Lady Elsie Finney House Home for Older People

Lady Elsie Finney House Home for Older People is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There is a registered manager at the service. 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.

At our last inspection we found that care plans did not always contain information around identifying and managing risks to people. This was a breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe care and treatment).

We looked at how risks to people were being managed during this inspection. We found people were protected from risks associated with their care because the registered provider had completed risk assessments. These provided updated guidance for staff in order to keep people safe.

During our last inspection we found that although feedback had been gained from people who used the service. There was not always evidence that the feedback had been acted upon. This was a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we looked at the feedback gained and any improvements made in this area. The registered manager told us they encouraged and sought feedback on the service provided from people who lived at the home and relatives. We saw minutes of ‘resident’s meetings’ which had taken place since our last inspection. The provider also used questionnaires to gain people’s views about the service they received. This information was feedback to staff and management in meetings and any actions needed were taken.

At our last inspection we found issues with ‘as and when’ plans for people’s medicines. The MAR chart did not always have the same information as the 'as and when' documentation and variable doses were not always recorded. We made a recommendation about this.

During this inspection we looked at how the service was managing medicines. We found monthly audits were being completed and management had oversight of these. We found protocols for ‘as and when required’ medicines were in place as per the provider’s medicines policy. These protocols were in depth and contained person centred information to guide staff.

At our last inspection we found that some of the training documentation for the staff was inaccurate. We made a recommendation about this. During this inspection we found staff training was on going and evidence was seen of staff completing training. We checked the full training records of four staff and viewed the training matrix for the service. Training subjects included areas which affected the wellbeing of people, such as safeguarding. Staff told us they received adequate training in order to care for people effectively.

The home was clean and tidy however some areas required attention such as carpets and areas of high dust. Audits and daily walk rounds were being completed. However, upon further inspection we found that bath and shower chairs had ingrained dirt on these. Replacement equipment was sourced before the end of the inspection. The registered manager amended the audit paperwork to include these areas to be regularly checked.

The service had procedures to minimise the potential risk of abuse or unsafe care. Staff had received safeguarding training and were able to describe good practice about protecting people from potential abuse or poor practice.

Staff told us that they were provided with personal protective equipment. We found people were protected by suitable safe procedures for the recruitment of staff.

We looked at how accidents and incidents were being managed. There was a central record for accident and incidents to monitor for trends and patterns and the management had oversight of these.

We found 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.

We found in depth assessments were carried out by the registered manager before any person received a service. Assessments took place to ensure people’s needs could be met by the service.

Peoples needs for nutrition and fluids had been considered. Files contained likes and dislikes with regards to food and drink. People were supported by staff to live healthier lives. The service referred people in a timely manner, if required, to other services such as chiropodist and GPs.

People we spoke with and their relatives told us that the staff were kind and caring. Staff understood the needs of people they supported and it was apparent trusting relationships had been created. We saw people were offered a variety of choices, which promoted independence, such as what they wanted to do and where they would like to sit.

Staff had a good understanding of protecting and respecting people's human rights. Some staff had received training which included guidance in equality and diversity.

We saw care records were written in a person-centred way and we observed staff followed the guidance in care records. Staff took note of the records and provided care which was person centred.

People told us they were encouraged to raise any concerns or complaints. The home had a complaints procedure. We looked at what activities the home provided in order for people who lived there to receive stimulation and to maintain social health. One person told us, “There has been activities on today my relative likes getting involved.”

We found the registered manager was familiar with people who lived at the home and their needs. We found the management team carried out audits and reviews of the quality of care.

The provider and registered manager had clear visions around the registered activities and plans for improvement moving forward. The management team were receptive to feedback and keen to improve the service. The managers worked with us in a positive manner and provided all the information we requested.

Lady Elsie Finney House Home for Older People is a residential care home offering accommodation and personal care for up to 46 older people who may be living with dementia. The home is divided into three separate units known as Meadows. Each Meadow has an open plan lounge and dining area plus a smaller lounge. All bedrooms are single and have en-suite facilities. There are enclosed gardens with patio areas and both of the first floor Meadows have large outdoor balconies. At the time of our inspection there were 43 people living at the home.

The service had a registered manager. 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.

At the last inspection on 14 November 2014, we found the provider was meeting the requirements of the regulations inspected. However, although people who lived at the home felt there were enough staff to keep them safe, some relatives thought staff were too busy at times to provide effective care. Since we last inspected, staffing levels had been reviewed and increased.

During this inspection, we looked at care plans and guidelines on how to support people safely. We noted one person was identified as having diabetes. A second person was identified as having a history of problematic behaviour. A third person’s care plan stated, ‘Sometimes I am unable to stand.’ However, care plans did not guide staff on managing the risk and did not reflect people’s needs.

We observed powder used to thicken drinks was accessible to people who lived at the home. NHS England had previously raised a nationwide patient safety alert highlighting the risks of choking related to inappropriate storage of these powders. The registered manager was unaware of the alert.

This was a breach of Regulation 12 HSCA (RA) Regulations 2014 (Safe care and treatment).

The registered manager arranged surveys with people who lived at the home. They used a mixture of happy and sad faces to allow people to reflect their views plus they had the option to leave comments. When concerns had been shared the registered manager was unable to show how they analysed, responded and addressed information gathered.

This was a breach of Regulation 17 HSCA (RA) Regulations 2014 (Good governance).

We have made a recommendation about the management of some medicines.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs. We have made a recommendation about the documentation and analysis of staff learning and development.

We found staffing levels were regularly reviewed to ensure people were safe. There was an appropriate skill mix of staff to ensure the needs of people who used the service were met.

Staff had received training around recognising abuse and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who were able told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were met. We saw the management team had responded promptly when people had experienced health problems.

Comments we received demonstrated people were satisfied with their care. The management and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people who lived at the home.

People told us they were happy with the activities organised at Lady Elsie Finney House Home for Older People. Activities were arranged for individuals and for groups.

A complaints procedure was available and people we spoke with said they knew how to complain. People and staff spoken with felt the registered manager was accessible, supportive and approachable.

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

We spent time observing how staff supported those living at the home. Staff explained what they were doing and offered reassurance to people. In discussions staff showed a good understanding of residents' needs.

Nutritional needs were assessed and support plans guided staff in how to meet any identified needs. The people we spoke with were happy with the meals provided at the home.

People were cared for by staff that had been appropriately recruited and were trained for their role. Checks helped to ensure that only suitable staff were employed at the home. New staff received a good level of support.

There were quality monitoring systems in place. Regular audits and checks were carried out. Risks were identified, monitored and managed.

There was an effective complaints procedure. The relatives we spoke with confirmed they felt able to speak with senior staff if they had any complaint and were confident that it would be dealt with. One relative told us, 'Nowhere is perfect and there have been little niggles, but they are quickly sorted.'