Archived: Elswick Hall Care Home

Updated 19 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 4 and 5 June 2018. The first day of the inspection was unannounced which meant the provider did not know we would be visiting. The second day of inspection was announced so the provider knew we would be returning. The inspection was carried out by one adult social care inspector.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This information was used to support the planning and the inspection process.

We reviewed information we held about the service, including statutory notifications we had received from the provider about deaths, safeguarding concerns or serious injuries. Notifications are incidents which the provider is legally obliged to send the Commission. We contacted the local authority commissioners and safeguarding teams and the local Healthwatch team. Healthwatch is an independent consumer champion which gathers and represents the views of the public about health and social care services.

We contacted the infection control lead for care homes, the fire service, tissue viability nurse specialist, nutrition team, the local authority DoLS (Deprivation of Liberty Safeguards) team, palliative care teams, advocate services and local pharmacists. We used any information received to support our planning and judgements.

During this inspection we carried out observations using the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with six people who used the service and four family members. We also spoke with the clinical service area manager, the head of health and clinical governance, the quality manager, the manager, the service administrator, the maintenance person, one nurse, three agency nurses, three team leaders, six care staff, two cooks, one activity coordinator and one kitchen assistant. We also spoke with two staff employed at a nearby service who had been asked to support the service. We observed how staff interacted with people and looked at a range of records which included the care records for five people and medicines records for 22 people. We looked at five staff personnel files, health and safety information and other documents related to the management of the service.

We placed a poster in the reception area to inform visitors of our inspection and asking for feedback about the service.

Updated 19 July 2018

The inspection took place on 4, 5 and 8 June 2018 and was unannounced on the first day, which meant the provider did not know we were visiting. This was the first inspection since the service registered with the new provider in May 2017.

Elswick Hall Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Elswick Hall Care Home is registered to provide accommodation for up to 47 people with residential and nursing care needs. Some of the people who lived at the service had complex needs, including those who were living with dementia and people with severe brain injuries. At the time of the inspection, there were 23 people living at the service. The service only had 45 bedrooms and the provider was in the process of arranging to update their registration.

The service did not have a registered manager. A new manager had recently commenced employment at the service in April 2018. 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.

A new management team were in place and were working hard to address the issues we had found during our inspection, some of which the provider was already aware of.

Medicines were not managed appropriately at the service. For example, thickeners were stored insecurely in dining areas. Thickeners are used to support people who have swallowing difficulties. However, they can pose a danger to people if consumed inappropriately. Some medicines lacked detail on how staff should administer them and medicine records were not always fully completed.

People had not always had pre-assessments completed before they moved into the service. Risk assessments, care plans and other associated documentation needed to fully support staff to meet people’s needs were either not in place or not fully completed. The new management team were in the process of rewriting every person’s care records, including those in connection with people’s capacity. Due to the nature of the service, we would expect to have seen a number of accidents and incidents involving the people living at the service. However, not all records were available and we were only able to see one recent accident. This meant that we could not be sure accidents and incidents were recorded and dealt with appropriately.

The provider supported people with their finances, although no care plans or risk assessments were in place and we found considerable amounts of money for two people held within the company’s bank accounts rather than in the bank accounts of the individuals concerned.

Checks on people’s pressure relieving mattresses did not happen regularly and we found people’s mattresses were not always set correctly. This meant people were put at further risk of pressure damage.

We found some issues with infection control, including kitchen staff not having suitable changing facilities. The provider had been in touch with the infection control lead for care homes to support them in any improvements needed and intended to address issues highlighted, including via refurbishment work planned.

Fire drills had not been completed as often as they should have been, although the provider rectified this during our inspection. Some actions on the fire risk assessment were outstanding and the provider was in the process of addressing these.

On arrival at the inspection, we found only one member of staff on duty on the upper levels of the service for the people living there. Some people required two staff to support them. The provider recognised at the same time that this was unsafe and asked another member of staff to work in that area.

There were safe recruitment procedures in place and staff were checked prior to starting work to ensure they were suitable for their role and safe to work with vulnerable people. Staff told us they were much better supported than previously and said they were happy with the training they now received. We did see gaps in support sessions and training which the provider was aware of and were working to address.

Staff were aware of their safeguarding responsibilities and told us they would report anything of concern. People told us they felt safe living at the service and relatives thought that their family members were safe too.

People were not always supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service were not always being followed. Staff had not always sought ways to offer people choice of meals for example, particularly those people who could not always communicate. People’s care records did not always reflect people’s capacity and decisions made in their best interests.

People told us they generally enjoyed the food prepared for them. There was a varied weekly menu. Although kitchen records were not up to date with people’s special dietary needs, we saw that people received the correctly prepared nutrition to correspond with their needs.

Arrangements were made for people to see their GP and other healthcare professionals when they needed to.

Many of the staff we spoke with had a caring nature and treated people with dignity and respect. A number of staff were about to complete a charity bike ride to raise money for people’s activities and outings. However, we found elements of an uncaring culture within the service. A number of staff had been recently suspended or dismissed due to not following correct care procedures. Minutes of previous staff meetings indicated conduct from some staff which was not conducive of a caring environment. The new management team had been very proactive in addressing these concerns with current staff.

Activities were available for people to participate in and some people were happy with these. However, not all people received the type of stimulating activity which was more suited to their particular needs, including for example, those people living with dementia. We spoke with the provider about this and they agreed that this needed to be addressed.

Information on how to make a complaint was available to people at the service and to relatives and visitors alike. Not all records of complaints were available to confirm they had been dealt with effectively.

People were now encouraged to make their views known and the service supported this by holding meetings and asking for feedback in a number of ways, including suggestion boxes, and completing surveys.

Audits and checks had not always been completed. The new management team were in the process of implementing a range of audits, including those in connection with medicines and infection control.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safe care and treatment and good governance.

We have also made six recommendations in relation to staff induction, supporting people to make their own choices, peoples finances, activities, complaints and the format of people and relative meetings.

You can see what action we told the provider to take at the back of the full version of this report.