Archived: Elmhurst Residential Care Home

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.

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 the top two 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.

We observed and people told us they felt safe living at the service. Staff were trained in safeguarding and understood how to keep people living at the service safe.

General risk assessments and service risk assessments were completed although some person specific risk assessments were not in place.

Medicines were not always managed in a safe manner. A clear 'as required' (PRN) policy was in place which was being followed by the service. However, there was no stock audit completed for boxed medicines and we saw some medicine counts did not correspond to the amounts that should have been in the packets. 'Time specific' medicines were not given when indicated on the medicines administration record (MAR). Handwritten MARs were not countersigned.

Accidents and incidents were clearly documented although resulting action plans such as new risk assessment forms or revised care plans needed to be more clearly evidenced on the form.

The premises was clean and generally well maintained. Staff used gloves and aprons where appropriate to help control the risk of infections.

Staffing levels were good and there was a robust recruitment procedure in place.

There was wide ranging evidence of consent requested, although the provider had not documented consent from people living at the service and staff about the use of close circuit TV (CCTV) in communal areas.

Staff had a good understanding of the Mental Capacity Act 2015 (MCA) and Deprivation of Liberties Safeguards (DoLS) and knew how to apply this in practice.

People were provided with a choice of nutritious, home cooked meals. People told us they enjoyed the food consumed at the home.

Staff training was up to date. A training matrix was in place which showed when training was due. Staff had access to key training and service specific courses and told us training was good and supported by management.

Good interactions were observed between staff and people living at the service. Staff knew people's care needs and their likes and dislikes. There was a relaxed and friendly atmosphere at the home and a positive culture among the staff.

There was good evidence of people and their involvement in the planning of their care. Care files were up to date, person centred and reflected people's care needs.

People's independence was promoted and we saw people's choices were respected, with people treated with dignity and respect.

The service had an effective complaints policy and people told us they knew how to complain.

An activities programme was in place, according to people's wishes.

People and staff told us the management team were approachable, professional and well respected. Staff told us they felt supported in their roles.

Staff and resident/relatives meeting were held regularly.

A range of quality audits were in place with analysis and improvements seen to take place where required as a result of these.

Statutory notifications were generally received by the Care Quality Commission in a timely manner.

You can see what action we told the provider to take at the back of the full version of the report.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Staff had attended several training courses which took into account the needs of the people who used the service. This ensured that people's needs were met.

Is the service effective?

People's health and care needs were assessed with them or their relative and responded to as part of the care planning process

Is the service caring?

Care staff were attentive and spent time talking to people and making sure their needs were being met.

A person who used the service said; 'Staff treat me very well.' Another said; 'They always knock before they come in.'

Is the service responsive?

People knew how to make a complaint if they were unhappy. People told us they had never needed to make a complaint but if they did they thought complaints would be investigated and action taken as necessary.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

People who used the service, their relatives and other professionals involved with the service had completed provider satisfaction surveys. Feedback was very positive and comments included 'Staff are always very welcoming, friendly and informative'. Other comments included 'The management team are very professional and approachable, always supportive and helpful' and 'The home is always clean and tidy and smells pleasant'.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. This enabled the provider to focus on improvement

People told us they could make choices and decisions about how they wanted to spend time at the home and staff encouraged them to be fully involved in making decisions about their care and treatment. A relative told us they were involved in discussions and decisions about their relatives care needs and were kept informed about any changes. They said "my relative gets very good care, it's friendly and home from home. The staff respect my relative's dignity and meet their needs; I would not want to move my relative. They are not like staff they treat my relative with love." People who lived in the home and a relative said the food was very good and the home was clean, nice and comfortable.

They said if they needed to talk with the manager or any of the staff they were confident they would be listened to and their concerns would be acted on.