Archived: Eltandia Hall Care Centre

Updated 29 April 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 29 March 2017 and 6 April 2017 and was unannounced. It was carried out by one inspector and a pharmacist inspector. This inspection was completed to check that improvements to meet legal requirements planned by the registered provider after our comprehensive inspection on 16 December 2016 had been made. We inspected the service against two of the five questions we ask about services: Is the service safe? Is the service well-led? This is because the service was not meeting legal requirements in relation to those key questions at that inspection.

Before our inspection, we reviewed the information we held about the service such as statutory notifications relating to allegations of abuse.

During our inspection we spoke with four people, the registered manager, the operations manager, two clinical leads, two nurses and a maintenance operative. We looked at records, which included four people's care plans and risk assessments, medicines records and records relating to the management of the service.

After our inspection we contacted the local authority commissioning team for their feedback on the service.

Updated 29 April 2017

This inspection took place on 29 March 2017 and 6 April 2017 and was unannounced. At our comprehensive inspection in December 2015 we found breaches of regulations in relation to safe care and treatment, staff support and good governance. We carried out a focused inspection in April 2016 to check whether these breaches had been met. We judged that the service had made improvements and was meeting these breaches of regulations. However, at our last comprehensive inspection in December 2016 we found breaches of the same regulations as at our December 2015 inspection with further breaches of regulations relating to receiving and acting on complaints and the need for consent. We issued warning notices to the provider in relation to the breaches of safe care and treatment and good governance and requirement notices for the other breaches. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches by 13 February 2017.

We undertook this focused inspection to check the provider had followed their action plan and to confirm that they now met the requirements of the warning notices. We will check the provider’s improvements in relation to the other breaches of regulations at a future inspection. We found the provider had improved their medicines administration processes overall. However, we identified one medicines error which resulted in a person not being administered a medicine as prescribed. It was a similar error to one we had identified at our previous inspection and meant the person was not being treated appropriately for their health condition.. This meant the provider was still breaching the regulation relating to safe care and treatment, although they had made many of the improvements we had asked them to make in the warning notice. You can see what action we had asked the provider to take at the back of this report.

Eltandia Hall Care Centre provides care and support for up to 83 people and at the time of our visit 73 people were using the service. It has two units on the first floor for people who need personal care and two units offering nursing care on the ground floor. Three of the units provide care for older people and one unit provides nursing care for younger adults with physical disabilities. The service has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

Medicines management was not always safe. Our checks indicated people did not always receive their medicines as prescribed. When we raised our concerns with the provider they carried out a thorough investigation and initiated proceedings to prevent this from occurring again. Other medicines practices had improved. Medicines were stored securely and medicines stocks were well managed. ‘As required’ (PRN) medicines and ‘homely remedies’ (medicines which can be purchased over the counter) were administered safely following clear protocols. Staff who administered medicines received suitable training and assessment of their competency to ensure they were suitable to manage medicines in the service.

The registered manager had reduced the risks to people which can arise from the use of bed rails. Risk assessments of the use of bed rails had been carried out with risk management plans in place for staff to follow as part of keeping people safe. Where risk assessments identified people were at risk of entrapment or from falling out of bed due to inappropriate use of bed rails the registered manager had taken action to reduce these risks.

The provider had reviewed systems to assess, monitor and improve the service, including introducing a new system of medicines audits. However this new system had not identified the medicines error we identified. Systems to monitor staff supervision, complaints and issues relating to consent had been improved. Records relating to people’s care plans and monthly evaluations of people’s support needs were more comprehensive and consistent. In addition staff were using and recording findings from a tool to screen people’s risk of malnutrition correctly.

Records relating to accidents and injuries and water temperatures across the home had also improved and were now well maintained. We found that records relating to wound management were lacking on the day of the inspection. However the registered manager addressed this immediately and evidenced they had implemented frequent recording of wound evaluations in order to track and monitor progression of people's wounds.