Background to this inspection
Updated
15 March 2019
The inspection:
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team:
The inspection was carried out by one inspector.
Service and service type:
Elm Tree House is a care home. People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided and both were looked at during this inspection.
The service is required to have a manager registered with the Care Quality Commission. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The service did not have a registered manager at the time of our inspection.
Notice of inspection:
The inspection was unannounced.
What we did:
We reviewed the information we had received about the service. This included notifications of events that had happened at the service such as deaths and serious injuries, which the provider is required to send to us by law. We looked at the Provider Information Return (PIR). This is information we ask the provider to send to us at least annually to tell us about what the service does well and any improvements they plan to make. This information helped us to plan our inspection.
During the inspection, we spoke with two people who used the service and two relatives. We carried out observations in communal areas to assess how staff supported people.
We spoke with the acting manager and three care workers. We spoke with a senior manager and managing director who came to the service during our inspection visit. We viewed four people’s care records. We saw records relating to the management and operation of the service such as audits, policies and procedures.
Updated
15 March 2019
About the service: Elm Tree House is a residential care home that was providing personal and care for 15 older people at the time of the inspection.
People’s experience of using this service:
¿The provider had not ensured enough staff were deployed to meet people's needs throughout the day. Staff did not always have time to support people with meaningful and fulfilling activities. When they had time, the activities were meaningful and stimulating.
¿People did not have personal emergency evacuation plans that would be used in the event of an emergency, such as a fire. These were completed after our inspection.
¿People were happy living at Elm Tree House. They felt safe and liked the staff who looked after them. Relatives were satisfied with the service the staff gave to their family members and they felt welcomed at the home.
¿Staff enjoyed working at the home and felt supported by the manager. They understood people's needs their needs and had received the relevant training.
¿Staff were caring and supported people in ways to make people feel they mattered to them. Staff respected people’s privacy. People were involved in decisions about their care and support.
¿Staff followed infection prevention and control procedures. However, during our inspection we saw a mouse in the manager’s office. The manager arranged for a pest control person to come to the home. We reported this to the appropriate local authority environmental health department.
¿Staff supported people to access health services when they needed them. External healthcare professionals supported staff to help people maintain or improve their health.
¿Staff supported people to have enough to eat and drink. Staff cooked a variety of nutritious meals, based on people’s choices and including special diets for those who needed them.
¿Staff did not always weigh people when they should. Two were weighed a month after they were last weighed instead of a fortnight later.
¿Staff supported people to have the 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. However, not all staff understood the purpose of the Mental Capacity Act 2005. We have made a recommendation about staff training on the subject of the Mental Capacity Act 2005.
¿The provider was working to improve the décor of the premises to make them ‘dementia friendly’.
¿When staff had time they supported people to participate in activities they enjoyed. Staff had creative ideas about activities but did not always have the time to support people with these.
¿The provider had not ensured that the Care Quality Commission (CQC) were notified of events or changes at the service.
¿ The service did not have a registered manager. The provider had not supported the manager to understand and meet the responsibilities of a registered manager.
¿The provider wanted to improve the service but there was no plan of how they would do this.
¿We found there were breaches of regulations. Action we told the provider to take is at the end of the report.
Rating at last inspection:
At the last inspection we rated the service Good (Report published 16 July 2016).
Why we inspected:
This was a planned inspection based on the rating at the last inspection. At this inspection we found the service had dropped to Requires Improvement. We found that the provider was in breach of two regulations. Please see the ‘action we have told the provider to take’ section towards the end of the report.
Follow up: We have required the provider to submit an action plan of how they intend to improve the service. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.