Elvaston Lodge Nursing Home

Elvaston Lodge Residential Home accommodates 44 people, providing long-term, respite care and palliative care. The home is over two floors, with bedrooms on both floors. There were 37 people living at the service at the time of our inspection visit.

We found the following examples of good practice.

¿A COVID - 19 screening questionnaire and track and trace details was required for all visitors, to complete upon entry. Temperature checks, hand washing facilities and hand gel were in place to comply with the required guidance.

¿ During the COVID - 19 outbreak the provider had closed the home to non-essential visitors and people were supported to contact their relatives and friends through video calls and telephone calls.

¿ The registered manager was aware of the Government guidelines to enable essential care givers to continue to visit the home, if they wished to during lockdown.

¿ Enhanced cleaning schedules included regular cleaning of touch areas such as handrails and door handles. This reduced the risk of cross infection.

¿ Staff changed into and out of their uniforms at work. This reduced the risk of infection spread.

¿ Staff had received training in infection prevent and control and the use of personal protective equipment (PPE).

¿ Staff were observed wearing PPE appropriately.

¿ Staff and people living in the service accessed regular testing for COVID-19, so that action could be taken swiftly if anyone developed symptoms or had a positive test result.

¿ The infection prevention and control policy was up to date.

¿ People and staff had risk assessments in place to identify their individual risks associated with COVID-19. We saw protective measures were in place to keep people and staff safe.

Elvaston Lodge 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.

Elvaston Lodge accommodates up to 44 people in a purpose built building. At the time of the inspection there were 32 people in residence who were aged over 65 years.

People’s experience of using this service:

¿ We found improvements had been made following the previous inspection of Elvaston Lodge by the Care Quality Commission.

¿ We found Elvaston Lodge met the characteristics of a ‘Good’ service.

¿ People told us they felt safe and had confidence in the staff who provided their care.

¿ Potential risks were assessed on an ongoing basis when people’s needs changed. This reduced risk and ensured people’s needs continued to be met. This promoted people’s health, welfare and safety.

¿ People were supported by staff who had undertaken training and were knowledgeable about people’s needs and who had their competency assessed.

¿ People’s needs were regularly reviewed with their involvement or that of a family member. Where people’s needs changed, referrals were made to the relevant health care professional, which included the review of prescribed medicines.

¿ People lived within a well-maintained environment, which took account of people’s needs and provided signage to help them navigate around the service.

¿ People’s rights and choices were promoted on an ongoing basis. Where people were not able to make informed decisions, then decisions were made in their best interest. Family members were consulted about their relative’s health as part of best interest decisions.

¿ People’s equality and diversity was respected and their privacy and dignity maintained.

¿ People spoke positively about the meals provided. Mealtimes were seen as an important social event, with staff eating their meal at the dining table to promote conversation. Family members were encouraged to join their relatives for meals.

¿ Staff spoke positively about the staff. We observed positive examples of staff interacting with people. However, we did note missed opportunities for staff to engage people in conversation and ask them if they required any assistance.

¿ Staff provided consistent care by following people’s care plans.

¿ Staff had effective systems in place to share information about people so they could respond to people in a timely and coordinated manner, which included the verbal sharing of information and the recording of information electronically.

¿ People’s views and that of their family members were sought. The registered manager implemented changes based on the feedback they received.

¿ Staff, people and family members spoke positively about the management of the service.

¿ The provider had systems in place to monitor the quality of the service through auditing. Audits in a range of topics and areas were undertaken by members of the management team. Action plans were developed following audits to drive improvement.

Rating at last inspection: Requires improvement. The last report for Elvaston Lodge was published on 07 February 2018.

Why we inspected:

This was a planned comprehensive inspection based on the rating from the previous inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

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

After the previous comprehensive inspection, the provider sent us an improvement plan to say what they would do to meet legal requirements in relation to the breach. At this inspection we found that further improvements were needed and that there was a continued breach of the regulation. This is the first time the service has received an overall rating of Requires Improvement.

Elvaston Lodge Residential Home 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.

Elvaston Lodge Residential Home accommodates 42 people and specialises in caring for people living with dementia. The home is over two floors, with bedrooms and communal and dining areas on both floors. There were 39 people living at the service at the time of our inspection. Elvaston Lodge Residential Home is situated in a residential area in the Alvaston area of Derby.

There was no registered manager post in. However there was a manager in post who was going through the registration process with the Care Quality Commission (CQC). 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 2008 and associated Regulations about how the service is run.’

Risks to people were not always mitigated as far as reasonably practical. The provider did not have adequate infection control procedures.

We observed one occasion where staff used unsafe moving and handling techniques. This did not ensure the safety of the person or the staff members.

The provider's arrangements for staff recruitment were not always thorough and did not ensure suitable people were employed.

The management and the leadership of the service was not as effective as it needed to be. There had been a number of changes in management since the service registered, which had resulted in a lack of consistency and vision to drive improvement.

Staff did not have adequate training to support people's individual needs. Staff told us they enjoyed working at the service.

People received their medicines as prescribed and safe systems were in place to manage people’s medicines.

People and relatives we spoke with felt people were safe at Elvaston Lodge Residential Home. Staff had an understanding of potential abuse and their responsibility in keeping people safe. People's care records showed risk assessments were completed and were kept under review.

People were supported to maintain their health and well-being and had access to healthcare professionals such as GP's when required. People were supported with their dietary needs.

People we spoke with all told us that staff were friendly and caring. Our observation showed staff treated people kindly and in a way which respected people's privacy and dignity. People were supported to maintain relationships which were important to them.

People were supported to maintain their interests. People were supported by the provider in accessing the local community, which promoted integration with the local community.

The provider’s complaints policy and procedure were accessible to people who used the service and their representatives. People knew how to make a complaint. However, it was not clear if complaints had been resolved to the complainant’s satisfaction.

There were processes in place for people and their relatives to express their views and opinions about the service provided.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by staff. We observed staff in communal areas and saw how they treated people with dignity and respect. All personal care was provided either in the person's bedroom or in the bathroom. One person told us. 'Staff are very kind, they are like family.'

People told us that they knew how they could raise and felt confident about doing so without repercussions.

The home had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that protects vulnerable people who are or may become deprived of their liberty through the use of restraint, restriction of movement and control.

The provider employed housekeeping staff who cleaned the home. We saw that people's bedrooms and communal areas were clean and tidy. One person who used the service described the home as "clean and tidy". Maintenance is carried out regularly to ensure the service is safe. Management carried out regular audits of the service to ensure that all aspects of the service were safe and followed the provider's policy and procedures.

Improved signage around the service meant that people with dementia are able to find their way from their bedroom to the communal areas.

Is the service effective?

People's health and care needs were assessed with them or their relatives. Support plans included details of people's needs and information about how people were supported with those needs.

When we spoke with visitors, they told us they were confident that the service provided good care. One visitor told us. 'I would give this service ten out of ten, I am very happy with the way they care for my relative.'

We saw that where concerns were raised about the service they took action to minimise risks of it happening again.

Is the service caring?

People told us they were supported by kind and caring staff.

People's preferences, interests and diverse needs had been respected. Each support plan looked at the person's individual diversity and recognised their right to personalised care. Staff understood the importance of respecting people's dignity and always checked they were happy to have a male or female carer.

Is the service responsive?

People told us that staff supported them with their needs. People told us they were well looked after. Visitors told us their relative received good care and staff contacted other healthcare professionals when they needed to. Records we looked at showed that people had been supported with personal care and health needs.

Visitors we spoke with told us that they knew how to raise concerns and were confident they would be listened to.

All visitors we spoke with told us that the service had kept them informed about their relative's wellbeing.

The registered manager listened to concerns raised and took action necessary to minimise the risk of it happening again.

Is the service well-led?

The service had a system for monitoring the quality of service. This included checks of documentation and records.

Staff told us that they were supported by management to attend training and received regular supervision to help improve their practice. Staff also told us that they understood the standard of care expected of them by the registered manager.

You can see our judgements on the front page of this report.

During this inspection we spoke with three people who used the service and two relatives. We also spoke with three members of staff including the registered manager.

People who used the service that we spoke with were happy with the care that was provided. One person told us they were 'well looked after', another stated 'I only have to mention anything and the carers take action straightaway'. One person whose relative used the service told us that the 'staff are great' and that their relative was 'happy' at the home.

We found that care plans and risk assessments were up to date and had been reviewed regularly helping to ensure that people's needs were met.

We found that the provider had taken action since our last inspection. The provider was following their own policy and medication was administered safely. Records were accurate and showed where people were allergic to specific medications. The provider had introduced more detailed audits and action taken as a result of these.

One visitor told they found that the home 'had a nice feel when you come in', another stated that were 'really impressed with it'. A person who used the service told us 'I am very content here'.

People did not raise any concerns about their care. However we found that care plans did not always reflect people's needs and action identified had not always been carried out.

Staff were up to date with training on ensuring that people were kept safe and were able to tell us what they would do if they had concerns.

Sufficient pre employment checks had been carried out on staff members.

We found that the provider was not administering and recording medication correctly or following their medication policies.

All the people we spoke with enjoyed the food. One person stated that there was "plenty of food, its very nice and good choice".

One person who used the service commented "the staff are very friendly", another person told us they were very helpful.

We found that not all care plans were up to date and contained relevant information. There were concerns with the management of medicines and staffing levels.