Elmhurst Assisted Living And Care Facilities

We found the following examples of good practice.

¿ People were supported to stay safe when out in the community. The registered manager risk assessed different settings people were due to visit, such as the hairdressers, to ensure they were safe for individuals to use.

¿ Where people were able, they were supported to wear Personal Protective Equipment (PPE) when in the community, or when they received visitors to help maintain their safety.

¿ Staff had adjusted their working hours to 12 hour shifts, to minimise the amount of different staff entering the building.

¿ PPE outbreak kits had been prepared, so if there was a positive case recorded within the home, the staff could respond promptly and efficiently.

Further information is in the detailed findings below.

Elmhurst Assisted Living and Care Facilities provides accommodation, supported living and personal care to people with dementia, learning disabilities, autistic spectrum disorder or mental health. It is registered to provide care for up to 10 people in the main house. At the time of our inspection visit there were 10 people living in the house. The care home is made up of one two storey building compromising an additional mezzanine floor. The service is also registered to provide care and support for people living in 13 independent attached apartments. However, there was no one using the supported living service at the time of our inspection. The home also provides a ‘day care’ service to people who require respite during the day. The CQC does not regulate this part of the service.

People’s experience of using this service:

People felt safe using the service.

Staff recognised the risks to people’s health, safety and well-being and understood how to recognise and report abuse.

People received support from staff when needed.

Staff recruitment processes included background checks to review their suitability to work with vulnerable adults.

People received support with their medicines. Regular checks were undertaken to ensure people received the correct medicines by staff who were competent to support them.

Not all areas of the home were clean and staff did not always follow best practice when storing cleaning equipment.

The registered manager ensured staff had training to meet people’s needs and guidance on people’s needs was shared through supervision meetings and staff meetings.

People were supported to have enough to eat and drink to maintain their well-being.

People were supported to obtain advice from healthcare professionals, which was incorporated into people’s care.

People were supported to have 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.

Staff understood the importance of supporting people with empathy and compassion and provided reassurance when people became anxious.

People were treated with dignity and their independence was promoted wherever possible.

People were involved in planning their care with support from staff.

Staff supported people with activities that reflected their interests.

People and their families understood how to complain if they wanted to.

People’s care was reviewed and reflected people’s needs.

Some quality assurance processes were not effective.

The registered manager was open and honest, and worked in partnership with outside agencies to improve people’s support when required.

Rating at last inspection:

The last inspection was a focussed inspection which reviewed the areas of Safe and Well-led. It was rated Good (report published 11 April 2017).

Why we inspected:

This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

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

Since our previous inspection in April 2016, when we had rated the service as good, we had received information of concern about the service. The concerns related to the safety of people’s care and support and to the management of the service. We conducted this inspection in response to the information we received. We checked whether the service was continuing to deliver safe care and support and continued to be well-led.

We found no evidence to support the concerns that had been shared with us. The service continued to be safe and well-led.

The service is registered to deliver accommodation and personal care for up to 10 younger adults who live with dementia, mental health, learning disabilities or autistic spectrum disorder in the shared residential house. The service is also registered to deliver personal care to people in their own homes, including people who live in the 14 self-contained apartments in the grounds of the premises. Five people were living at the shared home and no one was receiving a personal care service in their own home at the time of our inspection.

There was no registered manager for the service. They had deregistered with us before our previous inspection. The provider had appointed another manager and planned for them to become the registered manager. However, this manager had been absent from the service for several weeks and had left the service the week before our inspection visit. The home was being managed by the area manager and training manager.

The provider understood the conditions that applied to delivering a regulated activity, including the requirement to employ a manager that has registered with us. Since our previous inspection, they had appointed a manager, in the expectation they would register with us. They planned to advertise for a registered manager.

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.

Support workers understood their responsibilities to protect people from harm and were supported to raise any concerns. The provider listened to staff’s concerns and took appropriate action to minimise risks to people’s safe care and support.

Risks to people's health and welfare were identified and support workers acted in accordance with people's care plans, to minimise the identified risks.

The provider's policies and procedures to minimise risks to people’s safety related to the premises were understood and implemented effectively by staff.

There were enough support workers to meet people's physical and social needs effectively. Medicines were managed, stored and administered safely by trained support workers, who were assessed as competent in medicines administration.

People were encouraged to share their opinions of the service, to enable the provider to make improvements in the quality of the service. The provider's quality monitoring system included regular reviews of people's care and observation of staff’s practice by a member of the management team.

There were effective arrangements in place to provide regular management oversight of the service and management support for staff, while the provider recruited another manager.

Our judgements about whether the service is effective, caring and responsive, and our overall judgement, are unchanged since our previous inspection, when they were all rated good. You can read the evidence we based those judgements on in our previous report about the service.

The manager had left the service a month before our inspection, and had deregistered with us. The provider told us in their provider information return (PIR), that they provided before our visit, that they planned to recruit a new manager as soon as possible. The home was being managed by the area manager and another registered manager from a nearby home in the provider’s group of homes. 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.

The service provides accommodation and personal care for up to 10 younger adults who live with dementia, mental health, learning disabilities or autistic spectrum disorder in the shared residential house. The service also provides personal care as a domiciliary service for older people who live in their own homes. Five people were living in the shared residential house at the time of our inspection and one person was receiving care and support in their own home.

The provider’s policies and procedures to minimise risks to people’s safety were shared effectively. Support workers understood their responsibilities to protect people from harm and were supported to raise any concerns. Risks to people’s health and welfare and were identified and support workers took action in accordance with people’s care plans, to minimise the identified risks.

There were enough support workers to meet people’s physical and social needs effectively. The provider checked they had suitable skills and behaviours during the recruitment process. The provider regularly checked the premises, to make sure they were well maintained, and to minimise risks to people’s safety. Medicines were managed, stored and administered safely by trained support workers.

People’s needs were met effectively because support workers received appropriate training and support. Support workers read the care plans and shadowed experienced support workers, until they knew people well and understood their support needs and abilities. They were supported and encouraged to reflect on their practice individually and as a team to develop their skills and knowledge.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Support workers understood the principles of the Act and people had the freedom to make their own decisions.

People planned their own meals and were supported them to maintain a balanced diet. Risks to people’s nutritional health were minimised because support workers knew about people’s individual dietary requirements. Support workers ensured people obtained advice and support from other health professionals to maintain and improve their health or when their health needs changed.

People were cared for with kindness and compassion. Support workers knew people’s individual preferences for support and their likes and dislikes. Support workers encouraged people to relate to each other and to support each other.

Support workers knew about people’s life stories and supported them to maintain their interests and preferred routines and to develop links with their local community. People were encouraged and supported to maintain their skills to promote their independence.

People and their relatives or representatives were involved in planning and agreeing the care to be provided. Care was planned to meet people’s individual needs and abilities and care plans were regularly reviewed. People and relatives told us support workers respected people’s privacy and dignity. They were confident any concerns would be listened to and action taken to resolve any issues.

People and relatives were encouraged to share their opinions to enable the provider to make improvements in the quality of the service. The provider’s quality monitoring system included regular reviews of people’s care plans and checks of the premises. The provider observed support workers practices, including how they administered and managed people’s medicines, to make sure this was done safely.

We reviewed four care plans and records of care, two staff files, and records of the quality assurance process. We checked how the manager protected people from the risk of abuse. We used our findings to answer the five key questions: is the service safe, effective, caring, responsive and well led?

This is a summary of our findings.

Is the service safe?

The care plans we looked at showed that risks to people's health and well-being were assessed. Care plans described the actions staff should take to minimise the identified risks. People's likes, dislikes and preferences were known to staff.

People told us they felt safe. We found people were protected from abuse and from the risk of abuse. This was because the manager checked that staff were suitable to work with vulnerable people before they started working at the home. Staff received safeguarding training. They understood the various forms of abuse and knew what they should do if they suspected anyone was at risk of abuse.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The deputy manager knew about a recent judgement by the Supreme Court in relation to (DoLS) and was checking the latest guidance for changes in the local authority's policy and procedures. The manager was re-assessing whether they needed to apply for a DoLS for two people who lived at the home. The manager knew how to make an application to the local authority if they needed to deprive people of their liberty.

Is the service effective?

People told us they were happy with the care they received and their needs were met. It was clear from our observations and from speaking with staff that they understood people's care and support needs and knew them well. People told us they spent their time how they wanted and were encouraged to maintain their hobbies and interests. We saw people were supported to maintain their independence and to go out into the community every day.

Is the service caring?

People told us the staff were, 'Alright.' A relative told us they were very pleased that their relation lived in, 'Such a nice place.' They told us, 'The staff are lovely.' We saw people were supported by kind and attentive staff. Staff checked people were happy with their meals and the events of the day. A member of care staff made sure people wanted to speak with us before introducing us to them.

We saw staff were patient and encouraged people to make their own decisions. Care staff understood people's non-verbal communication and responded appropriately to them.

Is the service responsive?

People's needs and abilities were assessed before they moved into the home. The care plans we looked were regularly reviewed and changed as people's needs changed. We found staff supported people to see other health professionals, such as doctors and the community mental health team, when they needed to. A relative told us they were confident that the manager would ask a doctor to review their relation's needs.

The manager listened to people's comments and suggestions and took action to resolve issues straight away. One person who lived at the home told us staff were always inviting them to make suggestions about the care and support they needed.

Is the service well led?

The manager actively consulted with people and their relatives through observation, conversations, meetings and surveys. The manager worked some shifts alongside staff so they could check that people received the care and support they needed.

The provider's quality assurance system included regular checks on the premises, the quality and relevance of written care plans and staffing. The manager provided regular reports to the provider so they knew of any issues or concerns. No complaints about the service had been received since our previous inspection.

We saw records of regular team meetings between the manager and staff. We saw they discussed any issues, concerns and agreed actions to be taken to improve the service. Staff had a good understanding of their role and responsibilities for delivering a quality service. A member of staff told us about the alternative venues they supported one person to attend, to make sure they went out every day.

We saw the provider assessed people's needs and abilities before they moved into the home. Care plans were written to maximise people's opportunities for decision making while minimising risks to their health and wellbeing. People's care plans were regularly reviewed and updated as their needs or abilities changed.

The provider and manager worked within the Department of Health Code of Practice guidance. We found this was effective and people lived in a clean and hygienic environment. Staff explained how they used the guidance in their daily practice.

Care staff told us they were supported by training and regular opportunities to discuss their working practice with the manager. One member of care staff told us, 'I am very happy working here, I love it.'

The provider's quality assurance system included checking that people received the care and support they needed. People who lived at the home, their relatives and supporters, were encouraged to share their opinions and suggestions for improvement.