Archived: Eltandia Hall Care Centre

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.

Eltandia Hall Care Centre provides care and support for up to 83 people and at the time of our visit 75 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. We were adequately concerned that we raised a safeguarding alert to the local authority. Our stock checks indicated people had not received their medicines as prescribed. Medicines records were poorly maintained so the provider did not know the quantities of some medicines they should have in stock. Due to the poor quality of medicines records we could not check stocks of these medicines. Medicines injections were administered late for one person and the provider did not ensure the person received the right support when this occurred.

Other risks to people were generally managed appropriately and people had suitable risk management plans in place. However, staff did not always manage risks relating to bed rails well to keep people safe from the risks of falling out bed or entrapment.

Staff did not always receive regular support and supervision. The registered manager was aware of this and told us she planned to put in place a supervision programme for 2017 for all staff.

Staff did not always use the Mental Capacity Act (2005) properly in assessing people’s capacity and in making decisions for them when they lacked capacity. This meant people’s rights may not always have been upheld in relation to this.

Records relating to complaints were poorly managed. This meant we could not track how complaints had been handled and whether this was in accordance with the provider’s policy.

People were not adequately protected against the risks associated with the management of records because the provider did not have appropriate systems in place. Quality assurance procedures were ineffective in assessing, monitoring and improving the service as they had not identified the issues we found during our inspection.

Systems were in place to safeguard people from abuse. However a small number of staff did not know the different types of abuse or how to keep people safe. The registered manager said she would support staff further in this area.

There were enough staff deployed to meet people’s needs. Recruitment was safe because the provider carried the required checks before staff worked with people to ensure they were suitable.

The provider carried out the necessary checks to maintain the home well and to ensure the premises were safe.

Staff received suitable induction and appraisal and a training programme was in place which meant staff received training to help them understand and meet people’s needs.

People were positive about the food they received and had choice over what they ate. Although people received the right support in relation to eating and drinking their care plans did not always reflect the support they required. People received access to the healthcare services they required, such as GP, dentist and psychiatrist when necessary.

The service was meeting their requirements under the Deprivation of Liberty Safeguards (DoLS). These safeguards are there to help make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The provider had assessed whether people required DoLS and made the necessary applications as part of keeping them safe.

People were treated with dignity and respect by caring staff. Staff knew the people they were supporting well and people were involved in planning their own care. Although staff reviewed peoples care plans regularly, sometimes they did not contain sufficient information about people’s needs to be reliable for staff to follow when providing care. An activities officer was in post who offered a range of activities to people through the activities programme in place.

We identified five breaches of the Health and Social Care (Regulated Activities) Regulations 2014 during our inspection. Three of these regulations were the same as those breached in 2015. We identified new breaches of regulations relating to complaints and consent. We are taking further action against the provider in relation to the breaches of regulations in relation to safe care and treatment and good governance. We shall report on this at the back of this report after any appeal or representation is complete.

Additionally, there was a risk people's needs may not always have been met as staff were not always suitably trained or supported by the provider to carry out the roles they were employed to perform.

We also found the providers’ governance arrangements to regularly assess and monitor the quality of the service had not identified these shortfalls, and therefore they were not effective in improving the quality and safety of the service people received.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches described above.

We undertook a focused inspection on the 27 April 2016 to check they had followed their action plan and to confirm they now met legal requirements. This inspection was unannounced.

This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Eltandia Hall Care Centre on our website at www.cqc.org.uk

Eltandia is a care home that provides nursing and personal care for up to 83 people. The service is divided into four separate units, Farish, Irvin, Scott and Ivy. Farish specialises in the care and support of younger people with physical disabilities, while the other three units accommodate older people with nursing and personal care needs, some of whom are living with dementia.

At the time of this inspection the service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 2008 and associated Regulations about how the service is run.

During our focused inspection we found the provider had followed their action plan. People were receiving their medicines as they had been prescribed. Staff were undertaking training and they were being supported to undertake their role and responsibilities. The provider had also ensured there were systems that were being effectively operated to monitor and assess the quality of service that people received.

Sufficient action has been taken to meet the legal requirements made at the last inspection, although we need to see consistent improvements over time before we are able to change the rating of this service from ‘requires improvement’.

Eltandia is a care home that provides nursing and personal care for up to 83 people. The service is divided into four separate units, Farish, Irvin, Scott and Ivy. Farish specialises in the care and support of younger people with physical disabilities, while the other three units accommodate older people with nursing and personal care needs. There were 56 people using the service when we visited, of whom approximately a quarter were living with dementia.

The service had undergone some organisational and management changes in the last six months and has been re-registered under Lifestyle Care Management Ltd.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

However, in the preceding two and half years, three different managers have been in day-to-day charge of the home for varying lengths of time. Constant changes to the management team and a lack of continuity have inevitably had an adverse effect on the quality of the care and support people living at the home receive. The provider told us a new permanent manager had just been appointed who would be replacing the current registered manager in February 2016.

People were not always given their prescribed medicines at times they needed them. We found a number of errors in the storage, administration and recording of medicines which may have compromised people’s safety. The service had established its own internal monitoring of medicines systems, but these auditing processes had failed to identify these errors.

There were risks that people’s needs may not always be met because staff were not always suitably trained or supported by the provider to carry out the roles they were employed to perform.

We also found the provider did not always operate effective governance systems to regularly assess, monitor, and where required, improve the quality and safety of the service people received. This meant the provider could not continually evaluate their service, and where required, drive improvement.

We identified three breaches of the Health and Social Care (Regulated Activities) Regulations 2014 during our inspection. You can see what action we told the provider to take at the back of the full version of the report.

The home employed activities coordinators who offered social activities. Relatives were able to visit whenever they wished. Thereby the risk of social isolation was reduced. However, people were not always offered the range of activities suitable to meet their needs. We have made a recommendation about the opportunities people using the service have to participate in meaningful leisure and recreational activities that reflect their social interests.

People told us they felt safe living at Eltandia. Staff we spoke with were knowledgeable about what they needed to do if they suspected anyone was at risk of abuse. The provider had recruitment processes in place to make sure only suitable people were employed by the service.

People said they felt they could raise issues with the registered manager and their concerns would be listened to.

Staff asked people’s consent before providing care. If people were not able to give consent the provider worked within the framework of the Mental Capacity Act 2005. The Act aims to protect people who may not be able to make decisions for themselves and to help ensure their rights are protected.

People and their relatives were positive about the care they received at Eltandia. They had access to healthcare professionals when they needed them. People told us staff were kind and caring. We saw there were enough staff on duty to meet people’s needs.

Care was individualised to meet people’s diverse needs. They were involved in deciding how care was to be provided.