The inspection took place on 21 June 2016. The inspection was unannounced which meant the staff and the registered provider did not know we would be visiting.Elm Lodge Residential Care home provides accommodation and personal care for up to 17 older people. Respite care is also provided. The home is arranged over two floors with bedrooms on each floor. In the grounds of the home there is a car park and a patio area. The centre of Horbury and local amenities are several minutes away.
The service was last inspected in April 2014 and they were in breach of regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010
Assessing and monitoring the quality of service provision registered person did not protect service users, and others, against the risks of inappropriate or unsafe care and treatment by operating an effective system to regularly assess and monitor the quality of the service provided; and did not operate an effective system to identify, assess and manage risks relating to the health welfare and safety of service users and others. Regulation 10(1)(a) and (b). The registered person did not analyse incidents that resulted in, or had the potential to result in, harm to a service user. Regulation 10(2)(c)(i). At this inspection we found accidents and incidents were monitored and analysed each month to see if any trends were identified. Where needed the relevant people were contacted for example the falls team. The registered manager carried out regular audits. However, none of the audits had picked up on the concerns we raised. Therefore we would question the effectiveness of these audits.
The service had 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.
We looked around the service and found that where window restrictors were in place these could easily be removed or were broken. One upstairs window had no window restrictor and could be fully opened. We tried to check a window in a person’s room but they became upset and asked us not to touch it as it was broken and the last time someone had tried to open the window it was difficult to fix and they were cold enough. Two people who mainly stayed in their rooms upstairs complained it was cold on the day of inspection. Some windows did have gaps of up to an inch wide which would cause drafts. We pointed these out to the registered manager.
We found issues around the cleanliness of the service. We found some areas could do with a deep clean. The bath also had a large hole around the edge where the side of the bath seemed to have slipped. In one room the carpet had been torn up by placing the bed therefore could not be properly cleaned and posed an infection control issue. In another room there was a hole in the carpet which could present a trip hazard.
A new stair lift had recently been fitted, this obstructed the bannister on the stair case and there was no handrail on the opposite wall. This could prove difficult for people who used the stairs not the stair lift.
Water temperatures were recorded as being too low. The registered manager carried out fire drill scenarios where staff could discuss what could happen. However no actual fire drills took place. We found the Personal Emergency Evacuation Plans (PEEP’s) did not contain enough information and the summary of people who used the service was out of date.
The service had purchased some new sit on weighing scales. However there was no evidence that these had been calibrated.
Staff we spoke with knew how to administer medicines safely and the records we saw showed that medicines were being administered and checked regularly. However the key to the treatment room was hung up outside which meant that everyone had access to it. The keys for the medicine cupboard and controlled drugs cupboard were left in a tub on top of the trolley. This meant that once someone had access to the treatment room they also had access to all the medicines. We highlighted this straight away to the registered manager who removed the key from outside and made sure the keys were kept with the designated person. Temperatures were not taken daily of the room the medicines were stored; therefore we could not guarantee the medicines were stored at the correct temperature which is not above 28 degrees. At the time of our inspection the room felt very warm.
Policies were in place to ensure people’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were protected. Where appropriate, the service had not always worked collaboratively with other professionals to act in the best interests of people who could not make decisions for themselves.
People were supported to maintain their health through access to food and drinks. The majority of people were happy with the food on offer and they were provided with plenty of choice.
Staff we spoke with understood the principles and processes of safeguarding. Staff knew how to identify abuse and act to report it to the appropriate authority. Staff said they would be confident to whistle blow [raise concerns about the service, staff practices or registered provider] if the need ever arose.
The registered provider followed safe processes to help ensure staff were suitable to work with people living in the service.
There were sufficient staff to provide the support needed and staff knew people’s needs well. However staff we spoke with said they found it difficult to provide support to people at teatime when there was no cook on duty.
We saw that all people who used the service had access to an advocate if needed and information was available. An advocate is a person who works with people or a group of people who may need support and encouragement to exercise their rights. At the time of inspection no one was using an advocate.
We found care plans to be person centred. Person centred planning [PCP] provides a way of helping a person plan all aspects of their life and support, focusing on what’s important to the person.
Activities took place between 2:00pm and 4:00pm each afternoon. The service had a file on what activities had taken place and how much people enjoyed them. One to one activities also took place.
The service worked with various healthcare and social care agencies and sought professional advice, to ensure that the individual needs of the people were being met.
The service had an up to date complaints policy. Complaints were properly recorded and fully investigated.
Staff felt supported by the registered manager.
Feedback was sought on a regular basis from people and their relatives on the quality of the service.
Staff and people who used the service had regular meetings.
The registered manager understood their roles and responsibilities, and felt supported by the registered provider.
We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.