This was an unannounced comprehensive inspection which took place on 17 and 18 July.People living at Eltandia Hall Care Centre receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
The care home can accommodate up to 83 people across four self-contained units located over two floors, each with their own separate adapted facilities. Three of the units known as Irving, Ivy and Scott support older people. Most people staying on these units are living with dementia. Irving and Ivy units also specialise in providing nursing care, whilst the Scott unit is residential and specifically for older people with personal care needs. The Farish unit supports both younger and older adults who have physical disabilities. Some of the people living on this unit also have a learning disability or autistic spectrum disorder or mental ill health problems. Some people living in the home have a sensory impairment. At the time of our inspection 73 people resided at the Eltandia Hall Care Centre.
The service has had two new registered managers in the last 12 months. The latest manager was registered by CQC in March 2018. A registered manager is a person who has registered with the CQC. Registered managers like registered providers 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.
In August 2017 the home was re-registered by the CQC after the service was taken over as a going concern by a new provider. At the last comprehensive inspection of this home in April 2017 when they were managed by the provider Lifestyle Care Management, we rated them 'Requires Improvement' overall. This was because we found poor management of medicines, risks, complaints and governance, and lack of staff support and understanding of the Mental Capacity Act (2005). We undertook a focused inspection in April 2017 and judged the service had made improvements to address the issues, but continued to rate them 'Requires Improvement' overall because we wanted to be sure they could maintain what they had achieved over a more sustained period.
At this comprehensive inspection we found after 12 months in charge the new provider had improved the service people living in the home received. However, the new providers acknowledged there is a lot more work they need to do to make the home better and ensure it continued to move forward in the right direction of travel. We have therefore rated Eltandia Hall Care Centre ‘Requires Improvement’ overall and for the two key questions ‘Is the service effective and caring?’ For the three key questions, ‘Is the service safe, responsive and well-led? we rated them ‘Good’.
We rated them ‘Requires Improvement’ for effective because staff did not have all the right knowledge and skills to carry out their roles and responsibilities. Although the new provider had a well-established training programme in place, it did not cover the needs of everyone who lived at the home. For example, most care staff had not received any training in learning disability or mental ill health awareness, preventing and appropriately managing behaviours that might challenge the service and understanding equality and diversity. This meant staff might not have the right competencies to effectively carry out all their roles and responsibilities.
We also rated the home ‘Requires Improvement’ for 'caring' because some people did not always feel they were well-cared for or supported by some of the staff who worked at the home. Although we observed positive interactions between people living in the home throughout our two-day inspection, several people and their relatives and community health and social care professionals expressed concerns about the caring attitude of a few staff and the way this minority sometimes treated people living at Eltandia Hall. The new managers had identified a shortfall in the caring attitude displayed by a minority of staff at times. They told us they had begun to address this problem through a combination of additional staff training and supervision and the use of staff disciplinary procedures, where appropriate, which staff we spoke with confirmed.
These shortfalls represent breaches of the Health and Social Care (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.
We also found important information people living in the home might find useful was not always accessible to people with a learning disability or a sensory impairment. This was because no easy to understand pictorial, plain English or audio versions of the ‘Service users’ guide, the providers complaints procedure or care plans were available in other formats other than the standardised written one. This meant some people might not have sufficient opportunities to be actively involved in making decisions about the care they received at the home.
The negative comments described above notwithstanding, most people living in the home, relatives and community health and social care professionals felt the standard of care provided at Eltandia Hall had begun to steadily improve since the new providers and managers had been in charge.
There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse and neglect. The provider assessed and managed risks to people’s safety in a way that considered their individual needs. Appropriate recruitment checks took place before staff were permitted to commence working at the home. There were enough staff to keep people safe. The premises and equipment were safe for people to use because managers and staff routinely carried out health and safety checks. Managers ensured the environment continued to be hygienically clean for people and staff demonstrated good awareness of their role and responsibilities in relation to infection control and food hygiene. Medicines were managed safely and people received them as prescribed.
People were supported to eat and drink enough to meet their dietary needs and preferences. Managers and staff were aware of their duties under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff sought people's consent before providing any care and support and followed legal requirements when people did not have the capacity to do so. They also received the support they needed to stay healthy and to access health care services. People said the home was a comfortable place to live.
Staff communicated with people using their preferred methods of communication. This helped them to develop good awareness and understanding of people's needs, preferences and wishes. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. When people were nearing the end of their life, they received compassionate and supportive care.
People received person centred care and support that was tailored to their individual needs. Each person had an up to date and personalised care plan, which set out how their care and support needs should be met by staff. These were reviewed regularly. The opportunities people had to participate in meaningful activities that reflected their social interests had improved in the last 12 months. People were encouraged to maintain relationships with people that mattered to them.
The newly registered manager and her deputy manager were well-regarded by people living in the home, their relatives, community professionals and staff. The provider operated effective governance systems which ensured all aspects of the home were routinely monitored. Any shortfalls or gaps identified through these checks were addressed promptly. The provider had suitable arrangements in place to appropriately deal with people’s concerns and complaints. The provider also gathered feedback from people living in the home, their relatives and staff.