Elms House

Elms House is a short-term residential care home providing personal care to up to a maximum of 14 people. The service provides rehabilitation support to adults with mental health needs. At the time of our inspection there were 13 people using the service.

The service is situated close to local amenities and has 11 bedrooms in the main house and 3 independent living flats. People have access to communal living space and a large garden.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Governance systems were in place. However, the provider did not always have oversight of the landlord’s health and safety checks to ensure all the required areas were covered. Numerous in-house audits were completed but we found the actions identified were not always documented in an action plan which could be monitored.

Risks to people’s safety identified at the previous inspection had been mitigated and actions from the previous fire safety report had been completed. Infection prevention controls were safely managed.

People received their medicine on time from staff who had been trained in safe administration and a better process was in place for people needing to take their medicine out of the home.

People were supported by sufficient staff who had received appropriate training for their role and showed dedication to helping people achieve their outcomes. Staff worked closer with the mental health trust and plans were in place to increase the support and training they received.

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.

Lessons were learnt when things went wrong and it was evident improvements had been made to several aspects of the service since our last visit. Roles and responsibilities were clearer, and the culture was positive.

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 16 November 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. It was agreed we would carry out a focused inspection to review an historic breach of regulation 12.

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, which will help inform when we next inspect.

Elms House is a care home located in Shrewsbury and can accommodate 14 people. 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.

Elms House is registered with CQC to provide rehabilitation and recovery support for younger adults and adults with mental health needs. Elms House consists of 11 bedrooms in a main house and three attached flats. Within the main building people have access to communal lounges, quiet spaces and activity rooms which includes a dedicated relaxation room. At the time of inspection there were 12 people residing at Elms House.

Elms House is required to have a registered manager in post. At the time of inspection, the home did not have a registered manager in post however a new manager had been appointed and a start date identified. 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 that Elms House was in breach of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We identified that following a Fire Risk Assessment completed in 2017 actions were requested of the provider. Unfortunately, Elms House could not evidence that appropriate action had been taken. We found that people did not all have a Personal Emergency Evacuation Plans (PEEP) and that required works to the property remained outstanding.

We found that some actions from health and safety audits had not been addressed in a timely manner.

We found that medicine was not always being safely managed as the procedures for people taking medicine home was not included in the provider’s policy and that there was inconsistent practice in the team. We also found that protocols for ‘as and when’ required medicine, needed further details.

Elms House was a clean and homely building but on the day of inspection it was noted cleaning products had been left unattended, which left people at risk. When we spoke with the management team we were made aware that they had made the same observation and immediately addressed this issue.

People were safeguarded from abuse and staff had a clear understanding of their role in reporting any concerns.

We found that there was sufficient safely recruited staff to meet people’s needs. Staff were trained in subjects such as safeguarding, first aid, food hygiene. We found that staff had knowledge of mental health conditions and disorders such as Autism but that there had been a lack of formal training on such subjects.

People were treated with kindness and respect. People were involved in decisions about their care. People felt listened to and they knew how to raise a complaint if needed.

People received care and support that was relevant to their needs. Detailed risk assessments were completed and people were actively encouraged to become more independent. People had access to a wide range of activities.

People were supported by the wider multi-disciplinary team and supported to make plans for the future.

Elms House does not provide end of life care and there was no one at Elms House requiring this type of support.

Notifications to CQC were submitted as required.