Archived: The Elms @ Kimblesworth

At our last inspection in August 2017 we found breaches of regulations 11, 12, 13, 17, 18 and 19. The breaches related to the provider failing to meet the requirements of the Mental Capacity Act, ensuring people were cared for in a safe manner, staff were provided with the necessary support to carry out their roles and they had been appropriately vetted before they began working in the home. We also found the provider had failed to ensure there were sufficient and robust governance arrangements in place. The manager provided us with an action plan to show us what actions they were taking to continue with the improvements. At this inspection we found improvements had been made although we found there were continued breaches of Regulations 12, 17 and 18.

The Elms @ Kimblesworth 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. At the time of the inspection there were 14 people living in the home.

At the time of our inspection a new manager who subsequently became the registered manager had begun to make improvements. They provided us with an action plan to show us what actions they were taking to continue those improvements. 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.

Security of the building needed to improve. Inspectors were able to access the building and people’s personal information undetected at 6.30am. The manager told us they would issue new guidance to staff which ensured greater security.

People were given their medicines in a safe manner. However we found improvements were required in the home to support people who had been prescribed topical medicines (creams applied to the skin).

During our last inspection we found a breach of Regulation 18 as staff had not received appropriate support through induction, training supervision and appraisal. At this inspection staff records showed there was a continued regulatory breach. Staff had not received supervision and training in topics relevant to their work.

Audits to measure the quality of the service failed to identify the deficits we found during our inspection and monitor the service across regulatory requirements. The service had yet to reach the stage where the outcomes of surveys, complaints and compliments drove improvements to the care provided to people.

Work had been carried out to make improvements to the cleanliness of the building and reduce the risks of cross infection. Further work was required to the home to complete this task.

The fire risk assessment had been updated and there were regular checks carried out on, for example, firefighting equipment and alarms. However we found a number of concerns about fire safety and asked the local fire safety officer to visit the home. The fire safety officer reported they had found a number of deficits and the area manager and the manager had agreed to address these.

At our last inspection we recommended the provider develop a strategy which took into consideration national guidance on caring for people with learning disabilities. To date this had not been carried out and the service had begun to admit people with learning disabilities. The newly appointed manager agreed to explore this area of work.

Kitchen staff were aware of people’s dietary needs and how people managed their health conditions. People told us they enjoyed the food at The Elms and described it as, “Lovely.” Staff had put in place food and fluid charts for people who needed additional support. However we found these records had not been accurately maintained. Improvements had been made to other records to increase accuracy and bring them up to date. We found further work was required to ensure all records were up to date.

Appropriate checks had been undertaken before staff began working for the service. Disclosure and Barring Service (DBS) checks were carried out and at least two written references were obtained, including one from the staff member's previous employer. Staff provided information about their skills and experience on an application form. We found there were sufficient staff on duty to meet the needs of the people using the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Not every person had signed their care plans. The area manager devised a consent form during our inspection to seek people’s consent for living in the home.

People were protected from the risk of abuse because the staff in the home understood their responsibility to keep people safe and the actions to take if they were concerned a person may be at risk of harm. Staff told us they would be comfortable in raising concerns with the newly appointed manager.

Staff were caring and kind toward people who used the service. They knew people well and were able to describe their preferences, their likes and dislikes. They were able to respond to people with compassion and respected people’s privacy. We saw in people’s care records staff had sought advice from other professionals on the best ways to provide people’s care.

Staff promoted people’s independence and encouraged them to do things for themselves. Systems were in place to assess and monitor people who wished to independently take their own medicines.

The provider had a complaints process in place. We found two people had made a complaint to a member of staff who had documented the issues they had raised. The area manager was unaware of the complaints and agreed to look into people’s concerns.

The area manager and the manager told us a new activities coordinator had recently been appointed and was due to start work in the service. Staff had continued to engage people in activities of their choice.

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

The Elms provides accommodation for up to 19 people who require nursing and personal care. There were 14 people using the service during our inspection.

There was no registered manager in post at the time of the inspection. The last registered manager had submitted their notice to the Commission to cancel their registration in November 2016. Two subsequent managers had been appointed but both managers had needed to tender their resignation. 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. A registered manager for one of the provider’s homes expressed their intention to add The Elms to their registration and during our inspection was acting as the manager. Following the inspection an application was received by CQC and the manager was registered for the service.

Since the last registered manager had left the staff had not received consistent management. As a result staff had resorted to trying to resolve difficulties themselves. A number of staff had contacted CQC to blow the whistle on their employer. This means they told CQC their worries about the home. Staff expressed concern that the fabric of the building was poor, people had been cold during a period when the boiler did not work, food bills had been cut and items not replaced or repaired when they had broken down. People confirmed to us they had not been able to have coffee. During our inspection we saw improvements were being made to the building and a jar of coffee was made available. The manager provided us with an action plan to refurbish the home.

We found the home to be lacking in cleanliness and the fabric of the building required improvement to allow cleaning to take place and prevent the spread of infections.

People’s medicines were safely administered. However, we found people who required medicines on an ‘as and when’ basis did not have plans in place to tell staff when people may need this type of medicine.

People’s personal risks had been identified by staff and actions put in place to mitigate the risks. Staff understood what these risks were and how to keep people safe. We found some risk assessments had not been updated since 2015 and we could not be reassured the risks were still pertinent. Other risk assessments including those appertaining to the building were in place and up to date.

We found there was not enough staff employed in the service. This meant staff were having to work long hours to cover shifts. We found new staff were being recruited and were awaiting a start date. One of these new staff members was an activities coordinator to support and encourage people’s participation in stimulating activities. People told us there was little to do in the home and they wanted some activities.

Audits had been carried out in the service. These include, kitchen audits, infection control and maintenance checks. We found these did not address the deficits we found in the home.

A staff member had been delegated to update people’s care plans. Where the plans had been updated we found they provided a good level of person-centred information and gave guidance to staff on how to meet people’s needs.

Staff knew people well who lived in the home. We found staff were caring and responsive to people’s needs. We saw they respected people and ensured their privacy and dignity was preserved. However we found staff wanted to be able to provide better care and create a more homely environment for people. They felt their care was compromised by the lack of investment in the home. Following the inspection the provider told us they had made investments in the home including refurbishing the staff room and the sun room and buying new furnishings for the lounge

The service had not embedded the principles of the Mental Capacity Act. Staff told us there were people living in the home who they would try and distract them to keep them safe if they tried to leave. We found their capacity had not been assessed and decisions were not in place to make applications to the local authorities to seek authority to deprive them of their liberty.

We looked at staff supervision records. We found staff had not been consistently supported using supervision. Staff were in the process of completing new training to learn about the needs of people with disabilities. The service had a training matrix which showed when staff had last completed their training.

The provider had completed pre-employment checks on staff new to the service. We found staff who had been recently recruited to the service with a background in care services had not had their Disclosure a Barring Services (DBS) check updated. This is a check which enables employers to make safe recruitment decisions. Following the inspection we were given evidence and assurances these checks had since been sought.

We made the following two recommendations following our inspection:-

We recommend in the light of the change to the provider’s Statement of Purpose which informed the Commission the provider intended to admit people with learning disabilities that they develop a strategy which takes into consideration national guidance on caring for people with learning disabilities.

We recommend the provider consider the safety and security of the building and documents.

During our inspection we found five breaches of the 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.