Archived: Elston House

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Prior to our inspection we reviewed all the information we had received from the provider. We utilised a variety of different methods to help us understand the experiences of people residing at the home because they had complex needs which meant they were not able to tell us their experiences.

We spoke with the registered manager, the chef and three staff. We also looked at some of the records held in the service including the support files for two people. We observed the support people received from the staff and carried out a tour of the building and outdoor areas.

Is the service safe?

We found the service to be safe, as people were supported in an environment that was maintained to a safe, clean and hygienic standard. We also found equipment at the home had been maintained and serviced on a regular basis.

We found there were sufficient staff to support people with their assessed needs. One member of staff told us, 'We have some people who need more support than others, but there is always sufficient staff to meet their needs.'

We found that an on call system was in place to ensure a member of the management team was available at all times. This was to ensure that in the event of an emergency staff would always have access to guidance in promoting the safety of people residing at the home.

We found that staff personnel records contained all the information required by the Health and Social Care Act to ensure that staff employed to work at the home were suitable and had the skills and experience needed to support the people.

Records showed that staff had received a comprehensive induction and training package to ensure their knowledge and skills remained up to date and they could deliver a safe service. This was confirmed by one member of staff who told us, 'We have refresher training throughout the year on topics such as safeguarding adults, infection control, dealing with concerns at work, equality and diversity, food safety, moving and handling, governance awareness, medicine management and first aid.' This information was supported by records seen in staff files on the day of our inspection.

We found that people were protected against the risks associated with medicines because, the provider had appropriate policies and procedures in place to manage medicines. The staff we spoke with had an excellent knowledge of their roles and responsibilities in this area.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted recently proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

We found that procedures had been undertaken to establish if people had capacity to provide informed consent, as required by the Mental Capacity Act (2005). The Mental Capacity Act (2005) is legislation used to protect people who might not be able to make informed decisions on their own about the care they receive. This was to ensure that people's human rights were respected and people were are only deprived of their liberty when it had been assessed to be in their best interests and there were no other, less restrictive, ways of keeping people safe and well.

We found that the organisation had utilised the services of Nottinghamshire Advocacy Alliance (NAA) which is an independent Voluntary organisation. The service provided advocacy services for vulnerable people to speak out and have a say about their own interests, services and the decisions made about them.

Is the service effective?

We found effective systems were in place to ensure that care and support had been delivered in such a way as to meet the individual needs of people. We also established through our observations throughout the day of the inspection, and from speaking with staff that they had a good understanding of the people's needs and how they were to be met. Records also showed that staff had received training pertinent to meet the needs of the people living at the home.

Is the service caring?

We found the service to be caring, as through our observations throughout the day of the inspection, we saw that people were supported by patient, considerate and attentive staff. We observed staff asking people to make choices in relation to their day to day activities, which included their food preferences and what activities they wanted to take part in. All observed interactions showed that the staff were proactive in obtaining consent from people who used the service and they valued and respected their opinions.

Is the service responsive?

We found the service to be responsive. Whilst it had been several years since a person had been admitted to the home, procedures were in place to assess them before they moved in. We found that people's support plans were very well maintained and highlighted people's holistic needs and preferences. We found that people had access to a comprehensive activities programme both within the home and the broader community. People were also supported to maintain relationships with their friends and relatives.

Is the service well-led?

We found the service to be well-led as staff had a good understanding of the aims and objectives of the home and told us they received appropriate support and direction from the manager. We found that staff meetings were performed on a regular basis and staff told us they were useful and supportive. They said the management team had performed discussions with them before implementing changes and they felt valued by the management team.

We found that the manager had undertaken quality assurance processes to show that the home's aim and objectives were being achieved and people received an appropriate support package.

We found that systems such as satisfaction surveys and residents meetings were undertaken to ensure people residing at the home, or those acting on their behalf, were provided with a forum to express their views and opinions.

We asked the relatives of people who used the service if the support staff respected their relative's wishes and options. Comments included, 'Definitely, all the staff are brilliant, very dedicated.'

Relatives told us they had been involved in the formation of people's support plans and received verbal and written updates when required. One relative told us, 'I feel fully involved in my daughters care. It's really very good. The activities are brilliant. My daughter has a wonderful lifestyle and goes to pubs, the cinema, and trips to London. The staff are really imaginative when it comes to the activities provided."

Relatives of people who used the service also felt the support staff were suitably qualified to promote people's health and wellbeing. They told us,' The staff are terrific and they manage very well.'