The Care Quality Commission (CQC) has rated Elmwood House in Chesterfield, inadequate and placed it in special measures following an inspection in November.
CQC carried out a focused inspection to look at the key questions of safe and well-led. This was prompted in part due to concerns received about safety, infection control and management of the service.
During the visit, inspectors found concerns in relation to the key question of caring, therefore this was also looked at during this inspection.
Elmwood House is a nursing home providing personal and nursing care for up to 32 people. The service supports adults with learning disabilities and is split into four living areas across three floors. At the time of the inspection, 23 people were living at the service.
Following this inspection, the home’s overall rating has dropped from requires improvement to inadequate. It has also dropped from requires improvement to inadequate for being safe and well-led. Caring has dropped from good to requires improvement. Responsive and effective were not included in this inspection and remain rated as good.
The service is now in special measures which means it will be kept under review, by CQC and re-inspected to check sufficient improvements have been made.
Debbie Ivanova, CQC’s director for people with a learning disability and autistic people, said:
“When we inspected Elmwood House, we found that the standard of care had deteriorated since our last inspection in June. It was unacceptable that people’s decisions about how they wanted their care and support delivered wasn’t always respected.
“Staff didn’t always use respectful language which people understood and responded well to. During our inspection we overheard inappropriate conversations between staff about people, in front of them, which was totally disrespectful. However, the provider took immediate action and investigated our concerns, after they were highlighted.
“The environment didn’t always promote people’s safety. Someone had asked for things to be fixed in their bedroom, but this hadn’t happened, such as a broken aerial which had been snapped at the socket. They also had a leak in their bathroom ceiling.
“Additionally, not all areas within the home were well maintained to facilitate good infection and control procedures. Some areas of the home such as walls, doors, skirting and paint work were in a poor state. This prevented good cleaning practices and increased the risk of infection.
“There was no oversight of medicine errors within the service. During our inspection, we identified medicine errors which hadn’t been reported or investigated. A lack of system to report, record and investigate medicine errors placed people at risk of harm.
“People were at risk of harm as there was a lack of protection to prevent unnecessary restraint. Also, the service didn’t always record when staff restrained people and there was no monitoring of restraint in order for staff to learn from the use of restraint and consider how it could be reduced.
“However, most relatives described long standing staff members as kind and caring. One said, “Some staff have been there a while and are brilliant. Two in particular go above and beyond.”
“As the service has been rated inadequate and placed in special measures. We will continue to monitor it closely to ensure people are safe. If we are not assured people are receiving safe care, we will not hesitate to take action in line with our regulatory powers as no one should have to live in a service that cannot meet their needs.”
Inspectors found:
- People were not protected from the risk of improper treatment. Some people at the service were sometimes restrained to administer their medicine. Best practice guidance in relation to the use of restraint was not always followed. This placed people at risk of harm
- People did not always receive their medicines at the times they were prescribed or when they needed them
- Staff recruitment processes did not promote safety. Robust recruitment checks were not always carried out. For example, full employment histories were not always obtained prior to the staff members employment
- People’s care records did not always help them get the support they needed. Staff were not always provided with guidance on when to escalate concerns about people’s health and wellbeing. Some people had consistently refused care and support, however staff had not always raised this with healthcare professionals. This placed people at risk of their health deteriorating
- Oversight of accidents and incidents within the service was not effective. Analysis was minimal, only recording number and type of incident. This meant identifying measures to implement and prevent re-occurrence or risk of harm were not identified, placing people at risk of further harm
- Governance processes were not always effective in helping to hold staff to account, keep people safe, protect people’s rights and provide good quality care and support. The systems in place to ensure good governance of the care provided for people were not effective in identifying the risks found during this inspection
- People’s clothing was not always labelled. Staff told us they guessed whose clothes belonged to who based on the size of the clothing. This increased the risk of people being put in clothes that did not belong to them, impacting on their dignity.