Archived: Elliott House

Elliott House is a residential care home providing personal care to 46 older people at the time of the inspection. Some people living in the service had dementia. The service can support up to 65 people. The service was provided over 3 floors in one large adapted building. There was a secure area for people with dementia called Poppy wing on the ground floor.

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

People were at risk of harm to their health and wellbeing and there were concerns about the management of the service.

People’s safety had not been sufficiently protected. Risks to people’s health, safety and well-being were not always mitigated. Where people expressed their emotions though behaviours there was a lack of information for staff on how best to support people and not all staff knew about people’s risks. The environment was not safe for people. Trip hazards had not been addressed. People would not be safe in the event of a fire, there were items blocking exit routes. Items which could be harmful if accessed by people with dementia, such as razors, were accessible to people. Medicines were not well managed to ensure people received these safely and as prescribed by their doctor.

People were not kept safe from the risk of infection. The service was not clean. There were insufficient cleaning staff to keep it so. The provider was not able to evidence they had checked staff had received their covid-19 vaccinations or were exempt, as required. There was no evidence staff were regularly testing for covid-19 which increased the risk to people.

Incidents were not always reported, it was not clear what actions had been taken to reduce the risk of incidents occurring again. People were not protected from the risk of abuse as safeguarding concerns had not always been reported to the local authority or Care Quality Commission (CQC).

There were insufficient competent staff to provide people with safe and effective care. There were a significant number of agency staff and they had not all received an appropriate induction when they first started work at the service. Staff had not always been recruited safely to ensure they were suitable to work in care. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There was a lack of provider oversight of the service. Checks on the quality of the service had not been effective to keep people safe. The provider had failed to address concerns found at the last inspection. Staff told us they did not feel listened to and were not happy in their role. The service worked in partnership with other health and social care professionals however their advice was not always followed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (Published 15 May 2019). We identified four breaches of Regulation. Regulation 12 (Safe care and treatment), 9 (Person-centred care), 10 (Dignity and respect) and 17 (Good governance).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to staffing levels and the management of the service. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. We reviewed the information we held about the service. Prior to the inspection no areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elliott House.

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 have identified breaches in relation to people’s health and safety, staffing levels, safe recruitment, , safeguarding, good governance and notifying CQC of events as required by law at this inspection.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Elliott House 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 inspection, there were 56 people living at Elliott House.

People’s experience of using this service:

¿People were not always treated with dignity and respect. Staff referred to people using their room numbers instead of their names. The use of inappropriate language was observed at the last inspection improvements had not been made.

¿ There were not enough staff to support people safely, especially at mealtimes.

¿ Risks to people were not always identified and/or effectively mitigated.

¿ The provider and registered managers did not have a robust system in place to monitor the quality and safety of the service people received.

¿ People had access to food and hot and cold drinks throughout the day. People told us that they enjoyed the food.

¿ Staff had the knowledge and training to protect people from abuse.

¿Staff received training relevant to their role to meet people’s physical needs.

¿ Sufficient consideration had been given to the environment for people living with dementia.

¿ People had access to a range of different activities throughout the week. People told us that they took part in these and that they were enjoyable. However, little consideration had been given to providing meaningful activities for people living with dementia.

¿ When people needed medical attention, this was quickly identified, and appropriate action was taken. For example, if people were losing weight referrals were made to dieticians, or if people fell regularly they were referred to a falls clinic. We saw district nurses and the GP visiting the service on inspection.

¿ When incidents and accidents occurred, they were investigated appropriately and learnt from.

¿ People had choice over their care and support and their choice and privacy was respected by staff.

¿ Peoples wishes for their end of their lives were recorded and respected. The registered managers were developing a leaflet, so this information could be collected when people joint the service.

¿ People were asked for their feedback through questionnaires and resident's meetings and we saw the registered managers had taken action as a result of these findings.

Rating at last inspection:

In March 2018 the provider changed from one relative to another. Therefore, Elliott House Care Home changed legal entity to become Elliott House. However, the registered managers, staff and policies and procedures remained the same.

At the inspection of the predecessor, Elliott House Care Home we rated the service as good in all domains except effective which was rated requires improvement (Published 6 October 2017).

Why we inspected:

Scheduled inspection based on timescale for unrated services.

Follow up:

We will require the service to send us action plans to demonstrate how they will address the breaches of regulation we found at this inspection. Areas for improvement will also be followed up on the next inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk