Elm House Nursing Home

Elm House Nursing Home is a residential care home providing personal care to up to 32 people. The service provides support to older people, including those living with dementia. At the time of our inspection there were 31 people using the service.

Elm House Nursing Home is a large, adapted house with 4 floors, with lift access to all floors. There was a communal lounge and a dining room located on the ground floor. People also had access to a private and enclosed rear garden.

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

Some checks about the safety of the environment were not up to date. (Fire safety and window restrictor checks were overdue for completion). Systems to analyse risks to help identify any trends or patterns required strengthening.

We have made a recommendation about the further development of risk management processes.

We were assured people received care and support based on their needs, however, some care plans required additional detail to provide specific guidance for staff.

Risks to people's health and safety were assessed. Staff had access to information about how to manage and mitigate people's identified risks, to support them in a safe way.

People were protected from avoidable harm and abuse. The home had effective safeguarding policies and processes in place.

Staff were safely recruited and there was enough staff on duty to meet people’s needs in a timely way. Many staff members were long standing and were familiar with people’s needs. People and staff told us they thought of the home as ‘one big family.’

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 and were followed by the provider in line with the Mental Capacity Act.

Some management systems to identify and manage risks to the quality of the service required strengthening.

We have made a recommendation about further developing governance and performance management.

We received positive feedback about the management team from people, their relatives and staff.

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 21 July 2017).

Why we inspected

This inspection was prompted by the age of the last rating. As we had received no concerning information about the service, we carried out an inspection of the key questions of Safe and Well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. We have found evidence that the provider needs to make improvements. Please see the well-led section of this full report.

The overall rating for the service has remained Good based on the findings of this inspection.

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

We found the following examples of good practice.

¿ One person told us “Staff clean my room regularly and always wear PPE when doing my personal care.” Another person said “I cannot fault the staff, they are all wonderful. They are always covered up with PPE and this makes me feel safe.”

¿ All visitors were asked to complete a health screening form, have their temperature checked and were provided with face masks to wear throughout their visit. Full PPE was available for all visitors along with access to handwashing facilities and hand sanitiser. The provider had built a screened Perspex area within the conservatory which was accessible from the outside for visitors and inside for people living at the home.

¿ We observed staff to be wearing the correct personal protective equipment (PPE) throughout the inspection.

¿ People and staff were taking part in regular COVID19 testing. Bank staff were included in the testing process.

¿ People had individual risk assessments in place that reflected their specific relative visiting arrangements. Consideration had been given for the therapeutic benefits of relatives visiting along with the importance of supporting people’s mental health needs.

¿ Staff had all received training to meet the requirements of their role and for the management of COVID19. Staff told us they felt confident to support people with a COVID19 positive diagnosis.

We were assured that this service met good infection prevention and control guidelines as a designated care setting

Further information is in the detailed findings below.

Elm House 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.

At the last inspection of 19 June 2017 the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good:

The service met all relevant fundamental standards.

At the time of our inspection 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.

We looked at the care plans for four people receiving support at the service. Care documents were individualised so staff had the information they needed to provide care and support to people in accordance with their needs and wishes. People living at the home and relatives told us they were involved with their plan of care and this was reviewed with them when needed.

Staff were clear about the need to support people’s rights and needs regarding equality and diversity. Care records contained important information about people’s sexuality, ethnicity, gender and other protected characteristics.

People were supported by staff to maintain their health and wellbeing through access to external health and social care professionals and specialist services. This along with partnership working with external organisations helped to achieve effective safe outcomes for people. External professionals were complimentary regarding the service provision.

We talked with staff about people’s care needs and they demonstrated good knowledge and understanding of the care and support people needed to ensure their safety and wellbeing.

We saw good communication between staff and people they were supporting. It was evident that staff knew people well and had the skills and approach needed to ensure people received the care they needed.

People told us that staff had a kind, warm and sensitive approach and this we observed during the inspection.

People had been consulted regarding the social activities they wanted at the home. We saw a wide programme of social activities which were held each week and people also went out for day trips to local venues. There was a relaxed friendly atmosphere in the home with visitors popping in at different times of the day.

People told us they enjoyed the meals, especially the home baking. People’s dietary needs were assessed and managed with reference to individual need, preference and choice.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest.

Staff were aware of safeguarding procedures. Staff told us about reporting procedures including referral to relevant local authorities in accordance with agreed guidelines.

The registered manager had made referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

The complaints’ process was understood by the people that we spoke with. Complaints received had been investigated and responded to in accordance with the service’s policy.

We saw recruitment checks had been made so that staff employed were ‘fit’ to work with vulnerable people.

Medicines were stored and administered safely to people living at the service. People were encouraged to administer their own medicines where appropriate.

Staff received a good standard of training and attended supervision meetings and appraisal. This enabled them to meet the needs of the people they were supporting.

We checked the records in relation to concerns and complaints. The complaints’ process was understood by the people that we spoke with. We saw evidence that complaints had been responded to in a professional and timely manner by the registered manager.

People living at the home and relatives were complimentary regarding the leadership and management of the home. A person described the running of the home as “First class on all accounts.”

Quality assurance systems and process were in place to monitor the service and drive forward improvements. Required actions were completed in a timely manner and lessons learned were shared with staff to help improve the service.

The service was making increasing use of technology to aid communication and safety. For example, access to WIFI in the home for people to access the internet.

People were encouraged to share their views about the home and their opinions were taken into account in respect of improvements and further development of the service.

The ratings from the previous inspection were displayed as required in the care home and on the provider’s (owner’s) website.

We carried out an unannounced comprehensive inspection of this service on 4 January 2017.We found a breach of regulation regarding consent to care and treatment for people living at Elm House. When people were unable to consent, the principles of the Mental Capacity Act 2005 (MCA) were not always followed, in that assessments of the person’s mental capacity was not made based on individual decisions.

We also made a recommendation under the ‘Well led’ section of the report to further develop a more comprehensive series of management audits to monitor the service.

Following the inspection in January 2017 we gave the service a quality rating of ‘Requires improvement’.

After the comprehensive inspection, the registered provider wrote to us to tell us what they would do to meet legal requirements in relation to the breach; the provider told us they would be compliant with the regulation by 16 May 2017.

We undertook a focused inspection on 16 June 2017 to check that they had they now met legal requirements. This report only covers our findings in relation to these specific areas / breaches of regulation. They cover two questions we normally asked of services; whether they are ‘Effective’ and 'Well led'. The questions ‘was the service ‘Safe’, Caring’ and ‘Responsive’ were not assessed at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Elm House Nursing Home' on our website at www.cqc.org.uk.

At this inspection we found improvements had been made with respect to gaining people’s consent and adherence to the MCA 2005; the previous breach of regulation had been met.

We found there was a clearer understanding of the principles of the MCA 2005 and how this should be applied with people living in the home. We saw examples where people’s capacity had been assessed with regard to key decisions they were making and where they lacked capacity, decisions had been made in people’s best interest.

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.

We found action had been taken to improve the management and governance of the home by developing a program of on-going audits to monitor and maintain good standards.

We were satisfied that the improvements in overall governance evidenced an on-going consistency to meet standards in the home and we have raised the quality rating for Elm House from ‘Requires improvement’ to ‘Good’.

This was an unannounced inspection which took place on 4 and 5 January 2017. The service was last inspected in September 2015 and at that time was found to be in breach of two of the regulations under the Health and Social Care Act 2008 (HSCA). The breach of regulations was due to concerns with the level of hygiene in the home and adherence to infection control, as well as some environmental safety issues such as, poor monitoring of hot water temperatures which placed people at risk of scalds.

The service had been rated as ‘Requires improvement’.

The provider set us an action plan which told us the issues raised in the report had been addressed.

The service had 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 HSCA and associated regulations about how the service is run.

At this inspection we found many developments to the service following the appointment of the registered manager ten months ago. Both previous breaches of regulations had been met. Effective arrangements were now in place for checking the environment to ensure it was safe. For example, health and safety audits were completed where obvious hazards were identified. We found the environment safe and well maintained. This had improved since our last inspection. We also found the monitoring of cleanliness and infection control in the home had also improved.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 [MCA] were not always followed, in that assessments of the person’s mental capacity was not made based on individual decisions. We had some discussion how this could be further improved by evidencing assessment around individual key decisions; this would meet best practice and follow the principles of the MCA. We told the provider to take action.

The registered manager was able to evidence a series of quality assurance processes and audits carried out internally. These had been effective in developing and maintaining existing standards in the home and were based on getting feedback from the people living there. However, during the inspection we found areas that need addressing and further development; the existing auditing processes had not been sufficiently developed to encompass these areas.

We recommended that further progress is made to develop a fully comprehensive series of management audits and these are routinely scheduled.

We saw written care plans were formulated and subject to ongoing review. We saw that people were generally involved in the care planning and reviews were held.

We made a recommendation that people’s clinical care plans contain relevant detail in line with best clinical practice.

The registered manager had made appropriate referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found the applications were continuing to be monitored by the registered manager.

We reviewed the way people’s medication was managed. We saw there were systems in place to monitor medication so that people received their medicines safely.

There were enough staff on duty to help ensure people’s care needs were consistently met.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We found recruitment to be well managed and thorough.

We were given very positive feedback from the people we spoke with who were living at Elm House. They told us they enjoyed living at the home and they were well cared for. Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training and this was ongoing. All of the staff we spoke with were clear about the need to report any concerns they had.

Activities were organised in the home and these were appreciated by the people living at Elm House.

We observed staff interacting with the people they supported. We saw how staff communicated and supported people. Staff were able to explain each individual person’s care needs and how they communicated these needs.

People living at Elm House told us that staff had the skills and approach needed to ensure people were receiving the right care. People were satisfied with living in the home and told us they felt the support offered met their care needs. People we spoke with said they were consulted about their care and we saw some examples in care planning documentation which showed evidence of people’s input.

Care records showed that people’s health care needs were addressed with appropriate referral and liaison with external health care professionals when needed. We saw an example during the inspection where the registered manager and staff liaised well with community services to support people.

We saw people’s dietary needs were managed with reference to individual needs. There was good staff support for people at this time.

People told us their privacy was respected and maintained. When we observed staff interacting with people living in the home they showed a caring nature with appropriate interventions to support people.

We saw a complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. We saw that a record was made of any complaints and these had been responded to.

You can see what action we took with the provider at the back of the full version of the report.

We carried out some short observations between staff and the people who lived in the home. We observed some examples where staff supported people well, such as assisting people to sit comfortably and using appropriate communication with people. We spoke with one person who lived in the home, who told us "The staff are very kind."

We looked at six people's care records. We found they contained relevant and current information about the person's needs.

On checking medication management we found people received their medicines as prescribed. We found records regarding medication were accurate.

We spoke with four people who told us about their experience of living at the home.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We spoke with a person who told us how staff had supported them with what they needed.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We saw people who lived at the house were very relaxed and confident around staff. This showed people felt safe in the home. The people we spoke with were very relaxed around staff and said they were listened to so that any concerns could be addressed. One person told us, "I would speak to the manager if there was any problem.'

People we spoke with told us they were supported well at Elm House and staff were always available to assist and help as needed.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. All of the people we met with were living in accommodation that suited their needs. They told us they enjoyed living in the home and were able to talk about any changes they wanted with the staff.