Elliscombe House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During the assessment we found some aspects of the service were not always safe . There was an increased risk that people could be harmed. We identified breaches of regulation in relation to safe care and treatment, medicines, and staff training and support. The management of people’s risk was inconsistent. Medicines and treatments were not always safe. This was a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Records showed that not all staff were sufficiently qualified, skilled, experienced, or received effective supervision. This was a breach of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were systems in place to ensure the environment was safe and maintained, however we had identified some improvements were required in relation to some aspects of the environment. People were protected from the risk of harm and abuse.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People we spoke with told us they felt protected from abuse and mistreatment; they were happy living at Elliscombe House. One person told us, " I have never been mistreated here or anything like that. It is safe." Relatives said their family members were treated well by staff. One relative told us, “I do feel [name’s] safe; no concerns.”

Staff told us it was a safe place to live and work in. Most staff thought that something would be done if they reported concerns. One member of staff said they “hoped and assumed” so.

People were happy and relaxed in the company of staff; people clearly knew staff well and trusted them.

People had their capacity to make decisions assessed as part of their care plan. When people had been assessed as lacking mental capacity to make a certain decision, staff clearly recorded assessments and any best interest decisions. This included when people had others with legal authority, such as family members, to make decision on their behalf. Where needed, appropriate legal authorisations were in place to deprive a person of their liberty. Any conditions related to deprivation of liberty authorisations were being met. Policies and guidance were available to staff, and they had been provided with safeguarding training. There was a system in place to audit incidents and accidents and report any safeguarding concerns to the relevant authorities. However, records showed that some incidents had not been robustly investigated. This meant that the service did not always use this information to identify potential abuse in order to take preventative action, including escalation if appropriate.

Some people told us they understood the risks associated with their care. One person explained how important it was for them to be cared for in the right way. They said, “I have to be careful about how I am positioned in bed as I can [become sore]. This is the most comfortable position for me and staff know that.”

Staff had knowledge of people and their healthcare risks. For example, staff knew who required support with repositioning and who needed their food and fluid intake to be monitored. However, staff felt this needed to be improved. The lack of clinical oversight meant it was not possible to ensure important tasks had been carried out placing people at increased risk. For example, records showed that a GP had requested tests to be carried out for one person by staff, however there was no evidence to confirm this had been done. This meant there was a risk that they would not receive the right treatment or a delay in any treatment starting. One staff member said, “We need to improve clinical oversight. Sometimes things do get missed but we don’t always know when it's missed.”

We observed staff worked in a safe way. For example, when people needed equipment to help them to move, such as a hoist, they were supported in a safe and confident way by staff. People who required support to eat and drink safely were provided with appropriate meals, drinks and support from staff.

Most risks to people had been assessed, but the management of risks was inconsistent. When risks were identified, care plans were designed to informed staff how to reduce the risk of harm to people. For example, when people had been assessed for the risk of skin damage, care plans detailed any pressure relieving equipment in place, and how often people required staff support to change position. Wound care plans showed that although photographs of wounds had been taken, a measuring tool (which was available to staff) had not always been used. This meant it was not always clear if wounds were improving or not. Additionally, it was not easy to access photographs of wounds to compare them. This meant it would be difficult for staff who were not familiar with the people, such as agency staff or new staff, to assess the wound status or any changes in the risk. We reviewed a care plan for one person with a specific health condition. There was no plan in place for this condition. This was a significant risk because staff would not be aware of what was abnormal for this person or when and what action they should take if they had concerns. This meant that the provider did not always robustly assess and do all that was reasonably practicable to mitigate risks to people who received care. This placed people at risk of harm. This was a breach of Regulation 12 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The management team and the provider started acting on our feedback during the assessment and were making quick progress in addressing the clinical leadership of the service.

People and their relatives said the home was a safe place to live and was generally well maintained. One relative said, “It’s the best nursing home around for cleanliness and space.” There was an issue with a lack of hot water in the evenings. One person said, “There’s a problem. I had no hot water in my taps for a while. Now it’s luke warm in the evenings. Staff get hot water from the kitchen and have to carry it to my room. I don’t know what’s going on.” This ongoing issue was acknowledged and was being addressed by the provider.

Staff pointed out some environmental issues which they thought should be addressed, such as the lack of hot water. A new estate manager had been appointed recently, and they were working through the known maintenance issues.

The home was pleasant, well decorated and furnished. However, some furniture was not appropriate for people who lived there. For example, chairs in the ‘Orangery’ room did not have arms which may pose a risk to people with mobility difficulties. Some seating was very low which would prevent some people from using these seats. This was discussed with the manager who told us they had ordered new, suitable chairs. The room currently used as the dining area appeared cramped. Staff had to move chairs to enable people to sit comfortably. Some tables were not suited to people who used wheelchairs. Staff sometimes struggled to support people with meals and drinks as space was limited. This was discussed with the manager who told us this would be reviewed; they may wish to make use of the ‘Orangery’ to improve people’s dining experience. Following the feedback we gave to the provider; they told us that more tables were ordered for the “Orangery” and explained to us the sitting arrangements between the dinning room and the “orangery”.

One staff member went through the improved checks on the environment to ensure people’s safety they had introduced since starting work in the home. These included checks on any physical hazards, hot water outlets, shower head descaling, and fire prevention and detection equipment. Evidence showed that the service had a system in place to carry out environmental checks and these were maintained. These checks included fire, water and equipment safety. The service had identified through their own monitoring systems some areas of environmental safety which required action; however, the completion of these actions had been delayed. The provider told us that the service had a new estates manager in post and commented that they completed an “astonishing” amount of work in a short space of time and that communication had improved in this department. They were confident that all the outstanding actions would be completed without delay, and we have noted that during our assessment that the situation with the hot water provision had been addressed. The manager talked with us about the improvements they had identified and planned to make in relation to improving fire safety and training in the service and the timeline for completing this.

People had mixed views about whether there were enough staff to provide care when they needed it. People had call bells to summon staff when they needed care or support. These were not always answered promptly. One person said, “I have a call bell, but they don't always come that quickly. The staff get busy at times, so you have to wait. That's not very good is it. It needs more staff.” Most relatives thought staffing levels were good when they visited, although some relatives agreed people had to wait for care at times. One relative said, “It can feel like some days there’s not much staff. I don’t know. Sometimes it feels for [name] they [staff] don’t always come quickly [when they use their call bell].” People and their relatives said they liked the staff; staff were caring and respectful towards people. One person said, “Staff are wonderful. Brilliant people.” A relative said, “From what I’ve seen it’s very good, very caring, staff are brilliant.”

Staff thought there were enough staff to meet people’s needs. However, agency staff continued to be used, especially nurses during the day, which could affect the quality of care people received. One staff member said there was a good mix of male and female staff so people could express a choice about who helped them with personal care.

Staff were present throughout our visits, providing people with the care and support they needed. Staff knew people well and met each person’s care needs. There was a calm atmosphere and staff did not appear rushed.

The service recently focused on checking existing staff files to ensure each one contained all required information, including recruitment documents. Gaps had been identified and these were being urgently followed up. We saw 3 new staff files which evidenced a thorough recruitment process. The service used a staffing dependency tool, however there was little evidence this was continuously reviewed and adapted to respond to people’s changing needs There was no evidence that the call bell audit which showed long delays in responding to a high number of calls was factored into this. The service has a system in place to record staff training, however this did not evidence how the provider was assured that all staff had the mandatory and person specific training required. The service improvement plan identified that staff were out of date with high-risk training. There was no clear robust plan in place on how this would be completed and how the risk was mitigated in the interim. The training matrix showed a low number of staff had been enrolled onto the Care Certificate and did not evidence any other role specific qualifications. There was sparse evidence of staff supervisions and appraisals. Since the new manager was in place, we noted an increase in staff support, however the manager was unable to evidence if the staff who had supervisory responsibility had the necessary skills and experience., We were unable to see evidence of how any learning and development had been identified, planned and how staff were supported to achieve this. There was some evidence of this through supervisions, however this was inconsistent. The service had not consistently ensured that staff were suitably qualified, competent, skilled, experience and were provided with supervision and appraisal. This was a breach of regulation 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service discussed with us the plans they have to address these concerns.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us staff supported them with their medicines. People said they had the right medicines but did not always receive them at the right time. People also told us that occasionally medicines were not available to be administered. One person said, “I do take tablets. Now, that is really hit and miss; that needs to be much better organised. They [staff] don't really seem to know what they are doing as you get them at all different times.” Another person told us, “My medication is really important. They have missed it a couple of times but it's so important to have it at the right time. They need to get better at that.”

Staff were able to demonstrate how they identified and recorded creams administered as part of personal care, checking where and when to apply them. The deputy manager described the root causes they had identified for missed doses and the changes being introduced to reduce them. Staff were able to describe how they would administer variable dose and when required medicines to residents in more detail than was described in the care plans, variable dose and when required protocols. Therefore, we were not assured that medicines related care plans, variable dose and when required protocols contained sufficient personalised information and detail.

Medicines including controlled drugs (CD) and those requiring refrigeration were stored securely. However, the security of controlled drugs awaiting destruction and controlled drugs records could be improved. The CD safe had not been fitted in line with the legislation. Records provided assurance than medicines requiring refrigeration were kept within their recommended temperature range. However, medicines refrigerated when stored, and administered at room temperature lacked details of when they were removed from the fridge or a revised expiry date. The service did not always ensure that medicines and treatments were safe and met people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen. The concerns demonstrate a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.