Archived: Elm House Residential Care Home

Updated 8 September 2017

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 5 and 6 July 2017 and was unannounced. The inspection was carried out by an adult social care inspector and an expert by experience. An expert by experience is person who has personal experience of using or caring for someone who uses this type of service.

Prior to our visit we looked at any information we had received about the home and any information sent to us by the provider since the home’s last inspection. We also contacted the Local Authority for their feedback on the service.

At this inspection we spoke with 12 people who lived at the home, five relatives, the manager, the home service manager and three care staff.

We examined a range of documentation including three care files, three staff files, training records, medication administration records and records relating to the management of the service. We also looked at the communal areas that people shared in the home and visited some of their bedrooms.

Updated 8 September 2017

Elm House Residential Care Home provides accommodation for up to 40 people who require support with their personal care. The home is located in the town of Nantwich close to shops, public transport and other local amenities. The home is a two storey building and people live on both floors. The first floor can be accessed by a passenger lift for people with mobility issues. There are 38 single bedrooms and one bedroom which can act as double bedroom for people who wish to share. Car parking is available to the front of the building. On the days we inspected there were 39 people living in the home.

There was a registered manager in post at the time of our inspection. 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.’

During this inspection, we found breaches of Regulations 11, 12,13,17 and 18 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 this report.

Some of the risks in relation to people’s needs and care were assessed but not all of them and we found that some of the risk management guidance for staff to follow to keep people safe was limited. For instance, one person’s bed rails placed them at serious risk of harm and one person’s dietary records did not show they always got enough to eat and drink. We found therefore that the management of some people’s risks did not show that the service was doing all that was reasonably practicable to protect them from harm.

Care staff spoken with had a good knowledge of safeguarding and the action to take should abuse be suspected but the manager had not always followed the required processes to protect people from the risk of abuse.

For example, unexplained bruising on people had not been recognised as potential abuse and reported appropriately to the local authority and the Care Quality Commission (CQC). There was also no evidence that any investigation into how and when the bruising had occurred had been undertaken by the manager so that any potential abuse could be identified. This meant that the systems and processes in place to identify and protect people from abuse had not been followed to ensure their safety.

We saw that people’s care plans contained information about their day to day support preferences and wishes and people told us that these were respected by staff We found that the service was responsive to people’s healthcare needs by organising support for people from a range of different health and social care professionals. For example, dieticians, district nurses, mental health teams etc but we found that they were not always responsive to picking up and addressing other aspects of people’s care. For example unexplained bruising, unsafe equipment and a lack of coherent planning and action in respect of people’s dementia care or emotional needs.

Some people who lived at the home had short term memory loss or dementia type conditions. We found that the legislation designed to protect people’s ability to make their own decisions (the Mental Capacity Act 2005) had been followed correctly when a decision to deprive the person of their liberty was made. Other specific decisions in relation to people’s care for example the decision to install bed rails had not always followed this process and we found that this aspect of service delivery required improvement.

During our visit, we found that at various times throughout the day there were insufficient staff to respond to people’s call bells or calls for help. A staff presence in communal areas was also sporadic. Some of the people we spoke with told us that they did not think there were enough staff on duty at all times to meet their needs. One person expressed specific concerns about their safety at night as there were two staff on duty to care for 39 people. We spoke to the manager about this and found that there were no adequate systems in place to determine whether staffing levels were safe.

We saw that the majority of staff were recruited safely but found that one new member of staff had been promoted without a robust recruitment process or any formal evidence of their skills, competency and experience to fulfil the requirements of this more senior post. This meant the manager could not be assured that the staff member was capable of meeting the responsibilities of this more senior role in relation to people’s care.

The provider had a range of audits in place to check the quality of the service. Some of the systems however were ineffective. Care plans audits did not identify the gaps or inconsistencies in people’s information and had not picked up that some risks were not properly assessed or managed. Some of the actions identified from an external medication audit had not been acted upon properly and the manager’s weekly medication audits had not picked this up and there were no systems in place to ensure insufficient staffing levels were identified and addressed. This meant the way the service was monitored and governed required improvement to be effective in mitigating risks to people’s health, safety and welfare.

People views about the quality of the service were sought through resident’s meetings. People’s satisfaction with the food and drink on offer was also checked through mealtime audits. People told us that the manager and staff were open to feedback and always ready to listen. Accidents and incidents were recorded and monitored properly by the manager. This ensured people received the support they needed. The home’s environmental and infection control audits were effective in ensuring that the home was clean, well maintained and safe.

The majority of people thought staff had the right skills and knowledge to care for them. Records showed that most staff had received adequate training and support to do their job effectively. Staff spoken with spoke about the people they cared for with genuine affection and demonstrated a sufficient knowledge of their needs and preferences. We observed staff to be warm, caring and patient and we observed them supporting people kindly and at their own pace.

The majority of people felt safe living at the home and said staff treated them well. One relative told us that although staff were kind and caring they were not always observant in the delivery of care.

At the end of our inspection, we discussed the concerns we identified during the inspection with the manager and found them to be open and receptive to our feedback.