This was a scheduled inspection in addition to checking that improvements had been made following concerns raised during our inspection of 8 November 2013. During our inspection of 8 November 2013 we identified concerns that the delivery of care did not always ensure that people's individual needs, in regard to their welfare, were met.At the time of this inspection, six people were living at Elliott House. We observed the care those people received, spoke with two people who used the service, the registered manager and three members of staff, as well as reviewing relevant documentation.
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, effective, caring, responsive and well led?
Below is a summary of what we found.
Is the service safe?
There were risk assessments in place where required for people using the service in relation to their support and care provision. People were not put at unnecessary risk, but had choice and remained in control of their own decisions where they had the capacity to make those decisions. This meant that people's independence was promoted and they were not restricted from engaging in and accessing the wider community.
Systems were in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This meant risks to people were reviewed and monitored to minimise any further risks and help the service to continually improve.
The home had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Where necessary, applications had been submitted to authorise that any restrictions were in the best interests of the person. Some applications were in the process of being assessed. This meant that appropriate safeguards were in place to protect people.
People received care in surroundings that were safe and accessible and supported their health and welfare. Some refurbishment had taken place since the last inspection including the lounge, kitchen/dining room and a bedroom.
People were not fully protected against the risks associated with medicines that were prescribed to be used 'as required', because the systems and processes in place to manage those medicines were ineffective in practice.
We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to the management of medicines.
Is the service effective?
People's health and care needs were assessed with them and they were involved in the formulation of their support plan.
People had food and drink support plans in place where needed, so that people were protected from inadequate nutrition and dehydration.
Discussions with people who used the service and staff told us that in the main, people made independent choices about their breakfast and lunch. Each person chose a meal, for the main meal of the day in agreement with other people using the service at a weekly house meeting they attended. Our observations evidenced that where the agreed meal was not wanted an alternative was offered. People were not rushed with their meal and staff tried to make the mealtime a social occasion for people, engaging them in conversation about their day. We saw that where people needed assistance, they were provided with this by staff
Is the service caring?
We saw that care workers showed patience and gave encouragement when supporting people. We heard staff engaging with people who used the service and this demonstrated positive relationships had developed. We heard staff treat people with kindness and compassion when providing their day to day care and responding in a caring way to people's needs. Our observations of when staff spoke with people were that staff had a clear knowledge of people's individual likes and preferences.
We observed that people went about their daily lives and moved around the home as they wished. We saw that people looked well presented, for example, their hair had been brushed/styled and people looked clean and were wearing clothes that were clean.
Is the service responsive?
Services were organised so that they met people's needs. People completed a range of activities in and outside the service regularly and were assisted to access the community and maintain relationships with family members.
Is the service well-led?
The leadership, management and governance of the organisation was focused on the delivery of person-centred care. The service worked well with other agencies and services to make sure people received their care in a joined up way.
The service encouraged an open and transparent culture, promoting communication with people, staff and other stakeholders.
Staff felt supported by the manager and felt they were able to raise any concerns with him.
Discussions with staff told us they were clear about their roles and responsibilities. Discussions on best practice, improved ways of working and incident reviews were common throughout formal team meetings and informal discussions.
The service had a quality assurance system in place and records seen by us showed that identified actions, in the main were addressed within reasonable timescales.
If you want to see the evidence supporting our summary please read the full report.