the provider from operating a regulated service at this location.

Elsinor Residential Home is a residential care home providing personal care to 35 people aged 65 and over who may be living with dementia in one adapted building. At the time of this inspection 29 people were living at the service.

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

Governance systems had not been established and fully embedded into the service. Provider audits to monitor the quality and safety of the service were not effective.

Staff new to the service were not provided with a sufficient induction. Staff had not been provided with sufficient support and training to ensure they had the skills and knowledge to carry out their role.

Risks to people had not been consistently assessed. Risk assessments did not provide staff with sufficient information. We have made a recommendation about the management of risks. Medicines had not always been stored safely and recorded appropriately. Staff had not received appropriate medicines training. We have made a recommendation about the management of medicines.

Care plans did not always contain up to date information. 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. Capacity assessments and best interest decisions were not recorded. We have made a recommendation about MCA.

People told us they liked living at the service and felt safe. Support was provided by a consistent team of staff who had a good understanding of people’s care and support needs. Staff were visible around the service and it was clear positive, caring relationships had been developed. Improvements had been made to the recruitment process.

People and staff spoke positively of the new registered manager. The registered manager had begun to implement improvements since commencing employment and was committed to ensuring people were provided person-centred care and support.

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 22 September 2018) and there were two 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 enough improvement had not been made and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, response and well-led sections of this full report.

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

Enforcement

We have identified breaches in relation to the governance and staff training and support at this inspection.

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 work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Elsinor Residential Home is registered to provide residential care for up to 35 older people who may also be living with dementia. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Accommodation is provided in an adapted town house spread across five floors. There is lift access between the floors. At the time of our inspection, there were 25 older people and people living with dementia using the service.

At the last inspection in December 2017, we rated the service inadequate overall and identified five breaches of regulation. This included breaches of the fundamental standards of quality and safety relating to person-centred care, the need for consent, safe care and treatment, staffing and the governance of the service.

At this inspection, significant improvements had been made and the service was compliant with the regulations relating to the need for consent, safe care and treatment, person-centred care and staffing. However, there were a number of ongoing issues that had not yet been addressed and further sustained improvements were needed. There was a new breach of regulation relating to recruiting fit and proper persons and a continued breach of regulation relating to the governance of the service.

The service did not have a registered manager. 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 2008 and associated Regulations about how the service is run. The last registered manager left the service following our last inspection. A new manager was in post and had been managing the service since December 2017. They were planning to apply to become the registered manager, but had not completed this process.

Further improvements were needed to some of the arrangements for managing medicines to keep people safe. There were still some gaps in staff’s training. Supervisions that had been completed were good, but not all staff had received a supervision and these were not yet documented at the frequency set out in the provider’s new policy and procedure.

The provider did not have a robust recruitment process. Some records were not always well maintained. For example, mental capacity assessments and best interest decisions had not been documented in line with relevant legislation and best practice guidance. We spoke with the manager about reviewing and ‘signing off’ accidents and incidents and keeping more detailed records of the support provided with activities.

The provider’s audits did not evidence a sufficiently robust approach to monitoring and supporting improvements.

There were two breaches of regulation relating to fit and proper persons employed and the governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

Staffing levels had improved and sufficient staff were deployed to meet people’s needs. The manager monitored staffing levels to make sure they were safe.

The manager had made appropriate applications to deprive people of their liberty in line with the requirements of the Mental Capacity Act 2005.

People told us they felt safe living at the service. Staff were trained to recognise and respond to safeguarding concerns.

Action had been taken to improve fire safety within the home. We spoke with the manager about exploring risks relating to people falling down the stairs or falling from height because of single paned glass in some of the windows. They made arrangements to install safety film on single paned glass and keypads to restrict access to the stairs where there was a risk of people falling.

Staff were kind and caring. People gave positive feedback about the friendly relationships they shared with staff. Staff supported people to maintain their privacy and dignity.

Staff did not use picture menus or show people choices to help them decide what to eat. We have made a recommendation about reviewing best practice guidance relating to dementia care.

Staff were knowledgeable about people’s needs. Care plans had been reviewed and updated to include more person-centred information about people’s needs.

Staff supported people with activities. People were free to spend their time how they chose and staff respected people’s decisions.

Staff worked closely with healthcare professionals including the local hospice team to make sure people received the care and support they needed.

We received positive feedback about the food and staff supported people to make sure they ate and drank enough. The manager made changes to how staff supported people at mealtimes to make sure the care and support was effective.

People told us the manager was approachable and they would feel comfortable speaking with them or the staff team if they had any concerns or complaints about the service. The manager actively encouraged people to provide feedback and sought their views on how the service could be improved. We received very positive feedback about the manager’s ‘hands on’ approach, the support and guidance they provided to staff and the changes they had made since taking over as manager of the service.

The service accommodates up to 35 people in one adapted building and primarily caters for older people, some of whom may be living with dementia. The service does not provide nursing care.

The inspection took place on the 16 November, 4 and 22 December 2017. The first day of inspection was unannounced; the second and third days were announced. At the time of our inspection, 28 older people were using the service and a registered manager was 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 2008 and associated Regulations about how the service is run.

At the last comprehensive inspection in January 2016, we rated the service ‘Good’, but asked the provider to take action to make improvements as the environment was not suitable for people living with dementia. We completed a focussed inspection in January 2017 and found this action had been completed.

At this inspection, the overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Following the first day of our inspection, we communicated our concerns urgently with the provider who began taking action to make sure people who used the service would be safe.

After the second day of inspection, the registered manager left the service. A manager from another service owned by the provider took over this responsibility and informed us they planned to register with the CQC to manage Elsinor Residential Home. Therefore they were responsible for the service at our visit on 22 December 2017. We have referred to them as ‘manager’ throughout the report.

Insufficient numbers of staff were deployed throughout the service and staffing levels impacted on the quality of the experience people received within the service. The provider had not regularly reviewed staffing levels to make sure they were sufficient to respond to people’s needs. This was discussed with the manager who immediately began to recruit three more care staff positions and a waking night staff position to the service. Staff deployment throughout the service was also being reconsidered by the manager.

Robust systems and process were not in place to ensure the safety of people who used the service in the event of a fire. Fire drills had not been completed to simulate the night time staffing levels and ensure the procedure would work during the night time. This was immediately rectified with all staff attending drills and evacuation practises.

The provider had not assessed or properly managed environmental risks. Environmental risk assessments had not been completed and deficits within the service had not been identified and rectified by the provider. For example we found fire doors had not been fitted where required and window opening restrictors were not consistently in place to minimise the risk of falls from height. This put people at risk of avoidable harm.

Medicine management was not safe. We identified numerous examples where staff had failed to administer people’s prescribed medicines. This placed people who used the service at increased risk of harm. People's medicine administration records (MARs) were inaccurate and not updated by staff when medication had not been given. Staff responsible for administering medicines and the provider’s audit process had not identified and addressed these concerns. The registered manager delegated the role of medication audits to senior care staff, however, these audits were not robust enough to help them identify and address errors. Staff had not received regular training on how to administer medicines and the provider had not ensured competency checks were completed to monitor staff’s practice.

People were not supported to have maximum choice and control of their lives and the policies and systems in the service did not support this practice. People, and their representatives, were not involved or consulted when planning their care. Care planning documentation did not evidence consent had been considered. The registered manager and the provider failed to adhere to the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff were knowledgeable about the people who lived at the service, however, the provider had not ensured staff training was up-to-date. Staff had not received regular support through supervision and appraisal to enable them to fulfil their role.

The registered manager had sought people's views on the service, including the quality of care provided. However, no evaluation of the findings had occurred or action plan produced to evidence improvements made. The provider did not have effective systems to ensure safety and quality at the service. This meant they had failed to identify and address the significant issues and risks to people’s safety we found during our inspection.

The registered manager had systems in place to ensure safe recruitment processes were followed.

Safeguarding procedures and policies were in place within the service, but staff did not follow these procedures as they had not identified, or reported, the safeguarding concerns we found regarding missed doses of medicines.

Staff respected and protected people’s dignity and privacy; staff knocked on doors before entry. People said staff knew them well and treated them with kindness and compassion.

Staff supported people to access healthcare services when they required them. Staff had good working relationships with local doctor’s surgeries and the local hospice. Staff followed health professionals' guidance regarding people's specific needs. People’s preferences around food and drink were respected and support was in place for people with specialist dietary requirements.

At this inspection, we found the provider was in breach of five Regulations: safe care and treatment, staffing, person-centred care, need for consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.

We undertook this focused inspection on 5 January 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Elsinor Residential Home) on our website at www.cqc.org.uk.

Elsinor Residential Home is a care home providing accommodation and personal care for up to 35 older people living with dementia. There was a registered manager employed at the service. 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.

At the comprehensive inspection in January 2016 we found the environment was not dementia friendly and did not therefore meet the needs of the client group who were all living with dementia. When we returned we found that improvements to the environment had been made. These included use of contrasting colours to highlight important areas such as toilets and more effective signage using pictures and words to help people find their way around.

There were plans in place to change all the patterned carpets in the service over time. Patterned carpets can cause confusion if you have dementia, as it becomes increasingly difficult to distinguish between design and actual objects. We saw people's pictures and name on their bedroom doors making it easier for people to identify their room.

The registered manager was using current good practice guidance to identify where further improvements could be made to enhance people's well-being.

This meant that the previous breach of Regulation 15 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

Elsinor is registered to offer care and accommodation for up to a maximum of thirty five people. The home offers care for older people who are living with dementia. Dementia is an umbrella term used to describe the range of conditions that cause changes in memory and other cognitive abilities that are severe enough to interfere with daily life The service does not offer nursing care.There were 31 people resident on the day we inspected.

There was a registered manager employed at this service who has been in post for 20 years. 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.

The service was not consistently effective. The provider had not taken account of current good practice to make the environment dementia friendly. You can see what action we told the provider to take at the back of the full version of the report.

The staff were working within the principles of the Mental Capacity Act 2005. We saw staff give people choices and allow them to make their own decisions.

People’s needs were assessed by staff before they went to live at the service. This information was used to develop peoples care plans.

The service provided a range of activities for people but there was a need for more meaningful activity to support people living with dementia.

No recent complaints had been received at the service but people knew who to speak to if they wished to raise concerns.

People were provided with a choice of food and drink at mealtimes. People at risk of weight loss had been referred to their GP and the appropriate health professionals

Staff undertook training to learn new skills and keep them up to date. They had been trained in safeguarding adults and could describe the signs of potential abuse.

Risk assessments were undertaken to determine the risks present for people and action was taken to help minimise those risks. People had personal individual evacuation plans in their care records to assist staff in the event of a fire. Fire safety equipment was properly maintained.

Staff had been recruited safely and there were sufficient staff on duty to meet people’s needs. Checks of staff’s previous employment history had been carried out prior to them working at the service.

Medicines were managed safely. Senior care workers administered medicines and audits were completed.

Staff treated people with kindness and spoke respectfully to them. It was clear that they knew people well.

People were well supported at the end of their life. Staff worked with the care homes team from the local hospice to ensure people received good care.

People who used the service told us that the staff were friendly and 'Very nice'. They said that staff took time with them and helped them when they needed it. We observed positive interactions between staff and people using the service. Staff treated them with respect.

People told us they enjoyed the meals provided and staff told us they recorded what people had drank and eaten so they could monitor their dietary intake.

Elsinor was well maintained and health and safety checks on equipment used in the home was carried out at suitable intervals.

Staff told us that the manager was very supportive and they had received training to help them carry out their job. They told us they had regular supervision and an annual appraisal to ensure their skills remained up to date. We spoke with two social care professionals. They told us that the staff worked very well within the home and asked for advice when they needed it.

We saw the complaints procedure and noted there had been no complaints in the last 12 months. The manager told us they dealt with minor issues on a daily basis.

We found that people were consulted about their care and that the home sought people's consent to their care and treatment. We saw that the home assessed people's capacity to make decisions. Those people who were assessed to lack capacity and where decisions were needed about care and treatment had these made by a multidisciplinary team to ensure they were made in the person's best interests.

We saw that the home assessed people's care needs and developed care plans which were reviewed with risk assessments in place. We saw that staff had training in caring for people with a dementia and that care plans took account of people's dementia care needs.This meant that people received the care they needed. We saw that people were protected from risk of harm through the correct recruitment practice, staff training and appropriate checks.

The home handled medication safely to protect people's health.

The home monitored the quality of it's service through surveys and internal systems so that improvements could be identified and put in place.