The home had been subject to monitoring visits by Warrington Borough Council following safeguarding issues reported by the home and from whistle blowing concerns reported to the Care Quality Commission. Regular meetings have been held with the provider and all agencies involved and a decision was made by Warrington Borough Council to place an embargo on the home [not allowed to admit new residents]. The council will continue to monitor the home for improvements before this restriction will be lifted. All parties involved believe that it is crucial so that improvements can be made.
Workers from Warrington Borough Council with particular input from the contract monitoring team have been supporting the home throughout this process and they are currently in the process of providing training for staff members.
Notwithstanding the above we considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well led?
Below is a summary of what we found. The summary is based on our observations, speaking with people using the service, their relatives; the staff supporting them and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
There were not appropriate procedures in place should anyone need to be subject to a Deprivation of Liberty Safeguard (DoLS) application or plan. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. The home has an interim manager who was in the process of completing Mental Capacity Act assessments for all of the people living at the home following a visit and advice from Warrington Borough Council. Staff were receiving updated training to more fully understand DoLS and how it applied to people living at the home.
During our inspection, we looked at a sample of four staff recruitment records. We found that the safety and welfare of people using this service had been compromised because the provider had not followed safe recruitment practices.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the recruitment of staff.
Is the service effective?
During our inspection we looked at care plans for people living at the home.
Care plans looked at did not fully identify choice and consent for people living at Three Elms. Some people living at the home were unable to make choices about their care and treatment. We were told that staff always gained consent, but no consent forms were available in the documentation to confirm this.
We found that care plans did not reflect individual care for each person living at the home and that they would benefit from further development to make them more person centred and reflect the person's full range of skills and abilities.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to keeping accurate records and appropriate information in relation to the care and treatment provided to each person living in the home.
A Whistle Blower had raised concerns that the staffing numbers at the home were inadequate.
The staffing rotas we looked at and our observations during the visit demonstrated that there were sufficient numbers of staff on duty to meet the needs of the people living at the home on the day of our inspection.
Is the service caring?
We saw that staff interacted well with the people who lived at the home. The atmosphere in the home felt relaxed and sociable. During our inspection we found that the people living at Three Elms looked well cared for and were dressed appropriately for the weather on the day. People were clean and tidy and their hair had been brushed or combed. A hairdresser visited the home on a regular basis.
Staff spoken with were knowledgeable about the people they cared for. We could see that they enjoyed good relationships with the people who lived at the home and that they had sufficient time to meet their needs without hurrying.
People spoken with who were able to state their preferences said 'Staff treat me well' , 'I am happy and contented, I have no problems' and 'staff are good'.
However, where people did not have the capacity to make their views known, we saw that potentially inappropriate care interventions were sometimes carried out at unsuitable times.
Is the service responsive?
We looked at a care file for a person living at the home and it was recorded in the daily record sheet by the night staff on duty that they were given a bed bath at 4 o clock in the morning on at least 7 occasions from 28 June to 7 July inclusive. This person had a diagnosis of dementia and was unable to communicate their choices.
This was discussed with both area managers who were present at the home at the time of our visit. They said that this had been raised with staff on night duty and felt that this practice had stopped. This practice had also been reported by social service monitoring officers following their visit to the home in May. There was lack of evidence regarding any appropriate actions taken to address this practice and it was recorded in care plans that this was continuing up to the time of our visit.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to identifying and addressing poor care practices.
It was unclear from some records how current the information for staff was because they were undated and unsigned. Changes in people's abilities had not always been fully documented or assessed which meant there was a risk that the care provided would not fully meet people's needs.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to keeping accurate records and appropriate information in relation to the care and treatment provided to each person living in the home.
Is the service well led?
We looked at quality audits that had been completed at the home.
Audits had been completed but there were no action plans to address issues of concerns that had been raised. For example an audit had been completed in May regarding medication by a manager from another home. The score on the audit form was 58% however there was no action plan in place to address concerns raised so that the home could act upon this.
We attended a meeting chaired by Warrington Borough Council's safeguarding team and it came to our attention that not all reports of alleged abuse had been reported to the Care Quality Commission (CQC).
When we visited the home we asked the area managers and interim manager if they had copies of the notifications sent to CQC. They were unable to produce any.
Staff spoken with had mixed views of the home. Some were positive with regard to changes that needed to be made to improve the standards at the home. Comments such as 'I am trying to work together with the management and they have my full support' ' the care plans need to be better and need to be written by the staff on the floor as we know the people best ' and 'staff need to accept change. '
Some staff were negative about the management and leadership of the service and felt the management were not listening to them and things should not be changed.