St Elmo Care Home

Updated 4 April 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of 3 inspectors and an Expert 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. A second Expert by Experience contacted relatives of people living at St Elmo Care Home, by phone, following our inspection.

Service and service type

St Elmo Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. St Elmo is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We reviewed information we already held about the service. We used all this information to plan our inspection.

During the inspection

We spoke with the nominated individual, the registered manager, deputy manager, head of care, head of housekeeping, 2 care staff, 5 people and 10 relatives. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed 4 people’s care records, 3 recruitment records and a number of records relating to the management of the service.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 4 April 2023

About the service

St Elmo Care Home is a residential care home providing personal care to up to 23 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 21 people using the service.

St Elmo Care Home is an adapted building with accommodation over 2 floors. A passenger lift provides access to the upper floor and there are communal areas where people gather for meals and activities.

People’s experience of using this service and what we found

Accidents and incidents had not always been appropriately responded to and lessons learned had not been shared with staff to help prevent similar incidents from happening again. Medicines were not always safely managed. People and their relatives were confident the service was safe, and risks had been assessed and mitigated as far as possible. The premises were clean, and we had no concerns with regard to infection prevention and control.

The provider was not fully aware of their responsibilities under the Mental Capacity Act 2005. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People’s needs had been assessed and care plans devised to meet needs. Meals were appetising and people had been referred to Speech and Language Therapy for assessment should they have swallowing difficulties. The lunchtime experience for people could be improved. The provider sought referrals to health and social care professionals as needed. The provider was undertaking a full refurbishment of the premises and was decorating all rooms and communal areas.

Staff were caring towards people and knew them well, but we had some concerns relating to how people’s privacy and dignity was respected.

Care plans were person centred and the provider had met the Accessible Information Standard. The provider had been unable to recruit an activities staff member and while there were sufficient hours of care staff to cover this role, staff were reluctant to do so. This was a missed opportunity to engage people and provide them with fulfilling lives. There was no one receiving end of life care when we inspected however the registered manager was proud of their practice in this area.

We found a number of events had not been notified to CQC including an injury and a safeguarding concern. Audits had not picked this up and did not analyse information well, we were not assured the registered manager had full oversight of the service. Issues in the staff team were impacting on well-being and could potentially affect service delivery. The registered manager was struggling to address these concerns. The provider sought feedback from relatives on a regular basis and the registered manager was available should anyone need to speak with them. Working relationships were maintained with relevant health and social care professionals.

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

Rating at last inspection and update

The last rating for this service under the previous provider was good (published 4 September 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Elmo on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicines, safe care and treatment, governance and failure to notify CQC of significant events at this inspection. We also made a recommendation around consent.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.