Elpha Lodge Residential Care Home

Elpha Lodge is a care home providing accommodation and personal care for up to 24 people with physical disabilities. At the time of the inspection there were 21 people living at the service. Support was provided across two buildings which had been adapted to meet the needs of people.

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

The service was not well-led. There had been 3 changes of manager at the home during the last 12 months. The previous registered manager had left their employment after working at the home for a substantial number of years. These management changes had impacted upon the morale of some staff. A new manager had been recruited shortly before the commencement of our inspection. They were applying to register with CQC.

Some records across the service were disorganised and were difficult to locate. In addition, effective systems were not in place to audit and monitor quality across the service. For example, audits had not been completed at the frequency identified by the provider or had not identified the issues we found during our inspection.

An effective system to ensure all notifications were submitted to the CQC in a timely manner was not fully in place. The failure to notify CQC of incidents and other matters in line with legal requirements meant people were exposed to a risk of harm as there had been no overview by CQC to check whether the appropriate actions had always been taken.

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Safeguarding systems were not robust enough to ensure people were always protected from the risk of abuse. Staff said they would report any concerns to the management team. However, we were not assured they understood their safeguarding responsibilities.

Safe and effective infection control procedures were not fully in place to ensure people were protected from the risk of infection. Medicines were not always managed safely. There were inaccuracies and omissions with the administration and recording of medicines. Staff were not always recruited safely and there were not always enough staff to meet people’s needs. Risk assessments had not been completed for all the risks people were exposed.

Effective systems to ensure staff were supported and received the necessary training to enable them to carry out their job role were not in pace. Training was not delivered to all staff which was specific to the needs of people receiving support. For example, staff had not received training in relation to supporting people with learning disabilities and autism even though they were providing this support.

Consent had not always been assessed and the appropriate applications had not been made to authorise care and support where restrictions were in place for people in line with legal requirements. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The care and support provided by staff was not always person-centred to the individual needs of people and records did not confirm people had regular opportunities to take part in activities which were person-centred to them. In addition, people were not always treated with dignity and respect. We have made a recommendation about this. Systems were in place to investigate and respond to complaints. People were supported with their communication needs and advocacy services were used to support people where people required support to express their views. End of life care plans were not in place to ensure any wishes people had for their end-of-life care were recorded. We have made a recommendation about this.

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

Rating at the last inspection

The last rating for this service was outstanding (published 27 December 2017).

Why we inspected

We received concerns in relation to the treatment people received and the overall management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

We inspected and found there was a concern with the management of safeguarding matters, staff training and the overall governance of the service, so we widened the scope of the inspection to become a comprehensive inspection which included the key questions of safe, effective, caring, responsive and well-led.

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.

The overall rating for the service has changed from outstanding 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, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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.

Enforcement and Recommendations

We have identified breaches in relation to person-centred care, need for consent, safe care and treatment, safeguarding, good governance, staffing, safe recruitment and a failure to notify incidents to CQC at this inspection. We have also made recommendations in relation to dignity and respect and end of life care for people.

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. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The last inspection took place on 18 and 20 March 2015 and we rated the service as ‘Good.’ We found the service was exceptionally responsive and rated this domain as ‘Outstanding.’ However, at this inspection we found some action was needed to ensure a nominated individual was appointed. A nominated individual represents the provider and has responsibility for supervising the way that the regulated activity is managed. Following our last inspection this was rectified and a nominated individual was appointed.

Elpha Lodge Residential Care Home provides accommodation for up to 24 people. The service specialises in caring for people who have acquired brain injuries or degenerative diseases, and who, as a result, require assistance with personal care. The service consisted of a converted church and a newer purpose built bungalow. The bungalow was known as Sydney House. We will refer to the service as Elpha Lodge Residential Care Home throughout the report because Sydney House is registered as part of Elpha Lodge Residential Care Home. There were 19 people in receipt of care from the service at the time of our inspection.

There was a registered manager in post at the time of our inspection who had held this post for the last 20 years. 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.

Staff at Elpha Lodge Residential Care Home had worked collaboratively with people to assist them to ensure their voices were heard by healthcare professionals. Staff went over and above the expectations for residential care homes in order to ensure people had equity of access to healthcare and would vigorously assert the rights of people to good care and treatment. The GP and community healthcare staff we spoke with discussed how the tenacity of staff to advocate on behalf of the people and their dedication to the people who used the service had improved their quality of life. The GP, district nurse and wheelchair services staff discussed how they worked closely with the staff from Elpha Lodge Residential Care Home and had formed a strong working relationship. We also heard how staff had worked with hospital staff when people had needed to be admitted to hospital, to ensure the continuity of their care and demonstrate how medical devices were used.

The service was making a difference to people’s wellbeing by working well as a team, in harmony with one another sharing the same values and principles. The service was proactive in providing people with a range of information to assist them to make decisions about their health and wellbeing. Staff worked with health and social care professionals in ways that benefited people and had supported individuals to improve their general health. Also staff supported people to pay remembrance to their loved ones and took people to visit their graves as and when they wanted.

We found staff had formed strong therapeutic bonds between them, people who used the service and their relatives. The nature of many people’s degenerative conditions meant family members could be genetically predisposed to develop this health condition. People told us how a number of their relatives had, over the years, used Elpha Lodge Residential Care Homes for respite and long-term care. All felt this had been very beneficial. People told us that if not for the care and support their relatives had received they believed they would not still be around. Also we heard how the skilled interventions of staff had enabled people to improve their quality of life.

Staff were exceptionally caring and inspired people to achieve their goals. People were cared for by staff who knew them well; understood how to support them and enable individuals maximise their potential. The service's visions and values promoted people's rights to make choices and live a dignified and fulfilled life. This was reflected in the care and support that people received. Staff understood people's different ways of communicating and how to make people feel valued. They supported people to make decisions for themselves and spoke with people about their wishes and preferences. People were listened to and their voice was heard.

We found staff were committed to delivering a service which improved the lives of the people who use the service in fulfilling and creative ways. Their drive and passion had created an exceptionally dynamic and vibrant service. The culture embedded in the service was an absolute commitment to deliver a service that focused totally on the goals and aspirations of the people who used it. Their relatives told us the service provided care that was exceptional and contrasted dramatically from any other provision they had experienced.

We found that the manager had encouraged staff to constantly think about improvements. We found that the management style had led to people who used the service and staff feeling that they were an integral and essential partner in the operation and enhancement of the service. People were involved in the operation of the home and made the key decisions about who was employed, menus, the décor and the range of activities.

Staff were devoted to ensuring each individual found their lives were enriched. We found staff empowered people to voice their wants and aspirations for their lives and then supported them to achieve these goals. Alongside the activities coordinator we saw that a number of volunteers came to the service and supported people to join in activities. The volunteers were supported by the manager to complete a wide range of training and received regular supervision sessions.

Staff told us they received supervision on a monthly basis and they received annual appraisals. Staff were respected within the organisation and were provided with comprehensive range of training. We found staff were consistently striving for excellence and assisting people and staff to reach their maximum potential. We heard how the manager had supported staff to further their careers and those staff who had left had gone on to do nurse training. Staff were supported to achieve excellence in their roles by attending specialist training around working with people who had specific conditions and through self-reflection. The provider also supported staff to complete external training.

We found staff had an understanding of safeguarding and how to whistle blow. The manager was aware of risks within the service and was undertaking an analysis of risks. The service had emergency plans in place and took action when they became aware someone was at risk.

Staff safely managed medications. People’s care needs were risk assessed with risk management plans in place and support for staff when they needed it. Recruitment checks were carried out. Most staff had worked at the service for many years, which provided consistency of care for people.

We found the manager had provided strong leadership and constantly critically reviewed the service. They routinely identified how they could enhance the service and ensure the staff remained at the forefront of best practice when working with the people who used the service. Their oversight of the service and encouragement of staff to keep abreast of developments and be innovative had led to excellent outcomes for the people who used the service and their relatives.

We reviewed evidence submitted to us by the manager of this service and found the provider had taken action as required, to minimise the risks associated with unsafe or unsuitable premises. Previous shortfalls related to the security of the premises, the management of legionella risks within the home and the servicing of utilities within the buildings on site, had been addressed.

We found that people's care needs were assessed and their care and treatment was planned. Where necessary, external healthcare professionals had been consulted about people's care needs.

We looked at how the home managed medicines and found there were appropriate arrangements in place for the safe administration, recording, obtaining, handling, storage and disposal of medicines.

We saw that people had enough equipment available to enable them to maintain their independence as much as possible and this equipment was suitably maintained.

The records held in relation to people's care and treatment were suitably maintained in order to ensure that their care needs were met and their health and welfare promoted. Other records related to staff and to the management of the service were also well maintained.

However, we found that there were shortfalls in relation to the safety and suitability of premises, and as a result, people, staff and visitors were not protected against the associated risks.

We reviewed evidence submitted to us by the manager of this service and found the provider had taken action as required, to minimise the risks of people catching an infection. Previous shortfalls related to some of the infection control procedures that were followed within the service, had been resolved. Consequently, the provider has achieved compliance with the relevant essential standard.

People told us their consent was gained prior to care being delivered and we found that staff acted in accordance with their wishes. We found that the provider acted in accordance with legal requirements if people did not have the capacity to consent themselves.

We found that people's care and support needs were appropriately assessed and their care was planned. They received care safely, and to an appropriate standard.

There were enough suitably skilled and qualified staff on duty to met people's needs safely and appropriately.

We saw the provider had a complaints policy and procedure in place and people told us they were confident the manager would deal with any complaints they raised.

However, although people who received care and support from this service told us they were happy, and we saw they were well supported, we found that shortfalls in the management of infection control, may put people's safety at risk.