Elmleigh Homes Limited

About the service

Elmleigh Homes Limited is a residential care home providing personal care to up to 22 people who may have learning disabilities and older people. At the time of the inspection 19 people lived across four separate buildings. The service consisted of one 'main house', two smaller detached houses, 'Sapling 1' and 'Sapling 2', and a small house containing one flat which was occupied by one person. There was a secure car park area with tables and chairs people could use in warmer days and one 'summer style house' which was in the process of being set up to be used for arts and craft and other activities.

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

Right Support

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome. However, we found one medicine administration record was missing important information about a person’s allergies to certain medicines.

Staff followed government guidance in relation to wearing personal protective equipment (PPE) such as masks, gloves and aprons. The provider ensured all people and staff were following government guidance in relation to COVID-19 testing.

People had a choice about their living environment and were able to personalise their rooms. People’s rooms were very personalised, and people were able to decorate their room to reflect their interests and hobbies.

Staff enabled people to access specialist health and social care support in the community and people were supported to play an active role in maintaining their own health and wellbeing.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Care

People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. However, we found some care plans were lacking information about people’s health needs to guide staff.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. Staff understood and responded to their individual needs.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

People could take part in activities and pursue interests that were tailored to them.

Right culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.

Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. This meant people received compassionate and empowering care that was tailored to their needs.

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 was inadequate (published 05 November 2021) and there were breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 04 November 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met and to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

Follow up

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

Elmleigh Homes Limited is a residential care home providing personal care to up to 22 people who may have learning disabilities and autistic people. At the time of the inspection 19 people lived across four separate buildings. The service consisted of one ‘main house’, two smaller detached houses, ‘Sapling 1’ and ‘Sapling 2’, and a small house containing one flat which was occupied by one person. There was a secure car park area with tables and chairs people could use in warmer days and one ‘summer style house’ which was in the process of being set up to be used for arts and craft and other activities.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support: People were generally supported to have choice and control of their lives. The service promoted people’s independence and ensured people were encouraged to learn new and build on current life skills.

Right care: Despite the registered manager and staff telling us they had the safety of people at the heart of all they did, they had not considered the risk they were putting people at because they had not followed government guidance about wearing personal protective equipment (PPE) during the COVID-19 pandemic.

Right culture: Managers and staff were not clear about their roles, or did not understand quality performance, risks and regulatory requirements in regard to the COVID-19 pandemic. None of the staff had challenged this unsafe practice.

The management and staff did not fully understand the importance of the prevention and control of infection. Risks to people’s health was not managed in a safe way. Staff were not following government guidelines about wearing PPE. The provider had not embedded the government guidance during the pandemic to ensure lessons were learnt and people were always kept safe.

Staff were trained to administer medicines; however, the management of medicines was not always effective in identifying issues and concerns. Recruitment documentation was not always retained in line with the provider’s policies and best practice guidelines

Staff knew how to safeguard people from abuse and avoidable harm. There were sufficient staff to meet people’s needs. The service worked in partnership with other professionals to ensure people received the support they required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 was good (published 15 February 2019).

Why we inspected

We received concerns in relation to poor infection prevention and control practices and the service not following government guidelines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 Inadequate. We have found evidence that the provider needs to make improvement. Please see the Safe and Well led sections of this 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 Elmleigh Homes Limited on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The home had been registered with CQC before Registering the Right Support guidance and Building the Right Support had been developed. However, we found the care provided included choice, promotion of independence and inclusion. People living with learning disabilities at Elmleigh Homes were supported to live as ordinary a life as any citizen.

At our last inspection we rated the service as overall 'Good'. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

There were 20 people using the service at the time of our visit. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were kept safe at the service. Staff recognised signs of any abuse and knew the process to follow to report such incidents. Staffing levels were maintained to ensure people were fully supported in a safe manner. Medicines were stored and handled in line with current regulations.

People's consent was obtained before any support or care was provided. Staff completed regular training and refresher courses to ensure their knowledge was up to date and people's needs were met in the correct way. People had access to health care professionals and had a choice of food and snacks throughout the day.

Staff were caring and understood the needs of the people receiving support and how choices were to be provided. People's independence was respected and supported, with people enjoying trips outside the service, and attending college, whenever they had chosen.

There was a range of activities offered and regular discussions about how people wanted to spend their days. Appropriate staffing levels were in place to support all outings and activities. The local community was regularly accessed and people routinely undertook such activities as enjoying the local night club, days out for walks and shopping. Contact with family and friends was supported and encouraged, with relatives being part of any celebrations or special events.

Relatives and staff were happy with the leadership of the service and told us that the registered manager was actively involved in the daily routines and readily available to discuss any matters. Staff felt they were fully supported by the management and were included in any developments of the service.

At the time of our inspection the service had 18 people living there. The service offers accommodation in four separate units situated on the same site. The largest unit has 13 bedrooms. There are then two houses which offer four places in a domestic style house. The remaining unit provides one bedroom.

There was a registered manager in place and they were available during the inspection. 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 received safe and effective care from staff. Staff had a good understanding of the various types of harm and their roles and responsibilities in reporting any safeguarding concerns.

Risks to people's individual needs and the environment had been assessed. Staff had information available about how to meet people’s needs, including action required to reduce and manage known risks.

There were sufficient numbers of staff to meet people’s care needs and staff were recruited safely. Staff received regular training and supervision and were able to reflect on the care and support they delivered and identified further training requirements.

People told us they received their medication as prescribed. Staff were able to explain the process they followed when supporting people to safely take their medication. Records we checked confirmed this.

People’s rights were protected under the Mental Capacity Act 2005. People were supported to eat and drink sufficient amounts to meet their nutritional needs. External health professionals were involved in people’s care when required.

People’s care plans reflected their individual needs and personal wishes. People were involved in the development of their care plans and these were reviewed regularly.

The service encouraged feedback from all people involved with the service. A complaints process was in place, and people felt able to make a complaint. People felt confident that staff would respond in a timely manner.

People were very satisfied with all aspects of the service provided and spoke positively of both staff and management team. People received care and support from kind, caring and compassionate staff, who respected their privacy and dignity at all times.

People had confidence in the registered manager and the way the service was run. There were systems in place to monitor and improve the quality of the service provided. The vision and values of the staff team were person-centred and made sure people were at the heart of the service.

We found that the manager had made improvements to the training and development of the staff team. Systems were in place so that people who used the service were cared for by staff who were supported to deliver care safely and to an appropriate standard.

We found the environment was safe and adequately maintained. There was suitable nutrition provided. People who used the service consented to their care wherever possible and their rights were being protected if they were unable to consent due to their mental capacity.

We asked four people who used the service if the staff supported them safely. Comments received included, 'I live a really good life now because I have different friends and lots of people to socialise with. The staff are very friendly.' Also, 'The staff are very good with us, it's a friendly atmosphere. Sometimes I need my own space and the staff respect this.'

The care plans and care records showed that the staff placed the needs, wishes, preferences and decisions of people who used the services at the centre of the assessment, planning and delivery of care and support.

People using the service commented, 'I am happy here, I have lots of plans for holidays.' 'I am being supported to be more independent.'

The systems in place to monitor the training and development of staff were not sufficient to ensure that the staff had the skills they needed to support people who used the service.