Archived: Elmsleigh Care Home

Updated 25 November 2016

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 unannounced inspection took place on 25 October 2016. The inspection team consisted of two inspectors, a specialist nurse advisor and an expert by experience. The specialist advisor had a background in providing nursing care for older people and in the management of nursing care services. An expert by experience is a person who has experience of using or caring for someone who uses this type of care service. The expert’s area of expertise was dementia care and care for older people.

We reviewed information we held about the home before the inspection including previous reports and notifications. A notification is information about important events which the service is required to send us by law.

During the inspection we spoke with one person who was able to express their views of living at the service. Not everyone was able to verbally communicate with us due to their health care needs. We looked around the premises and observed care practices.

We also spoke with eight care staff, a nurse, the deputy manager, the organisation's head of operations and the provider. We also spoke with eight visiting relatives. We looked at nine records relating to the care of individuals, four staff recruitment files, staff training records and records relating to the running of the service.

Updated 25 November 2016

Elmsleigh is a care home that provides nursing care for up to 48 older people, some of whom had a diagnosis of dementia or other mental health conditions. On the day of the inspection there were 45 people living at Elmsleigh. Thirty-three people lived in the main house and 12 people lived in the adjoining annex (called the bungalow).

The service is required to have a registered manager and at the time of our inspection a registered manager was not in post. The manager who was in charge of the day-to-day running of the service had applied to become the registered manager. At the time of this inspection their application was being processed. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

We carried out this unannounced inspection of Elmsleigh Care Home on 25 October 2016. At this comprehensive inspection we checked to see if the service had made the required improvements identified at the inspection of 14 June 2016.

In June 2016 we found the premises and equipment were not properly maintained. There were two shower rooms, where the showers had been removed, and the floors were stained and dirty. There were three bathrooms that were not in full working order, including water that was too hot to be safely used by people living at the service. An unlocked boiler room, accessed through a bathroom, put people at risk of harm because the room had hot pipes and electrical equipment. There was broken equipment stored around the premises, including in areas identified at a previous inspection in September 2015.

At this inspection while we found some improvements had been made to the premises and the environment there were still areas of concern. There were communal bathrooms and en-suite bathrooms that either did not have hot water or had water that was too hot with the risk of scalding people. One shower room had a wall mounted electric bar heater approximately three feet immediately opposite the shower which meant water could come in contact with the heater. There was no hot water available in the kitchen on the day of the inspection. While the door to the boiler room, accessed through a communal bathroom, was locked the door leading into the boiler room in a corridor was not locked. Three bedroom self closing fire doors were seen wedged open by furniture and a suitcase in one case. These issues put people at risk of harm.

Most of the broken equipment that had previously been stored around the building had been removed. However, we did find an unused pressure mattress, unnamed continence pads and a ladder stored in the entrance area to a toilet used by people. The premises were warm throughout the inspection, except for one corridor which was cooler than the rest of the building. The communal areas were clean and odour free. However, some people’s bedrooms were not clean and had strong incontinence odours. Several toilets and bathrooms did not have paper towels, soap or waste bins to enable effective hand washing and infection control. All of the above created an environment that was not homely or pleasing for people to live in.

In June 2016 we had concerns about the safety of two people living at the service who had been assessed as being at high risk of falls and ‘unsafe if left unobserved’. At this inspection we found action had been taken to help reduce the risk of harm for these two people. One person’s health had deteriorated and they were less mobile than they had been. They had also been provided with head protection, to protect their head if they did fall. The other person had been given funding to have individual care. While this had helped to reduce their falls this person could still suddenly get up and attempt to walk. However, there was no risk assessment to provide instructions for staff about assisting them to mobilise safely as they were very unsteady on their feet.

At this inspection we found some people did not receive consistent or good care because systems to provide for, and monitor, people’s needs were inadequate. This included systems for food and fluid charts, hourly observation charts, monitoring people’s weight and checking the settings on pressure relieving mattresses. These inadequate systems had led to poor outcomes for some people. For example, some people had been assessed as needing hourly observations by staff because they were cared for in bed. These checks were had been introduced to try to ensure they were safe, their personal care needs were met and they had everything they needed. Despite these checks being in place for two people their needs had not been met. Staff had not provided personal care, made the environment safe or respected these individuals’ dignity.

The provider had not taken adequate action to address how staff could provide appropriate care for people identified as refusing care and who were at risk of self-neglect. The service had not monitored these people’s repeated refusal of care or sought any advice or guidance from external professionals in meeting their needs. Staff had not been given sufficient direction and guidance about how to meet these people’s complex needs. We observed that staff lacked knowledge and confidence in how to provide care for these people. Following our inspection visit we ‘alerted’ these two people to Cornwall Safeguarding to ensure they were protected from further harm.

Some people had been assessed as being at risk from developing skin damage due to pressure. Pressure mattresses were in place for these people. However, the mattresses were not monitored to ensure that they were correctly set for the person using them. If pressure mattresses are not set to the weight of the person using them there is a risk that pressure damage to their skin will not be prevented. Where people had been assessed as needing to be re positioned regularly, to help reduce the risks of pressure damage, this was being completed for most people. However, one person was not routinely re-positioned or checked by staff.

We found that slings used when people needed to use a hoist, of different sizes appropriate to peoples’ different sizes and weights, were shared between people. Net pants, used to wear over continence pads were shared. Continence pads were supplied to meet each individual person’s assessed continence needs to ensure people used the right size and type. However, it was clear from supplies left in communal bathrooms and other areas that these pads were also being used between people. These practices did not respect people's dignity and human rights and represented institutional ways of working.

The care we saw provided to people during the inspection was often task orientated rather being than in response to each person’s individual needs. Some people living in the service had complex behavioural needs and limited communication. Care plans did not always give staff guidance about how to communicate with people, especially where people refused care and were at risk of self-neglect. We observed some staff had little interaction with people with complex communication needs. Bedrooms for some people did not have any identification on the doors such as a number, their name or a picture to support people in recognising their own bedrooms. This meant it could be difficult for people living with dementia to orientate around the building and find their room.

Some people were at risk of losing weight due to having a poor diet. Food and drink monitoring was in place for these people, but records were not being checked so no action had been taken to address any concerns. Where records stated that people needed to be weighed weekly this was not being carried out. Some people had sustained substantial weight loss and it was not clear what action had been taken to help the person maintain a healthy weight. This meant some people were at risk of their needs not being met in relation to their weight, and food and fluid intake because this was not being sufficiently monitored.

Where people needed assistance or prompting from staff to eat their meals this was not actioned in a timely manner. Some people did not show any interest in eating nor had any insight into it being mealtime. These people were left, sat in the same seat in which they had spent their day, with their meals in front of them uneaten, even though most needed encouragement to eat. Hot drinks were provided throughout the day. However, some people didn’t drink them and staff took them away when they got cold. People who needed assistance from staff to eat did not always have hot food. Staff helped more than one person during the lunch period. However, meals came from the kitchen together so some meals were cold by the time a member of staff was available to help some people to eat.

When we observed the lunchtime period we found there was little interaction between people and staff. Staff who assisted people to eat their meals did so without any real conversation. There were three bank staff on duty on the day of the inspection. We noticed that they needed guidance from permanent staff. While they were willing and completed the tasks assigned to them competently they were reluctant to initiate interactions with people, due to being unfamiliar with people’s needs.

The management of medicines was not robust. We identified some concerns with the recording processes used by staff when administering and managing medicines. There were gaps in records which meant it was not always clear that people received their medicines as prescribed. Two peoples’ medicines were found in their rooms, having not taken them. One person had them on their bedside table and in another room medicines were strewn on the floor. However, when