Archived: Elmwood Nursing Home

Updated 27 January 2023

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 announced inspection took place on 12, 15 and 18 September 2017. The first day was unannounced. The inspection was undertaken by one inspector, one specialist nursing advisor and one 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.

Before the inspection we reviewed information we held about the service. This included reports from previous inspections and statutory notifications submitted by the provider. Statutory notifications contain information providers are required to send to us about significant events that take place within services. We also reviewed the provider’s action plan and we used this information in the planning of the inspection.

During the inspection we spoke with 14 people, eight relatives, the registered manager, deputy manager and administrator. We also spoke with 10 staff, the activities coordinator and the chef. We reviewed 10 people’s care records, risk assessments and medicines administration records. We looked at documents relating to staff and management. We reviewed 10 staff files which included pre-employment checks, training records and supervision notes. We read the provider’s quality assurance information and audits. We looked at complaints and compliments from people and their relatives.

Following the inspection we contacted 12 health and social care professionals to gather their views about the service people were receiving.

Updated 27 January 2023

This inspection took place on 12, 15 and 18 September 2017. The first day was unannounced.

At our last inspection on 2 August 2016 we found three regulatory breaches which related to staffing, the need for consent and quality assurance. Accordingly, the service was rated ‘Requires improvement’. Following that inspection the provider wrote to us with their action plan which set out what they would do to meet these regulatory requirements.

Elmwood Nursing Home is a purpose built residential home that provides nursing care and support for up to 60 older people, most of whom were living with dementia. At this inspection 51 people were living at the service.

The service did not have a registered manager in post at the time of the inspection although the new manager had started the registration process. 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.

People’s consent was not always obtained. Care records contained Best Interests decisions which stated that people were unable to communicate or make decisions whilst their assessments and care plans stated they could communicate and make decisions. We found that where a supervising authority had stated a person had capacity to make a decision and that a deprivation of their liberty had not been approved; the service had not amended care records to reflect this. Staff received training, appraisal and supervision but records of supervision meetings did not reflect what was discussed.

People were at risk of not having their needs safely met overnight because there were insufficient staff numbers available to provide care, support and supervision. People and staff were at risk of harm because care records contained inaccurate information about people’s assessed mobility needs. Care records stated that people required one member of staff to support them to transfer whilst their assessments stated two staff were required to do so safely.

People’s medicines were administered, recorded and stored appropriately. Staff were recruited using robust procedures that ensured they were suitable to deliver care. People at risk of choking, pressure ulcers and undernourishment had detailed assessments and care plans in place to support them. People were supported with nutritional assessments and received the support they required to eat and drink safely. People enjoyed the nutritious meals they received and healthcare professionals supported people whenever they were required.

People and relatives told us that staff were caring and kind. People and staff shared positive relationships. People’s independence and dignity were promoted and their privacy and confidentiality were maintained.

Care records did not reflect person centred care. There was significant replication of information between people’s care records which included the exact same wording for people’s preferences. This included identical information about people’s stated final wishes.

A range of activities were available for people to participate in support was available to prevent people from becoming socially isolated. Communication with relatives had been improved with the introduction of relatives meetings and the role of keyworker who liaised with them on an on-going basis. People’s cultural and religious needs were identified and met and the service created opportunities for people to experience cultures other than their own. Complaints were addressed in line with the provider’s policy which included a written response within the stated timeframe. The provider actively sought the views of relatives and people through meetings and surveys and responded to the feedback it received.

People did not receive a service were the quality assurance processes were robust enough to identify and rectify failings in care records. We found information had been duplicated across a number of people’s care records which resulted in inaccurate information about people’s needs, care and support.

The new manager had made a number of improvements to the service including redecorating the building, improving communication with relatives and increasing activities. The manager worked collaboratively with other agencies to improve the service people received.

During this inspection, we identified a number of continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.