Elliott Residential Care Home

Elliott Residential Care Home is residential care home providing personal care for up to 17 people. The service is able to meet a range of needs including learning disabilities or autistic spectrum disorder, mental health and dementia. At the time of our inspection there were 17 people using the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Right Support: Risks to people had been identified and addressed, though care records required further development to ensure all information was included in people's care plans. Care plans were under review at the time of our inspection. Environmental audits and checks were not always effective in identifying improvements. The registered manager addressed this following our inspection visit. Improvements had been made so people were supported to take their medicines safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: Staff were safely recruited and were knowledgeable about people's needs and wishes. Staff promoted equality and diversity in their support for people. They understood people's cultural needs and provided culturally appropriate care. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture: People were empowered to achieve their personal aspirations and positive outcomes from their care with staff support and guidance. Staff knew and understood people well and were responsive, supporting their wishes to live a quality life of their choosing. Staff respected people's rights, including the right to make unwise, informed choices and positive risk taking. People and, where appropriate, their relatives, were at the centre of their care and their voice was used to guide and inform how care and support should be provided.

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 2 March 2023) and there were breaches of regulation. We issued a warning notice. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 16 November 2022. Breaches of legal requirements were found and we issued a warning notice. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. 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 good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Elliott Residential Care Home is residential care home providing personal care to 17 people at the time of the inspection. The service can support up to 17 people, so the service was full when we inspected.

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.

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

Right Support: People were not always supported safely with their medicines. Risks to people had not always been identified and addressed. Environmental risks had not always been resolved to limit unnecessary risk to people. Oversight of the service was lacking, for example audits were not always in place where needed.

People were not supported to have maximum choice and control of their lives as staff did not always support them in the least restrictive way possible and in their best interests.

Right Care: The service needed more staff skilled to meet people’s medicines needs available at night. Staff had not always been recruited safely. Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture: People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff respected people’s rights. This included making reasonable adjustments for example for an autistic person to manage their sensory sensitivities.

Staff supported people to achieve their aspirations and goals, for example 1 person was supported to meet other family members abroad. People had a choice about their living environment and were able to personalise their rooms.

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

Rating at last inspection

The last rating for this service was good (published 16 November 2018).

Why we inspected

We received concerns in relation to staffing and communication of staff. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe 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 Elliott Residential Care Home on our website at www.cqc.org.uk.

Enforcement

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 safe care and treatment and governance and oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

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. The appeals period has now ended for this, and we have sent the provider 2 warning notices. These give a specified time period to make expected improvements.

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.

At the time of our inspection, there were 17 people using the service

We found the following examples of good practice.

The provider had robust visiting procedures to mitigate the risk of COVID-19. All visitors were required to have had a COVID-19 negative test, their temperature taken and wore personal protective equipment (PPE) and used hand sanitiser before entering the service. Professional visitors were required to show their COVID-19 passport to confirm they had received their COVID-19 vaccinations.

Staff and people using the service were participating in the COVID-19 testing and vaccination programme. Staff had received training in infection prevention and control. including hand hygiene and how to use and dispose of PPE safely, following best practice guidance. The registered manager kept staff aware of current government guidance and sought support and advice from external organisations when required.

The layout of the building caused some challenges with social distancing, but all reasonable action had ben taken to manage this safely. People were being supported to isolate in their bedrooms due to a current COVID-19 outbreak, and staff provided support and reassurance and monitoring of people's mental health and well-being.

Agency staff were used to cover staff shortfalls. We observed staff wearing the correct PPE throughout our inspection and sufficient staff were deployed to meet people's needs and safety.

Best practice guidance in hygiene and cleanliness procedures were followed, this included the frequent use of cleaning of high touch areas such as door handles, handrails and switches.

Elliott Residential Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is provided in a three-storey adapted Victorian villa. The service is registered to provide care and accommodation for up to 17 people. At the time of our inspection, there were 15 people using the service. Many of the people using the service were living with mental health needs and some people were living with dementia.

At the last inspection in November 2017, the service was rated as Requires Improvement. At this inspection, we found the evidence supported an improvement in the rating of the service to Good.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place and provided detailed information and guidance for staff about the potential risks people faced. Staff supported positive risk taking which enabled people to manage risks whist also promoting their independence. The service learnt from incidents and accidents and took action to minimise the chance of these occurring again.

People were supported by sufficient numbers of staff to meet their needs. Staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

People were supported to take their medicines as prescribed. Infection control procedures were in place and followed by staff to protect people from the risk of infection.

Staff were supported and supervised and completed induction and development training. This helped to ensure they had the skills, knowledge and expertise they needed to perform their roles. Specialist training was provided to ensure people's needs were met.

People's needs were assessed and people were supported to maintain good nutrition and access healthcare to maintain their health and wellbeing.

People's consent was gained before any care was provided. People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way possible. Staff had received training and information which enabled them to provide care in line with the guidance of the Mental Capacity Act 2005.

The provider had begun work to improve the premises, which included replacement of furniture and fittings and redecoration. Some work had been completed at the time of our inspection visit and further work was planned to complete the upgrade of the service.

People received care from staff that knew them well and consistently treated people with dignity and respect. People were supported to maintain their independence and staff protected people's right to privacy.

People were involved in developing their plans of care which enabled them to receive care and support in line with their preferences. People and relatives were involved in reviews of people's care to ensure the care provided met people's current needs.

A process was in place which supported people to raise concerns and complaints. People felt confident their concerns would be listened to and acted on.

People, relatives and staff had confidence in the leadership and governance of the service. The provider had effective systems in place to monitor the quality of the service to ensure people received good care. Actions were taken and improvements were made where required.

Elliot Residential Care Home provides accommodation and personal care for up to 17 people and is based near the centre of Leicester. The service specialises in supporting people who are living with mental health needs. Accommodation is provided over three floors, accessible only by stairs. At the time of our inspection there were 13 people using the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

Records showed people were involved in the development of their care and supported to make day-to-day decisions and choices. The provider had not undertaken assessments of people's mental capacity to make specific decisions about their care, support and treatment. Records did not reflect the possibility that people may lack mental capacity at times to make decisions in their best interests due to their health needs. This meant that people may not receive the support they need to make their own decisions and choices in line with relevant legislation and guidance.

People told us they felt safe in the service and relatives felt their family members were safe. Staff were trained in safeguarding and knew what to do if they had concerns about the well-being of people.

Potential risks people were exposed to and assessed and reviewed. Risk assessments lacked the detail and guidance needed regarding measures staff should take to reduce the risk of harm.

Care plans identified where people and others were at risk through behaviours that may challenge. However records did not include clear guidance on the nature of behaviours and interventions required by staff to keep people safe.

The provider had effective recruitment processes in place which helped ensure only suitable staff were employed in the service. There were sufficient staff to meet people's needs. People received their medicines safely and as prescribed.

Systems were in place to ensure the risk of infection was prevented and controlled. The registered manager reviewed incidents to improve safety within the service.

People's needs and choices were assessed and their care provided in line with their wishes and preferences.

Staff had most of the skills and knowledge to meet people's needs. Staff had undertaken training to enable them to provide effective care and support. We have made a recommendation that staff receive specific training in managing people’s complex mental health needs as a matter of priority.

Staff felt supported in their roles through supervision and were encouraged to develop within their roles through additional training and opportunities.

People were supported to have sufficient to eat and drink and maintain their health and well-being. Staff supported people to use and access a wide variety of services and health professionals to ensure they received healthcare to meet their needs.

The provider was in the process of upgrading the premises to meet people's needs. This included replacement of furnishings and redecoration.

People had developed positive relationships with staff, who were caring and treated people with respect. Staff understood and promoted people's right to privacy and dignity. Staff were knowledgeable about people's needs and effective communication ensured people were supported to make decisions about how their care was provided. Staff encouraged people to be as independent as possible.

Staff were knowledgeable about the people they supported and knew their likes, dislikes, preferences and interests. Care plans were not consistently person centred as they did not always include details of people's life history, significant events, routines or how they liked their care to be provided.

People were supported to pursue hobbies and interests and were able to choose how they spent their time and where.

People knew how to raise concerns and complaints and were confident these would be listened to and acted upon. The registered manager took complaints seriously and used these to bring about improvements in the service.

The registered manager promoted an open culture which provided people and staff with opportunities to share their views about the service. The provider had introduced a new quality assurance system based on audits and checks and was in the process of evaluating the outcomes of these at the time of our inspection. The provider had identified where some developments were needed to the service. Further improvements were required in record-keeping and time-scales for developments within the service.

At this inspection we found that Elliot Residential Care Home required improvement in four areas. They were in breach of one regulation relating to supporting people to make specific decisions about their care and support through mental capacity assessments.

You can see what action we told the provider to take at the back of the full version of the report.