Elm Tree Court - Care Home

Elm Tree Court – Care home is a residential care home divided into 3 bungalows, providing personal care up to a maximum of 72 people. The service provides support to older people, people with dementia and younger adults. At the time of our inspection there were 70 people using the service.

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

Effective safeguarding systems were in place. Safeguarding concerns were managed consistently and promptly. All staff had an awareness and understanding of abuse and felt comfortable raising concerns.

Systems were in place to record, store and receive medicines. Staff were trained and supported in their role to administer medicines. Risk assessments were person centred and contained enough information to guide staff in their practice.

There was enough competent staff across the service to meet people’s needs. Recruitment was managed effectively. Staff understood their roles in raising concerns and reporting accidents and incidents. Lessons were learned and communicated to support improvement in the service.

Some decorating and minor re-refurbishment work was required. However, infection, prevention, and control was managed well. Staff were trained and understood their responsibilities for maintaining high standards of cleanliness.

The registered manager and staff created a positive culture, that was person centred and empowering. Staff spoke positively about the registered manager and senior team.

The provider monitored performance and risk in the service to promote and deliver quality improvements. Staff were fully engaged in the quality improvement plan and understood their role in driving improvements in the service.

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 25 April 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service and due to the length of time since the service was last inspected.

You can read the report from out last comprehensive inspection, by selecting the ‘all reports’ link for Elm Tree Court – Care home on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Visits were arranged in line with government guidance.

Staff were wearing personal protective equipment (PPE) in line with government guidance.

People and staff were part of a regular testing programme.

Staff had received training in infection prevention and control (IPC).

Staff had received the COVID-19 vaccination as a condition of their deployment.

We found the following examples of good practice.

¿ All admissions had a 14-day support plan in place, which identified where individuals would be discharged to after their isolation period was complete.

¿ All staff and residents were tested regularly. There was a dedicated testing area where everyone could be tested, including visitors who were supported to complete Lateral Flow Tests.

¿ All staff had received donning and doffing training, their competencies had been assessed and refresher training was provided by Infection Prevention and Control (IPC) leads within the service.

¿ Staff were trained to administer medicines safely.

We were assured this service met good IPC guidelines as a designated care setting.

Elm Tree Court - Care Home is a residential care home providing nursing and personal care for up to 72 people in one adapted building. We inspected the unit that was to be used to admit people who had a Covid-19 positive test result. The unit would accommodate up to seven people. There was no one living on the unit at the time of our inspection.

We found the following examples of good practice

¿ Systems in place allowed people to be admitted to the home safely. Clear signage was used to identify the unit as a high risk area and instructed all people entering this unit to wear the correct Personal Protective Equipment (PPE).

¿ A dedicated staff team was to be allocated to support people entering the high risk unit and meet all their needs, including their meals and social support.

¿ National guidance was followed on the use of PPE. There was clear signage on the correct use of PPE and stations were in place to ensure staff had access to PPE in a safe area.

¿ An infection control champion was providing training on infection control, use of PPE and Covid-19 to all staff working at the service. Staff who were allocated to the high risk unit would be expected to refresh this training before starting work on the unit.

¿ The environment was very clean. Additional cleaning was taking place including of frequently touched surfaces.

¿ There were detailed risk assessments to manage and minimise the risks Covid-19 presented to people who used the service, staff and visitors.

¿ Discussion with the registered manager identified staff still required to be consulted about their specific risks or concerns. This action was added to the service’s designated scheme action plan.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Elm Tree Court – Care Home provides accommodation and personal care to a maximum of 72 people including those people who may be living with dementia. The building is single storey and purpose built. It is divided into three separate bungalows that surround a courtyard. Each bungalow has its own communal areas, bedrooms and bathrooms.

At the last inspection in June 2017 the service did not meet all of the regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection the service was rated ‘Requires Improvement’. This was because the provider was in breach of three regulations, for which we made requirements and the service was in need of other improvements, for which we made recommendations. Breaches related to failure to work under the Mental Capacity Act 2005 legislation, inaccurately written care plans and ineffective auditing. Improvements were needed in staff deployment, using best interest decisions, maintaining medicine records and care for people living with dementia.

Following the last inspection we asked the provider to complete an action plan to show what they would do to improve the key questions is the service safe, is the service effective, is the service responsive and is the service well-led, to at least good? The provider sent us an action plan.

This comprehensive rated inspection of Elm Tree Court – Care Home took place on 20 and 21 March 2017 and was unannounced. We checked that the action plan had been followed. We rated the service as ‘Good’ because previous requirements and recommendations had been met. The rating is based on an aggregation of the ratings awarded for all 5 key questions.

The provider was required to have a registered manager in post. When we inspected there was a manager that had been in post since November 2017 and registered since January 2018. A registered manager is a person who has registered with the Care Quality Commission (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.

Staffing numbers were sufficient to meet people’s needs and they were effectively deployed. People were protected from the risk of harm. Accidents and incidents were appropriately managed, risk assessed and mitigated. The management of medicines was safely carried out. Systems in place demonstrated there was a safe audit trail for handling drugs, which protected people from harm. The premises were safely maintained. Systems in place detected, monitored and reported any potential or actual safeguarding concerns, staff were trained in this area and understood their responsibilities in respect of managing them. Infection control practices were safely and effectively followed and were underpinned by good infection control management policies and procedures. Recruitment policies and procedures were safe and carefully followed to ensure staff were ‘suitable’ to care for and support vulnerable people. When events went wrong the provider and staff learnt lessons so that mistakes were not repeated. These were documented and discussed as part of the process.

People’s mental capacity was appropriately assessed and their rights were protected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Consent for all things to take place was respected so that staff always sought people’s cooperation and agreement before completing any support tasks. Adequate nutrition and hydration ensured that people were supported to maintain good health and wellbeing. The meal time experience for everyone had been improved.

People’s needs were assessed and staff were skilled and trained to carry out their roles. Qualified and competent staff were themselves regularly supervised and received annual appraisals of their personal performance. Staff respected the diversity that people presented and met their individual needs, for example, regarding health and social care. The premises were suitable for providing care to older people and measures had been taken when developing the service to include features which ensured the environment was appropriate for those people living with dementia. Facilities were being improved where needed.

People received compassionate care from kind staff that knew about people’s needs and preferences. The management team set good examples to the staff team with regard to attitude and approach, which meant staff had good role models to follow. People were provided with the information they needed to stay in control of their lives and maintain their independence. Information sharing and communication was effective. People’s diverse needs were understood and met and where necessary, advocacy services were accessed to ensure people’s choices were respected. People’s wellbeing, privacy and dignity were monitored and respected.

Person-centred care plans reflected people’s needs and instructed staff on how best to meet these. They were regularly reviewed. People’s preferences and views were respected. People had opportunities to engage in pastimes and activities that suited them and they enjoyed. They maintained good family connections and support networks with the help of staff if necessary. Their communication needs were assessed and met. An effective complaint procedure ensured complaints were appropriately investigated and without bias. End of life care was sensitively provided with regard to preferences, wishes and needs.

The provider met the regulation on quality assurance systems and these were effective. Audits, satisfaction surveys, meetings, handovers and the provider’s own internal quality monitoring tools ensured there was effective monitoring of service delivery. The system identified shortfalls in service delivery and was used to improve quality. The conditions of the provider’s registration were met in respect of submitting notifications of specific events as required by law. The registered manager understood their responsibilities with regard to good governance, strove for continuous learning around best practice, updated their learning and practice at every opportunity and searched for innovative ways to deliver the service. The culture and the management style of the service were positive and empowering for people that used the service and staff that worked there. Good community links for people and their families were fostered. Experiences of transition between services were well managed, as partnership working was efficient. Recording systems protected people’s privacy and confidentiality of information and records were securely held.

Further information is in the detailed findings below.

The building is single storey and purpose built. It is divided into three separate units that surround a courtyard. Each unit has individual communal areas, bedrooms and bathrooms.

This inspection took place on 27, 28 and 30 June and was unannounced. The service was last inspected May 2016 and was found to be in breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Need for Consent; a requirement notice was set for the provider to comply with. Part of this inspection included checking whether the provider had taken the necessary action to comply with the requirement notice.

At the time of the inspection 72 people were living at the service.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in May 2016 we asked the provider to make improvements to way the service applied the principles of the Mental Capacity Act (MCA) and the use of Deprivation of Liberty Safeguards (DoLS) to keep people who need this level of support with their care and decision making safe; at this inspection we found the application of the principles of the MCA and DoLS was not consistent across the service. This meant people were not always protected by the use of relevant legislation and their liberty was unlawfully restricted. We found the quality monitoring of the service had not identified the issues we found during the inspection and did not ensure people received safe, compassionate care and that the service was well-led. You can see what action we have asked the provider to take at the end if this report.

We found that people’s care plans did not always reflect their needs or had been up dated to demonstrate when people’s needs had changed. This meant people who used the service were at risk of receiving care which was not person centred and which did not effectively met their needs. We found some low level physical interventions were used which had been not been discussed or assessed as being the least restrictive option or in the person’s best interest. This meant people who used the service were exposed to the risk of harm and inappropriate care. During the inspection when we spoke to staff they told us people who used the service were up and dressed very early in the morning. An out of hours visit confirmed this, we found over 40% of the people were up and dressed at 6am. This limits people choices and does not respect their dignity. We found staff were not always deployed around the building effectively and this had an impact on the people who used the service particularly on the night shift. We have made recommendations about these issues and these can be seen in the main body of the report.

We found there were some medicine errors; these were report to the manger to rectify and monitor. This meant people were at risk of not receiving their medicines as prescribed by their GP. We found the meal time experience for some people was not conducive to them eating a good, balanced diet with support from staff. We have made recommendations about these issues and these can be seen in the main body of the report.

People were cared for by staff who had received training in how to recognise abuse and how to report this to the investigating authorities. Staff had been recruited safely.

Staff received training which equipped them to meet the needs of the people who used the service. People were supported by staff to access health care professionals when needed.

People were able to participate in a choice of activities and staff took the time to sit and talk to people and engage them in meaningful conversations. The provider had a complaints procedure which was accessible and all complaints were recorded and investigated.

People who used the service and other stakeholders were asked their views about how the service was run. Staff and people who used the service found the registered manager approachable and there was an open management style. All equipment was serviced and maintained as per manufactures recommendations.

The service had a registered manager in post as required by a condition of registration. 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 undertook this unannounced inspection on the 10 and 11 May 2016. At the time of the inspection there were a total of 72 people living in Elm Tree Court. At the last inspection on 16 January 2014, the registered provider was compliant with all areas assessed.

We found there was inconsistency regarding the application of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered provider and registered manager had not always followed best practice regarding assessing people’s capacity and discussing and recording decisions made in their best interests. We found there were people who met the criteria for DoLS but applications to deprive them of their liberty lawfully had not been made to the local authority. You can see what action we have asked the registered provider to take at the back of the full version of the report.

We found there was a quality monitoring system which consisted of audits, surveys and meetings and practice had been changed as a result of suggestions by people. However, the registered provider and registered manager had a responsibility to ensure any member of staff who worked in the service was able to fulfil their role and tasks. All permanent staff received training, support and supervision but there was limited audit regarding the skills of agency staff employed for one to one support tasks with people. We have made a recommendation about this in the well-led section.

We found people who used the service were protected from the risk of harm and abuse. Staff had received safeguarding training and knew what to do if they witnessed abuse or if it was disclosed to them. People had risk assessments which helped to analyse any risk of harm, for example with moving and handling and falls and how it could be minimised. We found staff knew what to do in cases of emergencies and each person who used the service had a personal evacuation plan.

We found staff were recruited safely with all employment checks carried out prior to new staff starting work. New staff received a full induction and shadowed more experienced staff until it was felt they were competent to work alone with people. We found there were sufficient care staff on duty to meet people’s current needs; there were ancillary staff for tasks such as activities, laundry, catering, domestic work, maintenance and administration so care staff could concentrate on looking after people.

We observed staff had a patient and caring approach. There were positive comments from relatives about the staff team. People who used the service and their relatives were provided with information on notice boards, in meetings and in newsletters. Staff treated people with respect and maintained confidentiality. Personal records were stored securely.

We found people received their medicines as prescribed and had access to a range of health care professionals in the community, when required to meet their health needs.

People enjoyed the meals provided to them. The menus enabled people to have choice and special diets when required. People’s weight, their nutritional intake and their ability to eat and drink safely was monitored and referrals to dieticians and speech and language therapists took place when required for treatment and advice.

We found people had assessments of their needs and care plans which gave staff information about how to care for people in a person-centred way as they preferred.

We found there were activities for people to participate in. These were provided in small and large groups and on a one to one basis. The activities helped to stimulate and include people and prevent them from being isolated.

The registered provider had a complaints procedure on display. Relatives told us they would feel able to complain and any concerns would be looked into and addressed.

We found the service was clean and tidy. Staff had cleaning schedules and equipment used within the service was maintained so it remained safe to use. The environment had been adjusted to meet the needs of people living with dementia.

The service had 71 people resident at the time of inspection, 45 of whom had a diagnosis of dementia and 23 had dementia type symptoms. Three people did not have dementia but they had chosen to be admitted to the service to accompany a relative or they had been happy with the care a relative had received in the past.

We found the manager and staff team provided care that was focussed on people's dementia care needs. All staff were aware of good practice guidelines and all had completed in-house dementia care training facilitated by HICA's training section. The manager, deputy manager, personal care manager and senior care staff had completed 'dementia ambassador' training with the Dementia Academy in Hull. This meant the staff team had skills and knowledge to use when supporting people with dementia.

We found people with dementia had their needs assessed prior to admission to the service. The assessment was kept under review and the information was used to develop individualised care plans. This provided staff with information on how to support people with dementia and enabled them to recognise when their behaviour changed and they required additional care and treatment.

We found people with dementia received care and treatment from a range of health and social care professionals. Staff within the service worked well with people from other agencies to ensure care was coordinated. For example, they provided information and escort when a person with dementia was transported to hospital.

We found there were systems in place to monitor the quality of the service people with dementia received. This included supporting people to make their views heard, completing audits and ensuring the environment was suitable for people with dementia.

People had assessments and care plans to guide staff in meeting their needs. People told us they saw their GP when required and records showed us people saw other health professionals. Two relatives told us they felt health needs were met and they were always kept informed of important issues. Comments included, 'They keep me informed and get the doctor when necessary' and 'I want to see him cared for and they do that here.'

People spoken with liked the food provided. They said they had enough to eat and drink. Comments included, 'The food is very good', 'I like to have muesli for breakfast and I get it' and 'The food suits me.' Relatives said, 'The food is like mother used to make' and 'They liquidise all her meals. She has put weight on since coming here.'

We found the home was clean and tidy and free from unpleasant odours although a carpet in one of the communal areas was in need of replacement.

We found there were enough staff to meet people's assessed needs. People who used the service and their relatives were complimentary about the staff team. Staff received training and supervision.

Accurate records were maintained of the care provided to people who used the service and of staff.