This inspection took place on 24 August 2016 and was unannounced. At our previous inspection no improvements were identified as needed.Ellesmere House is registered to provide accommodation with personal care to a maximum of 28 people. There were 15 people living at the home on the day of our inspection. The home supports older people, some of whom lived with dementia.
No registered manager is in post at the home. 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.
We had previously completed a comprehensive inspection at Ellesmere House on 14 July 2015 and found the provider was not meeting the law. They were in breach of regulations relating to how they obtained people’s consent and also the governance of the service. We gave the service an overall rating of requires improvement. We asked them to take action to make improvements in how they involved people in decision making and how they monitored the quality and safety of the service. We went back again 12 January 2016 to complete a focused inspection on these two concerns. We found the provider had made sufficient improvement to how they involved people in decision making. The provider had not made improvement in how they monitored the quality and safety of the service. Because the provider and registered manager had not made the improvements we had asked them to we issued a warning notice to each of them. A warning notice is issued when registered persons do not meet legal requirements. If they do not meet the conditions of the warning notice we may consider further enforcement action. We gave the provider and registered manager a timescale by when improvements must be made by. We returned to the service 24 May 2016 and completed a focused inspection on this one concern. We found the conditions of the warning notice had been met.
At our focused inspections we did not have enough evidence to show improvement in the overall rating of the service. This comprehensive inspection was completed to ensure the provider had maintained the improvements they had put in place at the focused inspections.
There was no registered manager in post and the provider is recruiting for this role. An interim manager was in place from another one of the provider’s homes. The interim manager had been supported by the provider in implementing and sustaining the improvements needed. However, the provider had not made sure they were meeting all of their regulatory responsibilities in the absence of a registered manager.
Staff had a good understanding of people’s needs and received training to make sure they had the skills to meet people's needs. This training was not always put into practice as staff did not always put their knowledge of delivering person centred care into practice. This was recognised by the manager who identified this as a training need for staff and agreed to take action.
Improvement had been made in how the service captured people’s capacity to make their own decisions about their day to day care. Staff supported people to make their own decisions and asked their permission before supporting them. However, some people required specific measures to keep them safe and not all staff were aware who had these measures in place.
Improvement had been made to make sure people’s changing needs were accurately recorded. People’s needs were assessed and they felt involved in what happened to them. Care was planned and delivered in a way that was individual and personal to them.
Staff had a good knowledge of how to keep people safe from harm and abuse. They understood how to raise concerns about a person’s safety or when they felt they were at risk of harm. Plans were in place to assess and monitor any risks to people’s safety and these were kept up to date as needs changed.
People were looked after by enough staff to support them with their individual needs. When people needed or asked for help and support they were not kept waiting and staff responded quickly. The manager monitored the number of staff needed at the home by taking into account people’s individual needs.
People were supported to eat and drink enough. They had access to drinks and snacks during the day and had choices at mealtimes. They were also supported to access health care services and their individual health and nutritional needs were met.
There was a process in place so that people's concerns and complaints were listened to and these were acted upon. Recent complaints had been looked into and resolved.
People, relatives and staff were kept involved in what happened at the home and the improvements that had been needed since our last comprehensive inspection. The quality of the service was monitored by the provider who visited the home on a regular basis.