Elm Park Lodge

Elm Park Lodge is a residential care home providing personal care and accommodation for up to 27 people with mental health needs. The home is on a residential street in a community setting and designed to promote people's inclusion and independence. There are two flats which are included in the registration for the care home, located next door.

At the time of the inspection there were 27 people living at the service.

People’s experience of the service

People and their relatives praised the service provided, and told us staff were kind and caring to them.

At the last inspection we found there were breaches of the regulations as medicines were not always safely managed and staff recruitment was not always safe. Improvements had been made in both of these areas.

People told us they felt safe and we saw they were safeguarded against the risks of abuse and harm by the provider systems and by the staff. Risk assessments were in place and staff understood how to minimise harm to people.

There were enough staff to meet people’s needs and provide responsive care. Staff recruitment was safe.

People told us they were happy living at the service, and we saw staff understood people’s needs and routines. People and their family members told us they were supported to access external health professionals to help promote good health and wellbeing. Health and social care professionals told us the management team worked in partnership with them to achieve good outcomes for people.

We saw the service had managed an outbreak of COVID-19 effectively and had put in place measures to minimise the spread, and prevent future outbreaks. We saw increased measures were in place to keep the service clean and the majority of staff wore personal protective equipment (PPE) correctly. Health and social care professionals told us the service worked well with them to manage the virus.

Family members told us they had been kept fully informed about the outbreak and maintained communication with their relative through phone or other electronic means. During the summer face to face contact had been safely facilitated.

Activities took place at the service and people were encouraged to go out walking whilst complying with lockdown measures.

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.

Quality audits took place to ensure health and safety, finance, medicines and care records were up to date and staff told us they were well supported in their role.

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 the service was requires improvement (published 18 September 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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, Caring and Well-led which contain those requirements.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

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 re-inspection programme. If we receive any concerning information we may inspect sooner.

Elm Park Lodge is a residential care home providing personal care and accommodation for up to 27 people with mental health needs. The home is on a residential street in a community setting and designed to promote people's inclusion and independence. There are two flats which are included in the registration for the care home, located next door.

At the time of the inspection there were 21 people living at the service.

People’s experience of the service

People told us they were happy living at the service and staff were kind and caring to them.

We found there were breaches of the regulations as medicines were not always safely managed and staff recruitment was not always safe.

People were safeguarded against the risks of abuse and harm by the systems and by the staff. Risks to people were assessed and mitigated. There were enough staff to meet people’s needs and provide responsive care.

We could see there was a friendly, warm atmosphere at the service and staff understood people’s needs and routines. People were supported to access external health professionals to help promote good health and wellbeing. Health and social care professionals told us the service worked effectively with them. Family members praised the service provided and the ability of staff and the management team to work in partnership with them.

Activities took place at the service and people were encouraged to engage in activities within the community.

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.

Quality audits took place to ensure health and safety, finance, medicines and care records were up to date.

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 the service was requires improvement (published 31 August 2018).

At the last inspection there was a breach of the regulations in relation to medicines. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last three consecutive inspections.

We will meet with the provider to discuss how they can make improvements to the service.

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 re-inspection programme. If we receive any concerning information we may inspect sooner.

This comprehensive inspection was to follow up on the actions taken following the last inspection and to check the requirements of the Warning Notice had been met.

Elm Park Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Elm Park Lodge accommodates up to 27 people with mental health needs in two buildings next door to each other. At the time of our inspection there were 22 people living in the main building with four people living in two flats next door.

At this inspection there was a registered manager at the service but they were on extended leave. The deputy manager was acting up into the role of manager, and providing day to day management of 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 this inspection we found the requirements set out in the Warning Notice had been met as the service had made improvements in key areas such as safeguarding, recruitment, person centred care and risk assessments. Recruitment was safe, people were safeguarded from abuse and the service could show us they were offering person centred care.

There were also improvements in areas such as hygiene, complaints and reviewing of accident and incident logs, with minor concerns remaining. The service had been notifying the Care Quality Commission of important incidents since the last inspection.

At this inspection we found that medicine stocks did not tally with medicine administration records which meant the service could not prove medicines were being safely managed.

Systems and processes were in place to check quality at the service and quality audits showed us the acting manager had an oversight of the majority of key areas including care plans, risk assessments, training and recruitment.

The service had appropriate documentation in place in relation to consent and compliance 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.

People told us they enjoyed living at the service and staff were kind and caring.

Staff told us they were supported in their role through supervision, training and team meetings. People were positive about the skills and knowledge of staff. Health and social care professionals highlighted that some staff had limited experience of mental health conditions.

People and their relatives told us the acting manager was approachable and responsive to issues raised.

We found a breach of the regulation relating to safe care and treatment due to mismanagement of medicines.

We have made recommendations in relation to supporting people to move onto independent living and regarding staffing levels.

Elm Park Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Elm Park Lodge accommodates up to 27 people with mental health needs in two buildings next door to each other. At the time of our inspection there were 20 people living in the main building with four people living in two flats next door.

There was a registered manager in post 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.

We found at this inspection that some areas which had been subject to a breach of regulation had improved, whilst other areas had not. We also found new areas of concern at this inspection.

At this inspection we found that recruitment of staff was not always safe as some staff had been employed before references had been received.

Whilst there were risk assessments in place for a number of risks identified, staff were not always provided with guidance on how to safely manage people’s needs.

Whilst people told us they felt safe living at the service and staff had been trained on safeguarding issues, the process to be followed by the provider to alert the local authority when safeguarding issues arose had not always been followed. CQC was not always notified of significant events as required by law.

There were issues of cleanliness at the service, and in particular, in the flats attached to the main building.

People and their relatives told us the registered manager was approachable and responsive to issues raised. However, there were concerns regarding the management of the service and the oversight of the provider in ensuring quality checking systems were in place and that they resulted in improvements and learning for the service.

People told us they enjoyed living at the service and staff were caring but we found a blanket ban on coffee provided at the service which indicated the service did not always provide person centred care. Although people told us they enjoyed the food, apart from breakfast items, food was stored in a locked basement and brought up as required by staff. People did not tell us this was a concern to them.

Staff understood the importance of consent and people were supported to have choice and control of their lives and staff supported them in this, although the ban on coffee was unquestioned by staff. The service operated within the requirements of the law in restricting one person’s liberty and the policies and systems in the service supported this practice.

Staff told us they felt supported in their role and they received regular supervision. People were positive about staff skills and knowledge and their ability to care for them. This was confirmed by relatives.

We found breaches of the regulations relating to safe care and treatment, safeguarding, person centred care, recruitment and notifying CQC of significant events.

We took enforcement action against the provider by serving an enforcement warning notice in relation to 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.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We reviewed care files for three people. We saw that each person had a life map which included areas such as, hobbies, likes and dislikes, important relationships and previous employment.

We found the provider worked closely with the primary care mental health team. This was confirmed by a mental health professional visiting on the day of our inspection who told us that he was generally happy with the service, but would like to see the provider do more to encourage people to develop life skills.

The provider had taken steps to provide care in an environment that is suitably designed and adequately maintained. We saw that service contracts were in place to help maintain the building.

There were systems in place to monitor the quality of the service, however we were concerned that there were no systems in place to assess the risk of and to prevent, detect and control the spread of a health care associated infection.

We spoke to a healthcare professional who told us that the person they were supporting had, 'settled in nicely.' However, they felt they would benefit from more intervention in terms of activities. We spoke with a group of three people sitting in the lounge. Feedback on staff included comments such as, 'fairly polite,' and 'quite nice.'

Care plans were not regularly reviewed and up to date, which meant that people were not always protected from the risk of unsafe or inappropriate care and treatment. The deputy manager was aware of this and told us that they will be addressing this issue with staff.

There were systems in place to ensure that people were protected from abuse and that they received the care they needed. We saw that people walked around the home freely, they told us that they felt safe. People were given a choice of activities which included the art project located at the back of the house. One person told us 'I enjoy art therapy and reading the newspaper.'

Systems were in place to monitor and to make improvements to the quality of care and support provided to people by the home. However, we were concerned that staff supervision was inconsistent and staff were not always supported to carryout their role in providing care and support to people.