Elmglade Residential Home

Elmglade Residential Home is a residential care home that was providing personal care to 23 older people at the time of this inspection, some of whom were living with dementia.

People’s experience of using this service:

People were satisfied with the quality of care and support they received. They told us staff were kind and caring, meeting meet their needs and respecting their choices about how they wished to be supported. Staff were patient and supported people in a dignified, respectful way which maintained their privacy and independence.

People were supported to give their views and to make decisions about the care and support they required. This helped the provider make sure care was tailored to people’s needs. People’s records were up to date and had relevant information for staff about how to provide care and support that met their needs and kept them safe. Records were kept securely to keep information about people, private and confidential. People said they felt safe with staff. Staff knew how to safeguard people from abuse and how to report any concerns to the appropriate individual and/or authority.

The home was comfortable with different spaces for people to spend time in. People’s rooms and communal areas were clean and tidy. Staff followed good practice to minimise hygiene risks when providing personal care and when preparing and handling food. The provider undertook regular health and safety checks of the premises and equipment to make sure they were safe.

Staff asked for people’s consent before providing any support. 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 practice.

Staff helped people stay healthy and well. They supported people to eat and drink enough to meet their needs and to take their prescribed medicines. Extra help was sought for people if they needed this, for example when they became unwell. Staff worked well with other healthcare professionals to ensure a joined-up approach to the care people received.

There were enough staff to support people. The provider made sure staff were suitable to support people through their recruitment and selection practices. Staff were provided relevant training to help them meet people’s needs. The provider supported staff to continuously improve their working practices.

People knew how to make a complaint and the provider had arrangements in place to deal with this. The registered manager recorded and investigated any accidents and incidents that occurred, and kept people involved and informed of the outcome. Learning from complaints and investigations was shared with staff to help them improve the quality and safety of the support they provided.

The registered manager was well liked and respected by people and staff. They were open and honest and encouraged people, their representatives and staff to have their say about how the service could improve. They made sure all staff were clear about their duty to provide safe, high quality care and support to people.

The provider had improved those areas of the service where we had previously found concerns and breaches in legal requirements. At this inspection we saw the provider had improved systems for reporting notifications, their quality monitoring systems, their responsiveness to suggestions for improvements, activities provision and the safety, cleanliness, décor and layout of the premises.

The provider also worked proactively with other agencies to make improvements at the service. They acted on recommendations made from us and other agencies to improve the quality and safety of the service for people.

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

Rating at last inspection:

At the last inspection the service was rated ‘Requires Improvement’ (26 April 2018). At this inspection we found the service meet the characteristics of a good service. The service rating has improved to ‘Good’.

Why we inspected:

This inspection was planned based on the previous rating of ‘Requires Improvement’. In these instances, we return to a service within 12 months of the publication of the last report to check that the service had taken the action needed to improve.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned in line with our inspection schedule or in response to concerns.

Elmglade Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Elmglade Residential Home accommodates up to 23 older people in one adapted building. At the time of this inspection there were twenty people using the service.

The service continued to have a registered manager in post. At this inspection we found the registered manager had not met their legal obligation to submit notifications to CQC of events or incidents involving people at the service. Failure to notify CQC of these incidents meant we could not check that the provider had taken appropriate action to ensure people's safety and welfare in these instances.

The provider had not taken appropriate action to improve the quality of the service for people when required. At our last inspection we made a recommendation to the provider to review the provision of activities. We found little improvement had been made to increase opportunities for people to have their social and physical needs met. People and their relatives said there was still not enough to do to keep them engaged and stimulated. The registered manager told us some attempt had been made to increase activity provision but acknowledged that not enough had been done to make the improvements required. The provider also did not act quickly enough to make improvements to the service when these had been suggested by people and staff.

Aspects of the premises posed a risk of injury and harm to people. The provider did not formally assess risks posed by the premises to identify potential hazards to people. We found people were not sufficiently protected from the risk of scalding as hot water temperatures exceeded permitted safe levels in some parts of the premises. Window restrictors had not been fitted on some first floor windows to protect people from a fall from these windows. In one person’s room, carpet was torn in two places which posed a potential trip hazard and increased the risk of falls.

However, the provider had continued to maintain a servicing programme of the premises and the equipment used by staff to ensure those areas of the service covered by these checks did not pose unnecessary risks to people.

The premises were generally clean but some parts would have benefitted from additional cleaning. Staff followed good practice to ensure risks to people were minimised from poor hygiene and cleanliness when providing personal care, cleaning the premises and when preparing and storing food.

The provider’s quality assurance systems were ineffective and did not identify the issues we found at the service. The provider did not undertake any formal reviews of the service themselves so could not be assured that checks and audits were looking at the right things and that managers were appropriately identifying gaps and shortfalls at the service that needed to be addressed.

Notwithstanding the issues above, people and staff spoke positively about the registered manager and deputy manager and said they were approachable, supportive and listened. The registered manager worked in partnership with other agencies to develop and improve the delivery of care to people.

People said they felt safe at Elmglade Residential Home. Staff had access to appropriate guidance on how to minimise identified individual risks to people due to their specific needs to help keep people safe. Staff were supported to take appropriate action to ensure people were protected if they suspected they were at risk of abuse.

There were enough staff to meet people’s needs at the time of this inspection. However staffing levels were not routinely reviewed in line with changes in people’s needs to ensure there were enough staff to meet people’s needs at all times.

The provider carried out appropriate checks on staff’s suitability and fitness to support people. Staff had regular and relevant training. Staff felt well motivated and said managers supported them in their roles and dealt with their concerns appropriately.

The design and set up of the environment provided people with a degree of flexibility in terms of how they wished to spend their time. People were given space and privacy to meet with their visitors if they wanted this. However some aspects of the environment were not tailored to support people living with dementia. There was minimal signage to help people orientate around the premises and the general décor offered little visual stimulation for people.

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 practice.

People continued to contribute to the planning of their care and support. People’s needs and specific preferences for how they wished to be cared for and supported were set out in their personalised support plan. Senior staff reviewed people’s care and support needs regularly to ensure staff had up to date information about these.

People said staff were able to meet their needs. They said staff were kind and caring. Staff provided people with support that was dignified, respectful and which maintained their privacy at all times. They prompted people to be as independent as they could and wanted to be. Staff had received training to ensure that people would receive support at the end of their life that was comfortable and dignified.

People were encouraged to eat and drink enough to meet their needs. Staff supported people to take their prescribed medicines when required. These were stored safely and securely. Staff monitored and recorded their observations about people’s general health and wellbeing and shared this information with all involved in people’s care. When they had concerns about people they took appropriate action so that medical care and attention could be sought promptly from the relevant healthcare professionals.

Overall, people were mostly satisfied with the care and support they received from staff. People knew how to make a complaint if needed and the provider had appropriate arrangements in place to deal with these.

At this inspection we found the provider in breach of legal requirements with regard to safe care and treatment, good governance and notifications of other incidents. You can see what action we told the provider to take with regard to this breach at the back of the full version of the report.

Elmglade Residential Home provides personal care for older people many of whom are living with dementia. It can provide accommodation for up to 23 people over two floors. At the time of our inspection 23 people were living at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

We found people did not always have enough social and recreational activities to engage in. We have made a recommendation about the opportunities available to people using the service to have meaningful leisure and recreational activities that reflect their interests.

People and their relatives were positive about the care that was provided by Elmglade. they told us they felt safe. Relatives said they could visit their family members in the home whenever they wished.

Staff were knowledgeable about people and how to care for them. Documentation which related to caring for people was regularly updated and individualised so it meant people received care that was in their best interests and met their needs.

The provider followed safe recruitment practices. Once recruited staff were sufficiently trained and supported to enable them to undertake their roles and responsibilities. There were sufficient levels of staffing to make sure people’s needs were met.

Risks to people were assessed and reviewed regularly. Accidents and incidents were monitored so that the possibility of re-occurrences were minimised.

We observed staff to be kind and caring. They ensured people retained privacy and dignity when personal care was provided.

People were asked their consent prior to care being provided. If people were unable to give informed consent, the provider worked within the framework of the Mental Capacity Act 2005. The Act aims to protect people who may not be able to make some decisions for themselves and to make sure their rights are protected.

People were encouraged to maintain good health. They had access to healthcare professionals according to their needs. People’s nutritional needs were assessed and monitored and people received a variety of meals according to their needs and choice. People received their medicines as prescribed by their GP.

People felt the registered manager took their views seriously and responded accordingly. There were quality assurance measures in place to continually monitor the quality of the service and make improvements when necessary. The registered manager was aware of their rights and responsibilities in relation to the running of Elmglade, and ensured they contacted relevant professionals when required to help provide safe care to people.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. If you want to see evidence supporting our summary please read the full report.

Is the service safe?

People using the service told us they felt safe. Assessments were carried out by staff to make sure that people's needs were identified so care plans could be developed about how to meet them. Risks were assessed and reviewed regularly to make sure people's safety was promoted while ensuring thier independence. People were supported to take their medicines in a safe way.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff had undertaken training in DoLS and in the Mental Capacity Act (2005) and they were aware of their responsibilities. Relevant staff had been trained to understand when an application for DoLS should be made and how to submit one, although we did note that applications were not always made appropriately.

Policies and procedures for safe working practices were in place to monitor that the service was prioritising people's safety. There were systems in place to ensure staff learnt from incidents and accidents and other untoward events.

Is the service caring?

People with spoke with were positive about the care they received. Comments included, 'It's nice here, ten out of ten' and 'I get on with everyone, we have a laugh'. People were supported by attentive and patient staff. We saw them give encouragement to people and these interactions were caring and compassionate.

Is the service responsive?

We found staff continually monitored people's condition and where necessary sought advice and assistance from other community based health and social care professionals.

The views of the people using the service and their relatives were routinely sought by the provider who regularly had contact with them and also used annual questionnaires to ascertain their views. Although we did note that there was not always evidence of people's involvement in care plan records.

Is the service effective?

Staff encouraged and supported people to make choices and decisions about how they lived. People's wishes were respected and we saw staff obtaining people's agreement before any care was provided. This meant that people had choice in the care provided to them.

People's specific needs were taken into account and there was guidance and instructions for staff on how these should be met. People's care plans were reviewed regularly and any necessary changes made. In this way people were receiving care that was appropriate to their needs.

Is the service well led?

The service had a registered manager who was experienced and knew the service well.

The provider carried out regular checks to assess and monitor the quality of the service provided. In this way the provider could ensure that the quality of the service was maintained.

Staff told us they were clear about their roles and responsibilities. Staff felt able to raise concerns and said that their manager was approachable and would act upon any concerns they raised.

The people who lived at the home had dementia and varying abilities to express their views verbally. We were able to talk to three people, one of whom told us 'I can't say there is anything wrong here, because there isn't'. One other person told us, 'the staff are good'.

As others were not able to communicate with us in such a meaningful way we were reliant on general observations and our SOFI tool to gather information about the care provided.

We saw that the staff that were on duty at the time of our inspection had knowledge of individuals needs and were able to respond appropriately. There was a great deal of warmth and understanding displayed by the staff. This was confirmed by a relative that we spoke with, who was visiting on the day of our inspection. The relative told us, 'can't praise them enough, they're all so friendly and my mums really settled in well'.

As people's communication needs were limited we completed a Short Observational Framework Inspection (SOFI) which is an observational tool to look at people's well being. This was completed over the lunch period and gave us information about the food that was provided by the home, but also more importantly staff interaction with people who used the service.

We found that the home had a relaxed, friendly and warm atmosphere. There was a lot of humour between staff and people who used the service. Staff that were on duty had a good understanding of people's needs and were able to respond appropriately.

The paperwork relating to people who lived at the home was comprehensive, up to date and accurate.

There were some areas that the home needed to focus on in order to meet minimum standards of care. These have been outlined in the body of the report or as compliance actions at the end of the report.