We carried out this unannounced inspection on the 7 and 9 April 2015. We last inspected this service in April 2014. On the first day of inspection the registered manager was on annual leave.
Elton Hall provides care and accommodation for up to 70 older people, some people living with dementia and others with mental health needs. Accommodation is provided over two floors and includes communal lounges and dining areas. Bedrooms are single occupancy and have en suite facilities which consist of a toilet and wash hand basin. At the time of our inspection occupancy was 32
The home had a registered manager in place and they have been in post as manager since May 2014. 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 we spoke with understood the principles and processes of safeguarding, as well as how to raise a safeguarding alert with the local authority. However, we saw only 15 out of 48 staff had received training in safeguarding. Staff said they would be confident to whistle blow [raise concerns about the home, staff practices or provider] if the need ever arose.
People living at the service said they felt safe within the home and with the staff who cared for them. Relatives of people who used the service also indicated that their family member was safe.
We found that medicines were stored and administered appropriately. We were told that one person received their medicines covertly, however we were unable to see a Mental Capacity Assessment [MCA] and best interests meeting records. The registered manager said this person no longer received covert medicines, this information needs to be passed onto all staff so they are aware.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). The registered manager had sought and acted on advice where they thought people’s freedom was being restricted. This helped to ensure people’s rights were protected. Not all staff we spoke with had a good understanding of the Mental Capacity Act (MCA) and how to ensure the rights of people with limited mental capacity to make decisions were respected. At the time of our visit five people were subject to a DoLS authorisation.
Three peoples care files we looked at showed staff did not understand what a best interest decision was and how to implement one. We found staff were preventing one person from leaving the building alone because of sensory impairment. We could see no evidence of consent to this and without their informed consent staff were restricting this persons access to the community.
There were gaps on the training chart for mandatory training such as food hygiene and infection control and only 15 out of 48 staff had received training in safeguarding. The registered manager said they are arranging training sessions to cover these gaps. Staff had regular supervisions and appraisals to monitor their performance and told us they felt supported by the registered manager.
Staff were observed to be caring and respected people’s privacy and dignity. People who used the service said that staff were caring and kind. However, improvements could be made to the level of interaction between staff and people who used the service while care was being provided. We observed staff hand out food without plates, therefore people had to balance the food on the arm of their chair which is not very hygienic.
The service employed an activities coordinator who was on annual leave on the first day of our inspection. We found that not all people who used the service had access to opportunities for social stimulation or activities that met their individual needs and wishes. It was a large building with people spread out that the activity coordinator struggled to occupy everyone. Staff downstairs did not interact much with people at all. Upstairs staff sat with people and we could see lots of conversations taking place.
People’s care records confirmed that an assessment of their needs had been undertaken, thereafter care plans were developed detailing the care needs/support, actions and responsibilities, to ensure personalised care is provided to all people. The care plans were found to be detailed outlining the persons ‘needs/risk’, the ‘aims/objectives’ and the ‘care and intervention.’ However it was difficult to gain a clear overview of people’s needs and the support they required. We found it a complex care file system, with lots of information [numerous care plans] and difficult to navigate which meant that people’s needs may be missed or overlooked.
Accidents and incidents were monitored each month to see if any trends were identified.
We found people were cared for by sufficient numbers of suitably qualified and experienced staff. Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. However, there were some gaps in peoples employment history, for example one person’s application stated the month they started working at a previous employment but no year was documented and nothing to say where they had worked at previously to this. We discussed this with the registered manager who was going to update the records. We saw they had obtained references from previous employers and we saw evidence that a Disclosure and Barring Service [DBS] check had been completed before they started work in the home. The Disclosure and Barring Service carry out a criminal record and barring check on individuals who intend to work with children and vulnerable adults, to help employers make safer recruiting decisions and also to minimise the risk of unsuitable people from working with children and vulnerable adults.
We saw that the service was clean and tidy and there was plenty of personal protection equipment [PPE] available. There were some issues with staff wearing nail varnish and false nails. We discussed this with the registered manager.
We observed a lunchtime meal upstairs on the dementia unit. We found the food was well presented, well cooked and plentiful. People were asked if they wanted more.
Staff were supported by their manager and were able to raise any concerns with them. Lessons were learnt from incidents that occurred at the service and improvements were made if and when required. The service had a system in place for the management of complaints. The registered manager reviewed processes and practices to ensure people received a high quality service.
We saw safety checks and certificates that were all within the last twelve months for items that had been serviced such as fire equipment and water temperature checks. Maintenance staff completed monthly health and safety audits but did not always act upon them.
We asked to see an environmental risk assessment for the staircase. The service has a large staircase that goes up and round to the first and second floors. Once on the second floor there was a sheer drop that could be considered dangerous. People on the mental health unit had free access to this staircase. No one had considered this an issue in the past. We recommended that the registered manager refers this to health and safety for advice.
We found there were two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.