Elm Tree House

Elm Tree House is a care home providing the regulated activity accommodation for people who require nursing or personal care to up to eight people. The service provides support to older people, younger adults, autistic people and people with a learning disability. At the time of our inspection there were six people using the service.

Elm Tree House is made up of two former domestic properties. Accommodation is laid out over two floors, with washing and toilet facilities accessible on both floors. People have access to a communal kitchen, dining area and communal lounges. The registered manager’s office is located on the ground floor, on the same floor there is level access to a well-stocked garden.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support: People were not always supported to pursue their interests and hobbies and maintain their independence. People were protected from the risk of harm because staff knew what to do if abuse was suspected or witnessed.

Right care: People had health plans in place to reflect their current health related needs. At the time of our inspection only one person had an end of life care plan in place, this contained conflicting information.

Right culture: The provider had implemented an action plan to help drive improvement in the service. Permanent and longstanding agency staff knew people well and talked about them in a person-centred way. Relatives said they knew how to complain and would complain if they needed to.

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.

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 January 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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, responsive and well-led sections of this full report.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, audits and checks at this inspection.

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.

We found the following examples of good practice.

An area had been set up at the entrance of the home so that hands could be cleaned before staff and visitors entered the building. Health declaration forms were completed on arrival at the home and staff checked visitors’ temperatures.

Staff had received training in infection control, including how to safely put on and take off personal protective equipment (PPE) such as gloves, aprons, and face coverings. The home had adequate supplies of PPE and we saw staff wearing PPE appropriately.

A visiting room was allocated for visits. There was a visiting procedure in place. Staff also supported people to keep in touch with their relatives via video calling.

Changes had been made to the inside of the home to enable social distancing such as placing circles on the floor to encourage people to keep two meters apart. There were also posters around the home. Additional cleaning had been implemented throughout the home. This included cleaning frequently touched areas such as handrails, light switches and handles.

There was a procedure in place for new admissions. No one would be admitted without a negative COVID-19 test first and they would isolate for 14 days.

The manager ensured regular COVID-19 testing was carried out for staff and people living in the home.

A business continuity plan was in place, to reduce the effects of potential disruption to people's care. There were policies and procedures to provide guidance for staff on safe working practices during the pandemic. The provider had a range of communication systems in place.

Staff were confident and knowledgeable about how to protect people from the risk of infection and the environment was clean.

Further information is in the detailed findings below.

There was a registered manager in post. 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 last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good.

People were protected from abuse because staff understood how to keep them safe, including more senior staff understanding the processes they should follow if an allegation of abuse was made. All staff informed us concerns would be followed up if they were raised. People received their medicines safely. There were enough suitable staff to meet people’s needs. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others.

Staff received training to ensure they had the skills and knowledge required to effectively support people. People were supported to eat and drink according to their likes and dislikes. People who lacked capacity had decisions made in line with current legislation. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

We observed that staff were kind and patient. People were involved in decisions about the care and support they received. People received care and support which ensured they were able to make choices about their day to day lives.

People were supported to engage in activity programmes. People knew how to complain and there were a range of opportunities for them to raise concerns with the registered manager and designated staff.

Further information is in the detailed findings below

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by staff. People told us that staff treated them well. People were cared for by staff who were aware of the risks to people's safety and health and staff knew how to support them in a safe way.

People were protected from the risks associated with medicines. There were systems in place to ensure the safe storage and administration of medicines.

Systems were in place to make sure the manager and staff learn from events such as accidents, incidents and complaints. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This means that people will be safeguarded as required.

Is the service effective?

People told us that they were happy with the care they received and that their care needs were met. It was clear from observations and from speaking with staff that they had a good understanding of people's care and support needs. One person told us, "I have regular keyworker meetings and staff provide the care I need'. Staff had received training to meet the needs of the people living in the home.

Is the service caring?

People were supported by kind and respectful staff. We saw that staff showed patience and compassion when supporting people. People told us that they could do the things they enjoyed. Our observations confirmed this. One person told us, "Staff treat me very well, they are kind.' Staff told us they were able to provide the care that people needed.

People using the service, their relatives and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

Is the service responsive?

People's needs were reviewed regularly and in response to any changing needs. We saw information in people's records which indicated they had been consulted over the care they received. This meant that information about people's preferences were gathered and used to plan care to meet their specific needs. People were supported to maintain relationships with people that were important to them.

The service worked well with health and social care professionals and services to make sure people received their care in a joined up way.

Is the service well led?

The service had a quality assurance system and records we saw showed that the registered manager monitored people's care needs and the care provided. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

We also observed the support provided by staff and checked a sample of records.

On the day of our inspection there were eight people living at Elm Tree House.

Some of the people who were using the service were not able to communicate with us verbally. They shared their views through gestures, facial expressions and body language wherever possible.

We observed that the service was run as an ordinary household. The people who used the service had an active role in daily activities and we observed some of them helping out in the kitchen to prepare their meals as part of an independent lifestyle.

We saw people who lived in the house were supported by six members of staff. We spoke with four people individually. They told us they were happy at Elm Tree House. Comments made included, "I am happy here, they look after me well" if I have any complaints I will tell the manager and my keyworker'.

We found systems were in place to ensure people were safeguarded from abuse.

We found the environment was clean and adequately maintained.

We found staff were trained and supported to deliver care to an appropriate standard.

We found the provider had an effective system in place to monitor the quality of the service to ensure people received safe care.