Archived: Elmwood House

Updated 12 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 2 inspectors, a pharmacist specialist and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Elmwood House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Elmwood House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We communicated with 5 people who used the service and 9 relatives about their experience of the care provided. Some people who used the service were unable to talk with us but used different ways of communicating including using sounds and body language. We spent time observing staff interactions with people.

We spoke with 14 care staff including the registered manager, deputy manager, clinical lead, nursing staff, care staff, domestic staff, kitchen staff and agency staff. We reviewed a range of records. This included 11 people's care records and 23 medicines records. We looked at 2 staff recruitment files. A variety of records relating to the management of the service, including some of the provider's operational policies were also reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 12 August 2023

About the service

Elmwood House is a nursing home providing personal and nursing care to up to 32 people. The service supports adults with learning disabilities, including autistic spectrum disorder, associated mental health and physical disability needs. The home is split into four living areas across three floors, with communal lounges and dining spaces. At the time of our inspection, 23 people were living at the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people, respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People’s care records did not always provide up to date information on risk for staff to support them safely. People did not always have access to specialist health and social care support as staff were not always guided on when this was needed. Medicines were not managed appropriately which meant people were put at an unnecessary risk of harm.

Incidents and accidents were not always effectively recorded or monitored. This meant action to prevent further risk of incidents or accidents was not always identified. Governance arrangements were not always effective to fully ensure the quality and safety of people's care.

Best practice guidance in relation to restraint was not always followed. The service did not always record when staff restrained people and there was no monitoring of restraint within the service in order to learn from the use of restraint and consider how it could be reduced.

People were not always supported within a well-maintained and clean environment.

Right Care:

People's care records did not always promote their care being delivered in a dignified way. There were improvements needed to the language used by staff to ensure people were always treated with respect and dignity.

The service had enough staff to meet people’s needs.

Right Culture:

People were at risk of harm because of a lack of protection to prevent unnecessary restraint.

Staff did not have enough guidance to support people to manage their distress, anxiety, feelings and emotional reactions in a personalised way.

The management team were developing systems to improve the culture within the service, particularly to ensure documentation was completed to support people to achieve good outcomes.

The service enabled people and those important to them to be involved in their care planning. There were opportunities for people, relatives and staff to feedback on the running of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 June 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about safety, infection control and management of the service. As a result, we planned a focused inspection to review the key questions of safe and well-led only. During our site visit we observed concerns which related to the key question of caring, therefore a decision was made to open up the key question of caring within this focused inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, caring and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elmwood House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safety, safeguarding, recruitment, dignity and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.