Elwis House

About the service

Elwis House is a residential care home providing personal care for up to four people and people with a learning disability and/or autistic people . At the time of the inspection four people were living there.

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

Right Support

Staff supported people to have the maximum possible choice, control and independence and they had control over their own lives. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Staff supported people to identify and work towards aspirations and goals.

The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. People had a choice about their living environment and were able to personalise their rooms.

Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

Staff supported people to play an active role, where possible, in maintaining their own health and wellbeing. Staff ensured people had full access to health and social care to maintain their health and wellbeing.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs and promoted equality and diversity in their support for people.

People told us or communicated with us they were happy living at Elwis House. Relatives told us their family members were happy, safe and comfortable at the service. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. There was enough appropriately skilled staff to meet people’s needs and keep them safe.

People were encouraged and supported to identify and take part in activities and pursue interests that were tailored to them. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

People received good quality care and support because trained staff could meet their needs and wishes. People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs.

Staff placed people’s wishes, needs and rights at the heart of everything they did. They knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.

People and those important to them were involved in planning their care. Staff valued and acted upon people’s views.

The registered manager and provider had implemented effective checks and audits on the quality and safety of the service. When shortfalls were identified, action was taken to address these.

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

At the last inspection the service was not rated (published 4 August 2021). This was because we carried out a targeted inspection. We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. The last rating for the service was on 1 December 2020 when the service was rated requires improvement.

Why we inspected

We undertook this inspection to see if improvements had been made to person-centred care and assess that the service is applying the principles of right support right care right culture. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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.

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.

Elwis House is a small residential care home which provides accommodation and support for up to four people with learning disabilities and/or autistic people. At the time of our inspection four people were using the service.

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

The provider had improved the way risks were managed. At the previous inspection we identified there was a risk that a vulnerable person could leave the service unattended. The provider had improved the risk management plan for this risk. The provider had assessed other risks to people’s health and wellbeing and put in measures to mitigate these.

We found people were protected from the risk of acquiring infections and the service was clean and hygienic. Personal protective equipment (PPE) was readily available to staff and all staff were now following the latest guidance. The provider had reviewed the visitor’s policy and were safely managing visitors to the service.

We have made a recommendation about improving weekly testing schedule to ensure all staff receive a Covid 19 test in line with government guidelines.

Rating at last inspection

The last rating for this service was Requires Improvement (Report published 3 December 2020).

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. Please see the safe section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elwis House 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.

Elwis House is small residential care home that provides personal care for up to four people with learning disabilities. Four people were living at the service at the time of the inspection.

People’s experience of using this service

People were not always safe. The provider had not ensured risks to people were always mitigated, particularly for one person who was at high risk of leaving the service unattended. People’s medicines were mostly managed safely, however, there was insufficient information regarding ‘when required’ (PRN) medicines. We have made a recommendation about the management of PRN medicines. We have also made a recommendation about recruitment practices.

The provider had responded to the risks associated with the Covid-19 pandemic. Infection control procedures had been increased in line with current guidelines to reduce the risk of infections being brought into the service. There were regular infection control audits and maintenance checks to ensure safety issues were resolved and hygiene levels were maintained. However, we observed some staff were not wearing PPE in line with current guidance. Staffing levels were safe to meet the needs of the people receiving care. However, there was a reliance on agency staff to maintain safe staffing levels. We have made recommendations about the correct use of PPE and the use of agency staff to reduce the risks.

At the last inspection, we identified not all people were actively involved in the review of their care and support needs. We found not enough improvements had been made in this area.

People were supported with their complex physical health needs and care records contained detailed information on these. People were supported to ensure they had enough fluid and nutrition to maintain good health.

At the last inspection we identified people’s communication needs were not always met and not all people were given meaningful choices about what activities they could engage in. Improvements had been made but we identified further improvements were needed. We have made a recommendation about supporting people to express their future wishes.

We received mixed feedback about how well the service communicated and worked in partnership. Relatives of people receiving care told us they were happy with how the service communicated with them and kept them informed. However, professionals told us the service did not always communicate effectively and did not always act on recommendations made. Systems were in place to monitor the quality of the service, however, they had not been effective in addressing all the concerns raised in this inspection.

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

At the last inspection, the service was rated as requires improvement (Report published 12 June 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two 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 undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. During the inspection we identified one person was at risk of leaving the service unattended. Due to this we widened the scope of this inspection to include the key question ‘safe’.

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 coronavirus and other infection outbreaks effectively.

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 have identified a breach in relation to safe care and treatment at this inspection. 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:

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. If we receive any concerning information we may return to inspect.

Elwis House is small residential care home that provides personal care for up to four people with learning disabilities. Four people were living at the service at the time of the inspection.

People’s experience of using this service:

• Not all people were given meaningful choices about what activities they could engage in.

• People’s individual communication needs were not always being met in line with best practice.

•The provider had quality assurance systems in place but these were not always effective as they had not identified and addressed the issues we found.

• People told us they felt protected from harm and abuse.

• The provider had appropriate risk assessments in place with guidance for staff about how to mitigate these.

• The provider supported people to take their medicines safely.

• The provider maintained a clean and tidy home and had systems in place to identify hazards.

• The provider ensured people’s nutritional and hydration needs were met.

• The provider followed safer recruitment processes and staffing levels were enough to meet people’s needs.

• People were supported with their complex physical health needs and care records contained information on these.

• People and their relative’s gave positive feedback about care workers and told us they were kind and caring. One relative said the service was “brilliant, I couldn’t ask for better.”

• People’s privacy and dignity was promoted, and we observed positive interactions between people using the service and staff.

• The provider had an appropriate complaints procedure available in an easy read format and people and their family members said they could complain if they were not happy about an aspect of the service.

Rating at last inspection: At the last inspection the service was rated as Requires Improvement (Report published 13 April 2018).

Why we inspected: This was a planned inspection based on the previous inspection rating.

Follow up: We will continue to monitor information we receive about the service until we return to visit per our re-inspection guidelines. We may inspect sooner if any concerning information is received.

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

Elwis House provides accommodation for persons who require personal care. The home provides care and support for up to four people with learning disabilities, some of whom have additional physical disabilities. At the time of our inspection there were four people living at the home.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager who was available on the second day of the inspection. 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.

Information about the home was accessible and understood by people who used the service. People were listened to and their rights were respected by caring and considerate staff.

Recruitment checks were completed to assess the suitability of the staff employed. Staff received suitable training and good support from the registered manager to enable them to carry out their roles effectively. There was a suitable number of staff to meet the needs of the people who lived in the home.

The safe storage and auditing of medicines needed to be improved to ensure people were safely supported with their medicines. Staff had received medicines training and their competency was assessed.

Care plans were personalised and evidenced how people would like to receive their care, however some records required a review of people’s needs.

Systems were in place to effectively improve the quality of care delivered. Surveys had been sent to obtain people’s views and these were used to implement change within the service.

Suitable arrangements were in place to ensure people received good nutrition and hydration.

Staff understood their responsibilities with regard to reporting suspected abuse in order to safeguard people from harm. Guidelines were followed by staff to minimise the risk of harm to people and minimise re-occurrences of any incidents.

People were supported by staff to attend medical appointments when there were changes to their health needs and/or associated risks to their health.

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 were encouraged to maintain good relationships with their relatives. People had access to activities that were important to them and were supported to be active in the community to help maintain their independence.

An easy read complaints policy was available to guide people how to make a complaint. The provider had received no complaints since the last inspection and one person told us they had no concerns.

We have made two recommendations about people’s medicines and their care records.

Another person showed us their bedroom in which they had been helped to display the things they liked. They told us that they got on well with staff and the other people living at the service. They told us they were assisted to go to Church and they were glad about this.

Some of the people living at the service were unable to contribute to the inspection because of the nature of their disabilities. We observed that they were relaxed in their home, with each other and with staff members. We contacted two people with an interest in the service through their involvement with the people who lived there. One of these people told us they felt the service provided was "high quality" and "personalised".

Staff told us that they enjoyed their work, one member of staff told us "I really like the people who live here". They said that they felt well supported in their work by the managers.

We met with all of the people using the service. Two people stated that they thought the home was good, a nice place to live, and that staff looked after them.

Staff had undergone safeguarding training and were familiar with the action they should take if they suspected abuse was taking place. The relevant authorities were notified of any safeguarding concerns.

Staff said that they felt well supported by the provider. They felt that they were provided with a satisfactory amount of training, although they were unable to provide us with documentary evidence of training courses attended.

There were a number of systems in use to monitor the quality of the service but we found that staff were not using these systems appropriately. This meant that the provider could not be assured that the service was of an acceptable standard.

We looked at records about care, medication, risk assessments and audits. We found staff were not keeping all of these accurately or securely. We also found that some of the actions the provider was required to take after the inspection on 27 March 2012 had not been taken.