This focused inspection of Elm Grove Care Home commenced on 23 August 2017 and was unannounced.

This inspection was prompted by the provider’s notification to CQC of a significant event. The information shared with CQC about the incident indicated potential concerns about safe care and treatment of people. This inspection examined those risks and reported on the findings in the safe and well led domains. This incident is subject to a separate investigation by the provider and as a result this inspection did not examine the circumstances of the incident

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Elm Grove Care Home’ on our website at ‘www.cqc.org.uk’. The last inspection report was carried out 24 and 25 August 2016. At that inspection the service was rated overall as “good” and was meeting all of the relevant regulations. Our findings at this inspection have not changed the current rating of ‘requires improvement’ for the key question Safe and the rating of ‘good’ for the key question Well-led. We have not changed the overall rating of ‘good’ for this service because we did not review all of the key questions. We will review all of the key questions at our next comprehensive inspection.

Elm Grove Care Home provides residential and nursing care to up to 60 older people. Adjacent to the main house, in the same grounds, there is a specialist unit for people who live with dementia, called The Chesnutt Unit. This unit is separately staffed but managed by the same registered manager. 48 people were using the service at the time of our inspection. Some of the people living at the home were living with dementia or other long term health conditions.

The home has a registered manager. 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 and associated Regulations about how the service is run.

People felt safe living at Elm Grove Care Home. However, people’s risks had not always been clearly assessed and risk assessments were not always clear or contained sufficient detail. As a result, there were not always sufficient instructions for staff to follow to minimise risks to people. The registered manager had identified prior to our inspection that improvements were needed to ensure people’s care records contained all the information staff would need to know how to keep people safe . They had started reviewing all of the care plans and risk assessments and we will review whether the planned improvements have been completed at our next comprehensive inspection.

Management systems were in place to ensure people were kept safe from preventable harm. The registered manager and senior staff ensured action was taken where shortfalls had been identified. The service learnt lessons from incidents within the service to prevent future harm.

This unannounced inspection took place on 24 and 25 August 2016.

Elm Grove Nursing Home provides residential and nursing care for up to 60 older people. Adjacent to the main house, in the same grounds, there is a specialist unit for people living with dementia, the Chesnut Unit, which is separately staffed. There are extensive grounds and a secure garden people can access from the Chesnut unit.

There was a registered manager. 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.

There were two breaches of legal requirements at the last inspection in May 2015. At our comprehensive inspection on 24 and 25 August 2016 the provider had followed their action plan which they told us would be completed on 2 September 2015 with regard to the insufficient number of staff and peoples dietary requirements and preferences and these Regulations had been met.

People had their medicines administered by the staff and generally they were safely managed but we recommended improvements could be made. People told us they felt safe in the home. Staff knew how to keep people safe and were trained to report any concerns. People were supported by staff that were well trained and had access to training to develop their knowledge.

People were treated with kindness and compassion and they told us staff were very good when they supported them with their care. Relatives felt welcomed in the home and told us the staff were kind but sometimes people had to wait for assistance.

People were provided with personalised care and were supported to make their own choices and decisions where possible. Staff knew what people valued and how they liked to be supported. Peoples care was regularly reviewed. External healthcare professionals supported people when required and people living with dementia were well supported by the visiting mental healthcare team and their GP.

People told us the food was good and there was a choice of meals. When people required assistance with their food staff supported them and gave them time to enjoy their meal. People had a range of activities to choose from which included quiz games, exercise classes, arts and crafts, musical afternoons and ball games. There were good links with the local community and trips out were organised.

The area director and the registered manager monitored the quality of the service with regular checks and when necessary action was taken. People and their relative’s views were taken seriously. They contributed in meetings and regular reviews of the service and improvements were made. Staff felt well supported by the registered manager and the deputy manager who were available to speak to people, their relatives and staff. Staff meetings were held and staff were able to contribute to the running of the home.

We previously visited this home in October 2012 and again in April 2013. We had on-going concerns about standards of cleanliness in the home. In particular there were a number of utility areas and communal bathrooms which were in poor repair and required refurbishment in order that they could be kept clean.

We were assured by the provider that significant investment would be made into the fabric of the building and a programme of refurbishment works would commence immediately to address our concerns. We returned to the home to check whether improvements had been made.

We found that a number of improvements had been made. Bathrooms and sluice areas had been upgraded and there were appropriate finishes which could be wiped clean; however refurbishment of the laundry was still outstanding. We found that the home was cleaned to an acceptable standard and was largely free from offensive odours. This included equipment, such as wheelchairs, commodes and lifting equipment. However, records were incomplete and did not evidence that cleaning standards were consistently monitored.

We previously visited this home in October 2012. At that time we had concerns about cleanliness and practices in relation to infection control. The provider took prompt action to remedy our concerns. We returned to check whether these measures had been effective. We were shown around the home by the senior housekeeper and the infection control champion. We spoke with the registered manager and the deputy manager and we looked at records, including audits.

We saw that some new systems had been put in place to monitor cleanliness in the home. Cleaning schedules had been reviewed and cleanliness was monitored on a daily basis by the senior housekeeper. An infection control champion continued to promote infection control and conducted regular audits. A newly appointed deputy manager was taking over the role of infection control lead and had started to put in place further new systems.

We saw that some improvements had been made to the physical environment of the home, including the refurbishment of one sluice area and the replacement of flooring, equipment and furniture in some rooms. Although most areas of the home were visibly clean, and there were no unpleasant odours, the home was generally in poor repair and decorative order, which made it difficult to keep clean. In particular sluice/utility rooms, laundry rooms and communal bathrooms still required attention.

Prior to our visit we had received concerning information from a relative. They told us that sometimes there were not enough staff to supervise people and provide support and stimulation. They told us that there were “a stream of maintenance issues which went on for a long time" and they were critical of the management of the home. They had complained to the home but didn’t think that their complaint had been taken seriously.

On the day of our visit we spoke with three people who lived at the home and three relatives. People told us they enjoyed living at the home and they were well cared for. One relative told us that when their family member had returned from a stay in hospital, their face lit up when they saw the staff. They spoke of the compassion and support shown to them by staff.

We observed staff interacting positively with people and treating them with respect. People appeared clean, well groomed and appropriately dressed.

The home acknowledged that there had been some concerns about the staffing levels on Willow Unit. We were satisfied that they continued to monitor this and had restricted admissions to this unit in the light of concerns.

There were effective systems in place to monitor quality, although it was evident that the recent absence of the registered manager and the departure of the deputy manager had resulted in some managerial duties not being completed in a timely manner.

This unannounced inspection took place on 7, 11 and 12 May 2015.

Elm Grove Nursing Home provides residential and nursing care for up to 60 older people. Adjacent to the main house, in the same grounds, there is a specialist unit for people living with dementia, the Chesnut Unit, which is separately staffed.

There was a registered manager in post at the service. 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.

Sometimes there was insufficient staff and people waited too long for assistance. Staff told us there were times when they had to manage with less staff and people didn’t go out much but those who were able used the garden. Three relatives told us the dementia unit was short staffed. There was a shortage of activity staff when we visited, which the registered manager was aware of. This has required improvement.

People’s dietary requirements and food preferences were not fully met for their well-being. People in the dementia care unit had a limited choice of nutritious snack food when they refused main meals. Catering staff were unaware of people’s dietary requirements and preferences and improvements were required. Most people told us they enjoyed their meals and relatives sometimes dined with them. One relative said “The food is super”.

Regular checks were made to ensure the service was safe and well maintained. The quality of care was monitored by the provider and staff evaluated care plans monthly. People were involved with planning their care and made decisions in their daily life. Where people were assessed as not being able to make decisions best interest meetings were held with those that knew them well and healthcare professionals. People’s medicines were managed safely and regular checks were made to monitor staff practice.

People were supported by well trained staff who knew people well. Staff had the skills and knowledge to safeguard people and maintain their health and wellbeing. People were treated with dignity and respect. A member of staff described respect and dignity as, “How I would like to be cared for”. Staff spoke about people with compassion during daily meetings between senior staff which highlighted where people required additional professional support. Any concerns raised were addressed. Weekly clinical meetings looked at people’s individual conditions, the treatment and their progress.

A range of activities people enjoyed were provided and included music, quizzes, craft making and trips out to local cafés and garden centres. Relatives and people in the community were invited to planned events during the year.

Concerns were listened to at residents/relative meetings, where all aspects of the service were discussed. Complaints were taken seriously and acted upon. The registered manager welcomed comments at any time from people, their supporters and staff. A relative said the staff were, “Absolutely marvellous and can’t do enough for people”.

People and their relatives were asked views about the care and how the home was run. They completed an annual survey about the service and their judgements and comments lead to improvements. A monthly newsletter informed people about changes and planned events. Regular audit of systems and review of procedures were completed. There was continuous quality monitoring throughout the year. Staff meetings provided information and training to staff to ensure improvements were completed. The vision and values of the service were to be the best provider of care, where staff were happy to work. This was discussed at staff meetings.

We found two 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 the report.