Background to this inspection
Updated
15 November 2017
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.
Our inspection of Elmhurst Residential Home took place on 11 September 2017 and was unannounced.
The inspection team consisted of three adult social care inspectors.
Prior to the inspection we reviewed information about the service from a number of sources. We reviewed information received from the provider and contacted the local authority safeguarding and commissioning teams. As part of the inspection planning, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This had been returned to us in a timely manner and we took the information within the PIR into consideration when making our judgements.
During our inspection, we used a variety of methods to help us understand the experiences of the people who used the service. We spoke with ten people who used the service, three relatives, two care staff, the deputy manager, the registered manager, the provider, the cook and one visiting health care professional. We looked at five people's care records, some in detail and others to check specific information, medication records and other records which related to the management of the service such as policies and procedures and training records.
On this occasion we did not complete a Short Observational Framework (SOFI) since people were able to speak with us about their experiences of the service.
Updated
15 November 2017
Our inspection of Elmhurst Residential Home took place on 11 September 2017 and was unannounced.
At the inspection carried out on 1 August 2016 we found the service was in breach of Regulation 12, Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to medicines management. At this inspection, although in some areas improvements had been made, further improvements were required to ensure the service was no longer in breach of regulation. A robust system of quality assurance should have been in place to prevent this occurring which meant we were unable to rate the service above 'requires improvement'.
Elmhurst Residential Home provides accommodation and personal care for up to 20 people. At the time of our inspection, there were 19 people living at the service. The service had bedrooms on all three floors and communal living space on the ground floor. The basement was for staff access only and contained the laundry, office and storage areas. The communal areas included two dining areas, a conservatory, TV lounge and a quiet lounge. Separate from the kitchen, there was also a kitchenette area where people could make their own drinks if they wished.
There was a registered manager at the home who had been in post for a number of years. 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.
People felt safe living at Elmhurst Residential Home. Safeguarding procedures were in place and staff understood how to keep people safe. Accidents and incidents were documented although further evidence needed to be recorded of the actions taken to learn from incidents. Risk assessments were in place to mitigate risk.
Improvements were required to the safe management and auditing of medicines.
The premises was clean and well maintained and people who lived at the service were consulted about changes made, such as to the downstairs carpet.
Safe staffing levels were in place. Staff were trained effectively and a system of supervision was in place.
The service was complying with the legal requirements of the Mental Capacity Act 2005 and we saw good evidence people's consent was sought. Consent had been obtained from people about the use of CCTV used within the home and signage about this was visible in the entrance hallway.
We saw people were consulted about the choice of food and there was a good variety provided on the menu. People who had lost weight were referred to the GP and dietician.
We observed kind and caring interactions during our inspection and staff had time to spend good, quality time with people. People were able to choose when they got up, where they ate, where they sat and other aspects of their life, including their end of life wishes.
Plans of care were person centred and regular reviews took place. People were involved in the planning of their care.
A plan of activities was in place although this was dependant on the wishes of the people living at the home. We saw the service promoted one to one activities as well as group activities.
People told us they understood how to complain if required and we saw a complaints policy was clearly visible within the home. However, no complaints had been received since the last inspection.
A system of quality audits were in place with some analysis and improvements seen to take place where required as a result of these. However, the system for auditing management of medicines needed to be more robust since it had not identified the issues we found at inspection.
People's feedback was sought though regular meetings and surveys. Actions from these were clearly seen to take place.
The registered manager was a visible presence within the home and well respected by staff, people who lived at the service, relatives and health care professionals. They were committed to making the service as good as possible and clearly passionate about this.
We found the service was in breach of Regulation 12, 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 the report.