Archived: OSJCT The Elms

The Elms is a 'care home' registered to provide accommodation and personal care for up to 45 older people, including those living with dementia. At the time of our visit, 41 people were using the service.

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

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were safe. Risks to people were assessed, monitored and well managed. A person told us, I'm confident [name of person] is safe here."

Staffing levels met people's personalised care needs. The provider had robust systems in place to prevent the spread of infection and to ensure people received their medicines safely and as prescribed. The home was clean, tidy and free from unpleasant odours.

Staff recognised people as individuals and worked to ensure people felt fulfilled and had access to a range of activities and social stimulation that met their individual needs and preferences.

People's care plans contained detailed, personalised information that the management team kept under constant review. The manager and provider carried out regular checks on the quality and safety of the service and understood their regulatory responsibilities.

People were supported to access health and social care professionals. Dietary needs were assessed, and guidance provided in care plans. People received enough food to eat and drink. People told us they thought the food was of good quality.

People received quality care that contributed to their wellbeing. Caring relationships were formed between staff and people due to the approach and continuity of staff. People were treated with dignity and respect. One person told us, "I can honestly say that the staff are the nicest people I have ever been with."

People and their relatives gave positive feedback about the service and its managers. Staff were also positive, stating the manager was open and supportive. A member of staff told us, “This is a lovely place to work, the residents are amazing and the staff I work with are amazing.”

People's communication needs were identified and planned for. The service had a clear process for managing complaints. People and their relatives expressed confidence they could raise any issues or concerns and that these would be addressed.

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 (03 March 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘OSJCT The Elms’ on our website at ‘www.cqc.org.uk’. The last inspection report was carried out 14 and 15 June 2017. At this inspection the service was rated as “good” and was meeting all of the relevant regulations.

OSJCT The Elms provides residential and nursing care for up to 45 older people. At the time of our inspection 38 people were using the service. Some of the people living at the home were living with dementia or other long term health conditions. Some people were staying at The Elms for a short period of time before returning to their own homes.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager was on leave at the time of this inspection. An Area Operations Manager employed by the provider was managing the home on a day to day basis.

The service was safe. Where people were at risk of choking this had clearly been assessed and comprehensive guidance was available to care and nursing staff. Nursing and care staff understood people’s risks and knew how to ensure people were protected from these risks. Nursing, care and catering staff felt they had the skills and resources they needed to protect people from the risk of choking.

All staff, including agency care staff received a handover at the start of their shift. This ensured staff had current information on people’s needs and risks. Agency staff who were unfamiliar with people living at The Elms were supervised and only assisted a small number of people to ensure they understood people’s needs and risks and promote familiarity between people and agency staff.

Management systems were in place to ensure people were kept safe from preventable harm. The provider, registered manager and senior staff took action where shortfalls had been identified. The provider had learnt lessons from the incident to prevent future harm. These lessons were being shared with other homes operated by the provider.

We have a recommendation to the provider as part of our inspection, to further build on their good practice in relation to the actions they have taken to protect people from the risk of choking.

At the last inspection on 17 and 18 February 2015 the service was rated Good. At this inspection we found the service remained Good.

There was one breach of legal requirements at the last inspection in February 2015. Following this inspection the provider sent us an action plan detailing how they would address the shortfall that had been identified. At our comprehensive inspection on 14 and15 June 2017 the provider had followed their action plan with regard to safeguarding people at risk of abuse.

People were protected against the risks of potential abuse. People told us they felt safe in the home and staff knew about safeguarding people and reported any concerns. There were sufficient staff and recent additional permanent staff had ensured staffing levels had improved. Recruitment was thorough and remained ongoing to help ensure less agency staff were used. We found peoples medicines were managed safely and reviewed. Individual risks for people were minimised and risk assessments of the environment were completed to help ensure people lived in a safe home.

People were able to make their own choices and decisions about their care. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s needs were met by staff who had access to the training they needed and had regular updates to their training. Staff were supported in their role and had regular individual meetings where they could discuss improvements to the service and their progress with senior staff. People had a choice of meals and their nutritional needs were met. People told us they liked the meals provided.

People had positive interactions with staff who respected their privacy and dignity. We observed staff were kind and compassionate to people and encouraged them to be independent. People’s wishes for the end of their life were recorded and reviewed with them.

People received personalised care responsive to their needs. People were assessed before they moved into the home and their care plans identified the care and support they needed which was regularly reviewed. People were supported by health and social care professionals who visited when required. There was a programme of activities provided every day by three part time activity organisers. There was a clear complaints procedure and people could use the suggestion box in the home.

The registered provider had quality assurance procedures to check the service was safe and people were supported to lead the life they wanted without restrictions. People and their supporters had opportunities to comment on the service and they were listened to. Staff felt well supported by the registered manager and were able to comment to help improve the service.

Further information is in the detailed findings below.

We returned to the home to check if improvements had been made. We spoke with staff and with the manager. We spoke with five people who lived at The Elms and two relatives. We observed how people were cared for and looked at their records.

People told us they were well cared for and were full of praise for the staff. One person said "I couldn't wish for better care. All of the staff are really lovely souls". The home had appointed a new activities coordinator and a range of activities was provided; however some people complained of being bored.

An active residents' forum ensured that people's views were listened to and acted upon. A new manager had introduced systems to ensure that the home ran more smoothly. Staff felt well supported and told us that team working and morale had improved. Record keeping had improved.

We spoke with people who lived at The Elms and one relative. We observed how people were care for and we looked at their records. People were mostly positive about their experiences but one person felt undermined because they had not been fully involved in decisions about their care. We found little documentary evidence that people were consulted and involved in developing and reviewing their care plans, although we observed staff allowing people to make choices.

People's needs were assessed and care plans reviewed but we saw little meaningful evaluation to show how people's needs were met. The standard of record keeping was generally poor, and we could not be assured that people received the care that was prescribed in their care plans. This was particularly the case for the most dependent and vulnerable people.

The home was clean and tidy and we observed staff taking appropriate steps to minimise the risk and spread of infection. Staff said they received adequate training and supervision but records did not support this. Some staff felt unsupported by management and felt that team working was poor.

There were monitoring systems in place but these were not sufficiently effective to provide assurance of quality and safety.