Elroi Manor

Elroi Manor is a residential service providing personal care for up to 33 people with mental health support needs and older people some of whom are living with dementia. The service consists of one adapted building separated into 3 sections Lotus, Lavender and Lily. Each includes individual bedrooms and communal spaces with access to the surrounding gardens. At the time of our inspection there were 32 people using the service.

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

People and their relatives told us they felt safe with the care and support they or their relative received. However, despite positive feedback, we found shortfalls with fire safety, the management of people’s risks, Mental Capacity assessments and quality assurance systems which placed people at increased risk of harm.

The provider had systems in place to monitor the quality and safety of the service, however they did not identify the issues we found during the inspection.

Risks to people were not always safely managed. We identified issues relating to fire safety and people’s risk assessments.

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.

Staff told us they felt supported; however, staff were not always trained in line with national standards.

People received their medicines safely and as prescribed, however we found some minor issues with the management of medicines. Staff followed infection prevention and control measures.

Appropriate recruitment procedures were in place to ensure staff had been assessed as safe to work with vulnerable adults.

Staff had received safeguarding training and were able to demonstrate an understanding of their responsibility to report any concerns.

People were supported to access a healthy diet.

Most people and their relatives told us they were satisfied with the service.

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 requires improvement (published 14 June 2021) and there was a breach of regulation. At this inspection we found the provider remained in breach of regulations. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We carried out an unannounced inspection of this service on 15 April 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they 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, Effective and Well-led which contain those requirements.

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.

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 remained 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 Elroi Manor on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, consent, and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Elroi Manor is a residential care home and was providing personal care to 24 people at the time of the inspection. The service can support up to 27 people. Elroi Manor provides accommodation across two floors. The ground floor is split into two sections called Lotus and Lily. Each section had private bedrooms, communal shower rooms and toilets. People can access one of three lounges, one large and two smaller, there is a large dining area located adjacent to the kitchen, and a smaller dining area in Lotus section. The ground floor has a kitchenette, indoor gardening room with raised flower beds and level access through the conservatory leads to a smoking area and extensive grounds. The registered manager’s office is located a short walk from the entrance.

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

Areas in the home were visibly dirty and had not been adequately maintained. The laundry room was being used to store soiled bedding close to freshly laundered items. We observed two staff members wearing their personal protective equipment (PPE) incorrectly. The provider was using generic COVID-19 risk assessments and so could not be sure of peoples’ individual risks in relation to COVID-19. One person who exhibited inappropriate behaviour to others living in the home, did not have a robust risk assessment and care plan to guide staff about how they should keep people safe. When the service experienced an outbreak, the deputy manager isolated with people to help prevent the spread of COVID-19.

Provider checks had not always identified shortfalls, errors and omissions we identified during our inspection. Staff spoke positively about the registered manager, deputy manager and there was a clear staffing structure. Staff and the management team provided person-centred care and we received positive feedback from professionals about care provision and partnership working. The registered manager had a vision for the future of the service and lessons were learned when things went wrong. The provider sought feedback and used different methods to communicate with stakeholders. Statutory notifications were submitted in line with requirements.

There were sufficient numbers of suitably qualified staff deployed across the service and staff were employed safely. The provider worked with the local authority safeguarding team when the need arose, and staff spoke confidently about how they would protect people from abuse. Medicines were stored, managed and administered safely.

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:

The last rating for this service was good (published 9 August 2019).

Why we inspected

The inspection was prompted in part due to concerns received about how the provider was facilitating visitors into the home during the COVID-19 pandemic. A decision was made for us to inspect and examine those risks.

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.

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.

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

Enforcement

We have found evidence that the provider needs to make improvements. Please see the Safe 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 Elroi Manor on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.

Elroi Manor is a care home registered for personal or nursing care, although at the time of the inspection the provider did not offer nursing care. The home specialised in people are living with dementia, or a mental health condition. The home can accommodate a maximum of 26 people. Accommodation is provided on one floor but spilt into two units. Six out of the 26 rooms had en-suite facilities, people in the other rooms shared communal toilets and shower rooms. At the time of the inspection there were 26 people living at the home.

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

People were supported by staff that were caring and treated them with dignity and respect. Staff understood the needs of the people they supported well and knew them as a person. All the feedback we received from people, their relatives and healthcare professionals was positive.

Risks of abuse to people were minimised. Assessments of people’s needs identified known risks and risk management guidance was produced for staff which they understood.

People received their medicines as prescribed, and the storage of medicines was safe. Health and safety checks ensured the home and environment were safe and well maintained.

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. There were systems in place that ensured people who were deprived of their liberty were done so with the appropriate legal authority.

People were supported by staff who had the skills and knowledge to meet their needs. Staff felt supported by the registered manager. Supervision and annual appraisals were carried out regularly but not always recorded. Staff understood their role and received appropriate training that supported them in their roles. Staff worked together with a range of healthcare professionals to achieve positive outcomes for people and followed professional advice to achieve this.

People’s care plans were consistent and had a person-centred approach to care planning. The provision of activities within the service was extensive and people could take part in multiple activities that maintained personal hobbies and interests.

Since 2016 onwards all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard (AIS). The standard was introduced to make sure people are given information in a way they can understand. The registered manager was aware of the AIS and implemented this within the home.

People's concerns and complaints were listened and responded to. Accidents, incidents and complaints were reviewed to learn and improve the home. People and their relatives commented positively about the registered manager and the quality of care their family member received. No concerns were raised about the quality of care provided.

Quality monitoring systems included audits and regular checks of the environment to ensure people received good care. These were effective and evidenced an effective governance system at the home.

The registered manager had ensured all relevant legal requirements, including registration and safety obligations, and the submission of notifications, had been complied with. The previous Good rating issued by CQC was displayed. The registered manager felt staff had a clear understanding of their roles and responsibilities. This was evident to us throughout the inspection.

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

Rating at last inspection

The last rating for this service was Good (published 30 August 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

The inspection team inspected the service against two of the five questions we ask about services: is the service well led and effective. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

At the last inspection in December 2017 the service was rated good.

Elroi Manor provides a service for up to 26 people. The home is approximately one mile from Wincanton town centre. The home provides personal care for older people living with dementia and other mental health needs. At the time of our inspection there were 20 people living in the home.

There was a registered manager in post 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.

Records relating to the repositioning of people who had or were at risk of pressure sores had not always been completed. We did not find any concerns directly about the care of people. However, there was no system in place to ensure staff were providing evidence, through completion of the record, that they had completed the specific care task.

Care planning did not always reflect the complexity of care people needed particularly around pressure care and risk of skin breakdown. There were no specific care plans for skin integrity or assessment to identify people at risk of pressure sores.

Where people had or developed complex health care needs there was no process in place to review their living at the home. This would be to identify where nursing care may be appropriate or what measures were needed to ensure care needs were met. We have made a recommendation about in relation to this this.

People spoke positively about living in the home. One person said, "I have really got on well here it has made a real difference." Another person said, "It feels like home and a family".

People enjoyed the meals provided and one person told us, "The meals are good I always enjoy my meal." Another person said, "I like to sit down and have a meal with people it is a bit of a social occasions."

People's nutritional and dietary needs were met. Where concerns about diet or the need for ensuring people ate well appropriate support was provided.

People described the registered manager as someone who was approachable and always available. Staff also described the registered manager as "Someone we can always go to, she knows what is going and how people are."

The registered manager had responded to our inspection by taking action to address the failures we found around completion of records. They had also put in place improved assessment of people at risk of pressure sores.

The service had worked hard to develop positive relationships with health professionals who regularly visited the home to support people who required nursing care such as pressure sore care.

Elroi Manor currently provides accommodation and personal care for up to 18 people. There were three vacancies at the time of inspection. The service is located in Wincanton and is a detached single storey building. There is a large communal lounge and separate dining room and people have access to a covered patio space and open gardens. At the time of inspection, the service was not providing nursing care for anyone living at the home.

The service did not have a registered manager at the time of 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. The manager at the home had moved into the post a few months previously and was in the process of applying to register with CQC.

Medicines were stored safely and given as prescribed. We saw that one medicine which required additional checks had an error when it was recorded. There were audits in place to ensure that this did not reoccur.

People were supported by enough, safely recruited staff to meet their needs. Staff were aware of the risks people faced and their role in reducing these risks. Where staff had required training or updates, these had been provided and staff had the necessary knowledge and skills to support people.

People were supported by staff who understood their role in protecting adults from abuse and were able to tell us about the signs of abuse. Staff received training in protecting adults and were confident to report any concerns or to whistle blow if this was required. Staff also received supervision from the manager and were able to discuss any concerns, practice issues or development opportunities.

People were supported to make choices about all aspects of their daily life. This included what they wanted to eat and drink, what activities they were involved in and how they wanted to be supported. Staff understood peoples individual likes and dislikes and how they preferred to receive their support.

Staff sought consent from people before providing support and they were aware of the principles of the Mental Capacity Act and had received training in this area.

Staff were kind and caring and we observed that people were relaxed and had a clear rapport with staff. Staff were familiar to people and supported people in a way which was respectful. Relatives and people were involved in planning and agreeing what support people received and felt that staff knew people well.

People had access to healthcare services when required and we saw that the service had referred to a range of different health professionals to ensure that they were supporting people effectively.

People were supported to have enough to eat and drink by staff who understood what support they

required. People had choices about what they ate and drank and mealtimes were a relaxed, social occasion.

People had individualised care plans which reflected what support they needed and how they wished to receive their support. The service was in the process of transferring care plans to use a more holistic approach. Where these were in place we saw that they were personalised and provided a clear picture of the experience of the person receiving support.

Relatives felt included and welcomed by the service. They told us that they were updated about their loved ones and felt that the service provided by the home was of a high standard. People were involved in, and enjoyed a range of activities and there were plans for increased activities with a clear dementia focus.

People and relatives told us that they would be confident to complain if they needed to and we saw that there were clear processes in place to manage this. We saw that relatives and people were comfortable talking with the manager, the owner and care staff.

Communication between staff and management was positive. Staff were encouraged to raise issues and discuss queries and felt valued in their role. There were informal team meetings daily where practice and ideas were discussed.

People, relatives and staff described the service as well led. Staff spoke positively about the management of the service and were supported in their roles. They felt encouraged to raise ideas and that they would be listened too. They had a clear understanding of their roles and responsibilities

At this inspection eight of the forty three beds were occupied. As seen at the previous inspection, one part of the home was closed off and was not accessible to people. We viewed all parts of the home. In the part of the home being utilised, accommodation was provided at ground floor level and we found there were 18 bedrooms which could be utilised.

The standard of d'cor in all but three of these bedrooms was good. The three bedrooms which required attention were not currently occupied The manager informed us these three rooms would be decorated before they were used and there were plans to lay new carpet in two of the bedrooms.

The eight bedrooms being occupied had been furnished in accordance with each person's tastes and preferences. Five of these bedrooms had en-suite toilets and three had the provision of a sink. The standard of d'cor and cleanliness in the part of the home currently being utilised was good. People had access to a large communal lounge and dining room, toilets and bathrooms.There were large and pleasant gardens and a covered outside seating area.

The manager escorted us around the part of the home which was closed off. This was accessed through a locked door. This part of the home was not accessible to people who lived at the home. This accommodation was set out over two floors. The manager told us there were plans to re-develop this area and they had 'no intention' of using that part of the home until major works had been completed. This was positive as, in its current state of d'cor and repair; it would not provide a safe, appropriate or homely environment for people.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

At our previous inspection on 19 November 2013 and 20 November 2013 we found there were not enough qualified, skilled and experienced staff to meet people's needs. This placed people at significant risk of harm. We judged that this had a major impact on people who used the service and served a warning notice. At our last inspection on 7 and 11 February 2014, we found the provider had not taken appropriate action to address this non-compliance.

At the time of this inspection only eight of the 43 beds at the home were occupied. We found the eight people were receiving safe and appropriate care in accordance with their assessed needs. We arrived for this inspection at six thirty in the morning so that we could meet with night staff and check whether people were safe. We found night cover was sufficient to meet the needs and numbers of the people currently at the home. This was confirmed by the two night care staff we spoke with. They told us that nights were covered by two carers and a registered nurse.

By speaking with the manager, members of staff and examining the duty rotas, we saw that staffing levels during the day were in excess of the numbers assessed as being required. The assessment tool calculated the staffing hours required each day as 45. We saw the home were currently providing 84 staffing hours over a 24 hour period. Domestic, administrative and maintenance staff were also employed.

Following our last inspection arrangements had been put in place to deal with foreseeable emergencies. A 'personal emergency evacuation plan' (PEEP) had been completed for each person who lived at the home. These provided information about people which included their level of mobility and equipment required. This helped to reduce risks to people in the event of an emergency. A fire risk assessment had been completed in March of this year and we saw that work had commenced on addressing concerns raised by the fire authority. This included replacing the hinges on fire doors.

We observed staff assisting people to transfer to/from wheelchairs with the aid of a hoist. We saw people were assisted in a safe and dignified manner. Staff took time to explain what they were going to do and offered constant reassurance to the people they were assisting. People appeared relaxed and comfortable when being assisted.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. Care plans included a range of individual risk assessments and agreed actions for managing these risks. These included reducing the risk of falls, skin damage and malnutrition.

Is the service effective?

We found the service to be effective because people's care treatment and support achieved good outcomes for the eight people living at the home. We also found that people's rights and choices were respected by staff.

We saw staff recorded information about each person on a daily basis. Information included how people had spent their day and how they had responded to activities of daily living. This meant the effectiveness of people's care plans could be fully reviewed.

Is the service caring?

The staff we spoke with had a very good understanding about the needs and preferences of the people they supported. They understood and responded to people's needs and requests where individuals were unable to make their wishes known verbally.

Staff interacted with people in a gentle and kind manner. We spoke with two visitors who told us 'The care here is very good. The carers are excellent and so kind.'

Is the service responsive?

We read that one person had recurrent urinary tract infections (UTI). At our last inspection we found the management of this condition to be poor. Improvements were noted at this inspection. Care records contained an assessment which stated the individual was at high risk of developing a UTI. The care plan we read detailed how to minimise any risks. We saw that staff monitored the person's fluid intake in accordance with the plan of care. We observed that staff offered the person regular fluids throughout the day. Care records showed that where the individual had been treated for a UTI, staff had tested a urine specimen to monitor the effectiveness of the treatment.

At our last inspection we found that people were not offered opportunities for social stimulation. We also found people were not sufficiently encouraged to mobilise. At this inspection we found improvements had been made for the eight people using the service. A varied activity programme had been displayed. On the day we visited people were able to have their hair done by a visiting hairdresser. During the afternoon there was a music session. We saw staff were available to respond to any requests by people.

Is the service well led?

At our previous inspections we identified concerns which resulted in us taking enforcement action against the provider. We found the provider did not have an effective system to regularly assess and monitor the quality of service that people received. There were no effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

Following our last inspection the provider/registered manager had commissioned an independent care consultant to review the home's policies and procedures and the quality of care people received. The provider had also recently employed a new manager. The care consultant developed an action plan which covered the areas of non-compliance found at our last inspection. We were sent weekly reports which detailed the actions taken to address the identified areas which required improvement. A registered manager from a sister home also provided management support to the home. A manager was recently employed and we were informed it was their intention to apply for registration with us.

At this inspection we saw that systems to monitor the quality of the service provided and minimise and mange risks to people in the home had been introduced. However we were unable to assess the effectiveness of these systems as some had only recently been implemented or were in the process of being implemented.

At our previous inspection we identified concerns about the standard of the environment. This related to part of the home which is not currently being utilised as occupancy levels have reduced to only eight people. We were shown around the part of the home which is not currently being used. We saw that this would require significant attention and improvement before it could be utilised. The provider and manager told and assured us that they would not accommodate people in that part of the home until major works had been completed. However, the maintenance schedule we were shown did not include any planned work for this area.

The part of the home currently being utilised provided all accommodation at ground floor level. People had access to a large, light lounge and dining area. We viewed the eight bedrooms being occupied. Each provided spacious accommodation and had been furnished in accordance with each person's tastes and preferences. The standard of d'cor and cleanliness in the part of the home currently being utilised was good.

We also found that care was not provided in an environment that was safe or adequately maintained. We issued a compliance action in respect of this.

At this inspection we found where people did not have the capacity to make decisions for themselves, the provider had still not acted in accordance with legal requirements.

People’s care and treatment was still not planned or delivered in line with their assessed care needs or plans of care or delivered in a way to ensure their safety and welfare. Care staff appeared kind and were trying to meet people’s needs but did not appear to have the necessary knowledge, skills or supervision to provide safe, effective and responsive care. There were ineffective arrangements in place to deal with foreseeable emergencies.

Care was still not provided in an environment that was safe or adequately maintained.

There were still not enough qualified, skilled and experienced staff to meet people's needs. Staff lacked knowledge of people’s care plans or risk assessments. There was no evidence that any checks were made to ensure that staff had understood their training and embedded it in their care practice. No formal staff supervision or appraisals were being carried out.

People who used the service and/or their representatives were asked for their views about their care but there was no evidence they were acted on. Roles and responsibilities within the management team were unclear. There was a confused approach in attempting to implement improvements.

People's choices about their day to day lives were limited. Some choices people made were not respected by staff. Where people did not have the capacity to make decisions for themselves, the provider had not acted in accordance with legal requirements.

Care and treatment was not planned or delivered in line with people's assessed care needs or plans of care or delivered in a way to ensure people's safety and welfare. Equipment was not being used for its intended purpose. The risks in using equipment in this way had not been assessed.

The provider did not provide care in an environment that was safe or adequately maintained. Some areas of the home had an unpleasant odour and others needed refurbishment. Some practices within the home could present a fire risk.

There were not enough qualified, skilled and experienced staff to meet people's needs. This placed people at significant risk of harm. Appropriate employment checks were undertaken before new staff began work.

We also reviewed the progress the provider had made in dealing with complaints. There was evidence that the home was doing all it could to ensure people were aware of the complaints procedure. Staff told us they were aware of where they could find the complaints procedure and how they were to respond to a complaint. One relative we spoke with said" I have been given advice about how to complain if I should need to".