Archived: The Elms

The Elms is a residential care home providing accommodation, personal and nursing care to six people whom have learning disabilities or autistic spectrum disorder. A maximum of six people can be accommodated at the home.

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

The condition of the home had deteriorated. There was evidence of leaks and damp throughout the home. There were risks to people’s health and safety as fire safety procedures were unsatisfactory and regular health and safety maintenance had not been carried out as required. Accidents and incidents were not always recorded. Parts of the home were unclean and infection control had not been considered in the cellar of the home. Recruitment was not always safe. Staffing levels had not been adequately assessed.

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. A blanket ban was placed on people leaving the home without staff support during the pandemic without individually assessing people. There was one shared bathroom which gave access to bath and shower facilities for six people to access and garden area stored waste which could put people at risk. The home required an update in its décor as well as internal improvements such as fixing a hole in wall and damaged windows.

People felt frustrated as they were unable to leave the house without staff. Records in care files and daily notes reflected a lack of person-centred care and dignity with people being referred to as ‘attention seeking’ or ‘unfragrant’. People were not involved in their care and treatment and staff did not effectively support people with their anxieties.

Care plans did not describe positive strategies to support people. Care plans did not capture goals and did not involve people and their representatives. People were not supported to undertake meaningful activities and during the pandemic, had been socially isolated as the provider had not explored safe ways of supporting people. End of Life care was not provided at the home with people being moved to other care homes, should they be at the end of their life. There had been no complaints received.

The provider and registered managers did not understand legal requirements. Lack of robust governance procedures meant little improvement was being made at the home. There was poor oversight of dignity and equality by the management team and no action had been taken following the lack of person-centred recording in people’s records. The lack of oversight from the management team meant any improvements were not identified in a timely manner.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

Most people in the home were independent and prior to the pandemic, were able to leave the home unsupported. During the pandemic, a decision had been made by the providers to issue a blanket ban on people leaving the home without the support of staff. Individual choices had not been explored. People had limited options within the home environment. There was one communal lounge and a separate lounge which doubled up as a staff room which was not always accessible to people. There was a kitchen / diner area where people gathered to eat and watch television. The front and back gardens were unsafe and posed risks to people. Two people were sharing a bedroom where one person had no access to natural light.

Right care:

Care was not person-centred and care plans did not support people to work towards goals and they were not written in a dignified language. Peoples needs were not regularly reviewed. Where further support was required in the night, this had not been considered by the provider. There was only one bathroom which meant people had to wait for others to use the facilities. The décor of the home required further improvement to ensure it was suitable for people to reside in. People commented on the home’s disrepair.

Right culture:

Staff did not treat people with dignity and respect. People were referred to as attention seeking or denied medical intervention after falls. The leadership of the home lacked oversight and did not understand how the lack of person-centred care planning and documentation did not promote people’s confidence and empower their lives.

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

Rating at last inspection The last rating for this service was good (published 30 April 2019).

Why we inspected

The inspection was prompted in part due to a safeguarding concern received which may have put people living in the home at risk of harm. A decision was made for us to inspect and examine those risks.

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.

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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s experience of using this service:

• Improvements had been made to the service since our last inspection. Issues relating to staffing training and quality assurance had been addressed.

• People told us they were happy living at the home and people got on well together. People told us they felt safe and well looked after.

• We saw that the property was clean, comfortable and homely. We saw that new carpets and curtains had been purchased since our last inspection. However, the home was tired in parts.

• People who used the service had the capacity to make decisions about their day to day lives and what they did with their time. The registered providers were aware of their responsibilities in relation to the Mental Capacity Act 2005.

• People told us that they enjoyed the food provided.

• People said they were treated with respect and felt well cared for. They spoke positively about the staff who supported them, who knew them and their support needs well.

• The atmosphere was relaxed and friendly and people who lived at The Elms told us they got on well together as a group.

• People had active lifestyles. They accessed a range of community facilities, used public transport and their independence was promoted wherever possible.

• We found there were adequate systems in place to monitor the quality of the service provided to people.

• The service met the characteristics for a rating of "good" in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was "good".

Rating at last inspection: The rating at our last inspection was ‘requires improvement’ as we made two recommendations. The registered providers had fallen behind with providing staff training and some aspects of quality assurance, which they openly told us about. This was due to the closure of one of their homes and resettling people into the Elms or finding alternative care homes had been their priority. We recommended that any outstanding staff training and quality assurance shortfalls were addressed as soon as possible.

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Follow up: We will continue to monitor the service through information we receive and future inspections.

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

At our last unannounced inspection which took place on 7 October 2015 we rated the service as GOOD.

The Elms 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.

The Elms is registered to provide accommodation for up to six people who have a learning disability and mental health needs and require support with personal care. There were six people living at the home on the day of our inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. There were two registered managers for the home who shared the role, one of whom was the provider.

During the inspection we spoke with five people who used the service either individually or as part of a group and a support worker. We also spoke with the registered manager and both providers responsible for the home.

We were aware that three people had recently moved into the home following the closure of one of the providers other two homes. The home closed due to financial constraints caused by changes in payments relating to sleep in allowance so as to secure the future of The Elms and another home nearby.

People who had moved told us or indicated that they were happy with the new arrangements and that they were still being supported by people who knew them well in a place they were familiar with.

Resettling people to The Elms or finding alternative care homes for people who used that service and resolving issues with staff had been the registered providers priority. This meant the registered providers had fallen behind with providing staff training and some aspects of quality assurance, which they openly told us about. We recommend that any outstanding training and quality assurance shortfalls are addressed as soon as possible.

We saw that the property though comfortable and homely was tired in parts. We were told that some upgrade of the property would be carried out once the sale of their former home had been completed.

We saw there had been significant improvements in the detail in people’s new support plans and risk assessments. Records provided good information about how people wished to be supported.

People who used the service and the support worker told us that they felt safe at the home.

We saw that there were recruitment and selection procedures in place to help protect people who used the service from coming into contact with potential staff who were unsuitable to work with vulnerable people.

People’s medicines were managed well and the home was seen to be clean and tidy throughout. Some maintenance concerns were seen on the day of our inspection, for example, exposed water pipes in the rear yard. Action was taken by the appropriate utilities service to address this longstanding matter following our inspection.

People who used the service had the capacity to make decisions about their day to day lives and what they did with their time. The registered providers’ were aware of their responsibilities in relation to the Mental Capacity Act 2005.

People could make choices about their food and drink and alternatives were offered if requested.

Arrangements were in place to request health and social care services to help keep people well and advice was sought when needed.

Feedback we received from community based professionals was seen to be highly positive. The relationships we saw between people who used the service and the staff supporting them were warm and friendly. The atmosphere at the home was calm and relaxed.

People told us they had a range of individual activities that they participated in at the home and in the local community; these included, for example, attending outreach centres and college courses, as well as visiting family and friends.

We saw people who used the service were encouraged to maintain their independence, wherever possible. People took responsibility for household tasks such as preparing meals, washing and drying after meals, washing their clothes, vacuuming and general cleaning.

People who used the service and staff reported the registered manager and the registered providers were approachable and supportive.

Before our inspection visit we contacted the local authority commissioning and safeguarding teams. They informed us they had no concerns about the service provided.

There was fruit on the dining table and a large jug of fruit juice available for people with additional ice cubes in the freezer to prevent people from dehydrating in the exceptionally hot weather.

We looked around some parts of the home. We saw that the house was comfortable and homely and maintained to a satisfactory standard.

We saw that there were infection control measures in place. For example we saw that there were different coloured coded mops for use in the kitchen, bathroom and the hallway.

We saw that there were frequent and friendly interactions with the support worker on duty and the atmosphere was calm and relaxed. The support worker said the staff team worked well together and communication was good.

Before our visit we contacted the local commissioning and safeguarding teams. They informed us that they had no concerns about The Elms at this time.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People told us that they knew the staff well because most had worked at the home for a long time. They said that they got on well with the staff.

People we spoke with told us that they could speak to the manager or a staff member if they had any problems or concerns. They said that they were confident that they would be taken seriously and they would do their best to sort the problem out.

Prior to our visit we contacted the local safeguarding and commissioning teams about the service. They informed us that they had no concerns about The Elms.