Elmstead House

Updated 5 December 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 25 and 26 October 2018 and was unannounced.

The inspection team consisted of one inspector, one CQC specialist advisor nurse and two experts-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, we checked for any notifications made to us by the provider and the information we held on our database about the service and provider. Statutory notifications are pieces of information about important events which took place at the service, such as safeguarding incidents, which the provider is required to send to us by law. We also looked at action plans that the provider sent to us following the last inspection.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we observed how staff interacted and supported people who used the service. We spoke with five people using the service, 13 relatives and 16 staff members which included the regional operations manager, the operations manager, the manager, the clinical lead, the chef, three lifestyle co-ordinators, two nurses, two team leaders and five care staff.

We also contacted a number of health and social care professionals to obtain their feedback about the service. We received responses from two health and social care professionals.

We looked at the care records of 13 people who used the service and medicines administration record (MAR) charts and medicines supplies for 10 people. We also looked at the personnel and training files of 10 staff. Other documents that we looked at relating to people's care included risk assessments, handover notes, quality audits and a number of policies and procedures.

Updated 5 December 2018

This inspection took place on 25 and 26 October 2018 and was unannounced.

We last inspected the service on 6 and 17 July 2017 and found the service to be in breach of Regulations 17 and 18 of the Health and Social Care Act 2008. Issues identified included staff not receiving regular supervision to support them in their role and the lack of regular monitoring and auditing to ensure that health care checks and monitoring were appropriately completed.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the ratings of the key questions of effective and well-led to at least good.

Elmstead House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Elmstead House accommodates up to 50 people across two separate units, each of which have separate adapted facilities. One unit supports elderly people some of whom were living with dementia. The other unit is a functional mental health unit which supports people with recovering and enduring mental health problems. At the time of this inspection there was 37 people living at Elmstead House.

A manager was in post at the time of this inspection and had submitted an application to the CQC to become the 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.

At this inspection we found that the service had made improvements to address previous issues that we had found. However, further improvements were required in relation to staff receiving regular, formal supervisions and annual appraisals.

Staff that we spoke with confirmed that they felt supported in their role and received regular supervisions and annual appraisals. However, records seen did not always confirm this. The newly appointed manager was aware of this and had plans in place to ensure all staff received regular, formal supervisions and an annual appraisal.

People and their relatives told us that they felt safe living at Elmstead House. All staff demonstrated a good understanding of safeguarding people from abuse and the actions they would take to report their concerns.

People’s care plans contained comprehensive information about identified risks associated with their health and social care needs and clear guidance for staff on how to support people to be safe and free from harm.

Staffing levels were determined based on individual people’s levels of need. We saw that there were sufficient number of staff available around the home.

Recruitment processes ensured that only those staff assessed as safe to work with vulnerable adults were recruited.

People received their medicines safely, on time and as prescribed. Medicine policies and processes in place supported this.

Accidents and incidents were recorded, reviewed and analysed to ensure that where things had gone wrong improvements and further learning were considered and implemented.

Staff received a comprehensive induction when they first started work at the home with regular on-going training which enabled them to deliver effective care and support.

People’s needs and preferences were assessed prior to their admission to Elmstead House so that the home could confirm that these could be effectively met.

People had access to a variety of snacks, drinks and regular meals which helped them to maintain a healthy and balanced diet. Where people had specialist diets and support needs in relation to their dietary intake this was appropriately catered for.

People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had access to a variety of health care professionals to ensure they were able to maintain a healthy lifestyle. The service worked effectively within as well as with other healthcare professionals so that people had access to specialist and relevant services which addressed and met their identified health and care needs.

We observed positive and caring interactions between people and staff. Staff knew the people they supported well and treated them with dignity and respect at all times.

People were supported to be involved in all aspects of the delivery of their care and support where possible. Relatives also confirmed that the home always involved them in every aspect of their relative’s care.

Care plans were detailed and person centred which gave specific information and guidance to staff on how to meet people’s identified needs and wishes.

People and relatives knew who to speak with if they had any concerns or complaints to raise and were confident that their concerns would be dealt with appropriately.

Management oversight processes in place ensured that the manager and provider monitored the quality of care people received. Where issues were noted, an action plan was compiled with details of the actions taken and lessons learnt.