St Elmos

Updated 24 July 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Service and service type

St Elmo's is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission at the time of our inspection. They had left several weeks before and we were not notified of this by the nominated individual who had advised the registered manager to inform us.

The provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave short notice, (1 hour) of this inspection to ascertain if there were any immediate risks we should be aware of or if anyone currently was unwell or showing symptoms of COVID19. This would enable us to take all necessary precautions.

What we did before inspection

We reviewed all the information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We did not request a provider information return, (PIR) before carrying out the inspection as the inspection was to follow up on specific risks identified prior to going on site. PIR are sent out annually and this is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. Since the inspection we have received a PIR.

We used all our information to plan our inspection. We had requested information from the provider prior to the inspection in relation to a specific safeguarding incident and in response to whistleblowing concerns. This information was used as part of the inspection plan.

What we did during the inspection

We spoke with the director, nominated individual and the deputy manager. We spoke with one member of the care team and the team leader. We spoke with two other members of staff briefly as they were supporting a service user. We met two service users but had very limited contacted. Throughout the morning people were engaged in one to one activity, we were unable to carry out direct observations of practice as people were supported by staff in their own flats.

We carried out observations and asked questions about infection control, medicines practices and audited a person’s medication. We reviewed staff files in relation to recruitment.

We chose to review records off site and requested these the same day and made additional requests for information. We also informed the nominated individual that we would be interviewing staff, relatives and health care professionals via telephone.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We spoke with four health care professionals, four staff and four relatives.

Updated 24 July 2021

About the service

St Elmo’s is a residential care home providing accommodation and personal care. It is registered to accommodate up to eight people but had seven people in occupancy on the day of our inspection. The service is registered to support people with a learning disability, physical disability and, or mental health need. The service is registered for younger adults.

Each person had their own self-contained apartment which was adapted to the person’s needs. For example, some people had a walk-in shower/wet room suitable for people with physical disabilities.

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

We identified a number of significant concerns which impacted on the safety and quality of the service people experienced.

The providers quality assurance systems had not ensured the service people received was safe and effective. The governance systems had failed to identify changes in people's needs or identify a change in risk which had resulted in people being admitted to hospital.

People were not consistently supported to manage risks to their safety and there was no clear escalation of risk or oversight. Care plans did not always include enough detail in line with the severity of risk and known history of risk. Staff training was not sufficiently in depth in line with the complexity of people’s needs.

Health and safety checks did not include all the areas we might expect them to cover. We have made a recommendation about this.

The service had not reported changes affecting people's health and wellbeing or notified the appropriate authorities of safeguarding concerns. The providers oversight was not sufficiently robust which had resulted in some areas of health and safety not being as robust as they should.

Recent changes in management and staffing has resulted in some unrest. The registered manager had left just prior to our inspection and since registration this service has had three managers and some staff had left including one senior and other seniors stepped down to carers after a management reshuffle. Recruitment was ongoing and robust but there was limited evidence of investment in staff in terms of their training and personal development. Annual appraisals were not completed, and staff did not regularly contribute to the overall development of the service.

We have made a recommendation about staffing in line with good recruitment processes.

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.

This service was able to demonstrate in some areas how they were meeting the underpinning principles of Right support, right care, right culture. Records showed people had access to and a choice of social activities which had been reduced due to the effects of the pandemic and restrictions placed on people. Staff continued to try and support people and maximise their opportunities against agreed objectives.

People were not consistently supported to manage risks to their health and guidance was not consistently in place to support people with their needs around food and drinks.

We have made a recommendation about training in line with people’s eating, drinking and associated risks of choking.

People’s preferences were recorded, and staff had a good understanding of people's needs. However, certain aspects of the service could be improved in line with people's individual needs to ensure people received consistent standards of care. We identified staff using terminology which was not appropriate and did not demonstrate a person centre approach. This was fed back at the time of our inspection.

During our feedback both following the site visit and later following review of all available information we were encouraged by the responsive and professional nature of the nominated individual, and the deputy manager. They immediately put systems in place to strengthen their processes and help ensure improvements in the quality of care continued.

We received positive feedback about this service and their willingness to learn from their mistakes and their total commitment to supporting people, some of whom had experienced multiple placements. Comments from family were very encouraging and most staff were committed to their role. There were areas of practice where the service was performing well. We have made a number of recommendations in regard to health and safety checks, staffing, and eating and drinking.

Rating at last inspection and update

The last rating for this service was Good (published 02/06/2018.)

Why we inspected

We received concerns in relation to how people were being supported and a lack of suitable staff to provide the support required to keep people safe. We received some specific information which related to the safety of two people using the service. As a result, we undertook a focused inspection to review the key questions of safe, effective 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.

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

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Elmo's 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 four breaches in relation to : risk management, reporting incidents and governance, staff support and training and provider oversight and governance at this inspection. We have also made three recommendations, one in relation to training, another in relation to staffing, and another in relation to furniture risk assessments.

Please see the action we have told the provider to take at the end of this report. 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 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 request an action plan. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.