6 December 2022
During an inspection looking at part of the service
Elmcroft Care Home is a residential care home providing personal and nursing care for up to 54 people. The service primarily provides support to older people and people with dementia. It is also registered to provide support to people with a physical disability, people with a learning disability and autistic people and younger adults. At the time of our inspection there were 42 people using the service.
The care home is in a rural location and has two separate units, called Blythe and GNU.
People’s experience of using this service and what we found
Feedback from people and families was negative in relation to poor management. They gave us examples where people’s individual needs were not met. They also told us some staff provided good care and recently there had been some improvements to the management of the service.
There had been significant management changes since our last inspection, and a new manager had just joined the service. Although the provider had detailed improvement plans and quality audits in place, these had not always been effective or implemented in a timely manner to ensure people received good quality care.
Morale among some staff was low. Senior staff did not always know what was happening across the service and did not communicate or organise staff effectively. Staffing were recruited safely, however improvements were needed in the oversight of agency staff. A revised timetable for staff training was helping ensure staff had the skills to support people safely and in line with their needs.
People did not consistently have a good quality of life. Staff did not always understand and meet people’s needs in a person-centred manner, including around communication and end of life care.
Concerns about people’s safety and complaints were not always managed well. The provider had focused on improving safety and practice around medicine management, risk assessment and care planning was improving. Maintenance and refurbishment works were helping minimise the risk of infection.
Staff did not consistently support people to have maximum choice and control of their lives and to support them in the least restrictive way possible and in their best interests. The policies and systems in the service were in place to support this practice but were not applied effectively.
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.
The provider did not demonstrate an understanding of Right support, right care, right culture.
Right Support:
Staff and managers did not consistently support people to have a fulfilling and meaningful everyday life.
Right Care:
People’s care, treatment and support plans were being amended to reflect their range of needs.
Right Culture:
The values, attitudes and behaviours of the management and staff did not demonstrate a consistently caring and open culture.
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 5 May 2019).
At our last inspection we recommended the service looks at good practice guidance and environments for people with dementia. At this inspection we found the provider had invested in this area however there was still room to improve the care and environment for people with dementia.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We received concerns in relation to poor governance, safety and lack of person-centred care. As a result, we undertook a focused inspection to review the key questions of safe, responsive 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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elmcroft Care Home on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to poor governance and lack of person-centred care at this inspection.
Please see the action we have told the provider to take at the end of this report.
We made a recommendation about Right support, right care, right culture.
Follow up
After the inspection we met with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan from the provider. We will work with the local authority and health professionals to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.