About the service:

Elmcroft Care Home provides accommodation, personal care and nursing care for up to 54 people. The service is split across two units, both of which support people who may have nursing and dementia related needs. At the time of the inspection, 40 people were living at the service.

People’s experience of using this service:

The service kept people safe from harm. Staff understood their responsibilities to protect people from harm and were confident about how to raise concerns in line with the provider's safeguarding and whistleblowing policies.

Risks to people's daily lives had been assessed and measures were in place to prevent avoidable harm and ensure people's freedom was supported and respected.

The service had a process in place for recording, monitoring and analysing accidents and incidents and action had been taken to mitigate the risk of reoccurrence.

Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Staff were well-trained and worked together as an effective team. Records confirmed staff had access to regular supervision sessions and received annual appraisals.

New members of staff were introduced to the service through an induction programme to ensure that they had acquired the necessary skills to care for people.

Staff supported people to maintain a healthy diet and to access drinks and snacks throughout the day.

The overall environment was not well adapted to people living with dementia or those with sight impairments. The provider had an on-going improvement plan in progress to address this. We made a recommendation that the service looks at good practice guidance and environments for people with dementia.

People were supported to make choices and no unnecessarily restrictive practices were in place.

People received individualised care and support from staff who were kind and patient. They knew people well and understood their choices, likes and dislikes and were committed to ensuring people received good quality care.

Staff felt well supported and had confidence in the management team’s ability to promptly deal with issues raised.

Rating at last inspection: Requires improvement (published 20 January 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection. At the last inspection on, 19 October 2017, we found staff competency assessments were not sufficiently robust and staff were not consistently skilled when supporting people with dementia or complex mental health needs. The provider and registered manager had not been pro-active in addressing concerns in a timely manner and the lack of a deputy manager and clinical lead had impacted negatively on the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the quality of the service. At this inspection, we looked to see whether the provider had implemented the action plan. We found the required improvements had been made to improve the rating of the service to good.

Follow up: The service will continue to be monitored through the information we receive.

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

The Inspection took place on 19 and 23 October 2017.

Elmcroft Care Home provides accommodation, personal care and nursing care for up to 54 people. Some people have dementia related needs and require nursing care. The service consists of two units: the General Nursing Unit (GNU) and Blythe unit. At the time of our inspection there were 42 people living at the service.

A registered manager was 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.

When we last visited the service in April 2017, we had found the care being provided was not consistently good. Whilst people in the GNU received good quality care, in the Blythe unit, care was not person-centred and people were not supported to engage in meaningful activities. We were also concerned that the manager had not put adequate processes in place to monitor people’s wellbeing.

At this inspection, we found the care people received had improved and was now consistent across the two units. A new activity coordinator had been appointed and people in the Blythe unit were receiving more personalised care.

In the period between the two inspections, a number of concerns had been raised following a specific complaint and a visit from an Environmental Health officer. These concerns had been acted on by the manager and improvements had been made, such as safer care for people using catheters and new kitchen equipment.

However, we were concerned however that the manager and provider had failed to put measures in place to pick up these issues in a pro-active manner. During our inspection we saw a number of tools to check the quality of the service had been recently been introduced and another set of measures were due to be implemented before the end of the year. Whilst these were positive, they had not been implemented in a timely manner after our last inspection and we were not able to measure how effective they were and whether any improvements were sustainable.

Staff, people and families were extremely positive about the registered manager. The manager promoted an open culture throughout the service and was now more visible in the Blythe unit. There was good communication at the service, and this was improving with the introduction of additional meetings with staff and families.

There was no longer a dedicated clinical lead at the service and the provider was recruiting for a new deputy manager. The manager was covering both posts and so their time was stretched. Nursing and care staff were focused on meeting people’s daily needs; however there was insufficient oversight and coordination of the care and domestic tasks being carried out. As a result the manager had not always picked up where there were gaps in staff skills.

People were supported to maintain good physical health. Staff ensured people had enough to eat and drink, and the dining experience had improved in the Blythe unit. At our last inspection we made recommendations around developing staff skills when supporting people with dementia and mental health issues. This was an area which required on-going improvement.

The manager was open and pro-active when safeguarding concerns were raised. There were effective plans in place to manage risk. There were sufficient, safely recruited staff to meet people’s needs, and there had been a focus on reducing the dependence on agency staff. Experienced staff were now working across both units so people were consistently cared for by staff who knew them. Medicines were administered safely by well qualified staff.

The service was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of capacity had been undertaken and applications for Deprivation of

The Inspection took place on 5 April 2017.

Elmcroft Care Home provides accommodation, personal care and nursing care for up to 54 people. Some people have dementia related needs and require nursing care. The service consists of two units: the General Nursing Unit (GNU) and Blythe Unit. At the time of our inspection there were 38 people living at the service, 25 in the GNU and 13 in Blythe Unit.

A registered manager was 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.

When we last visited the service in 2015, we found the care in the GNU to be of a good quality and Blythe Unit was not occupied. At this inspection people living in the GNU continued to receive good quality care. However we had concerns regarding the experience of people living in Blythe unit which was now partially occupied.

People living in Blythe Unit had not been supported to settle into their new home in a positive way. The care they received was not person centred and stimulating. Staff did not know or treat people as individuals. Care plans had gaps and there was a focus on meeting physical needs, with insufficient information about people’s mental health needs, life histories and preferences.

The registered manager had failed to pick up and resolve the concerns in Blythe unit and to address the lack of consistency across the service.

Staff, people and families were extremely positive about the registered manager. The manager promoted an open culture and relaxed atmosphere in the GNU but the layout of the service meant they were not as visible on Blythe unit. Complaints and concerns were investigated thoroughly.

The manager communicated very well with people, families, staff and professionals. There were measures in place to monitor the quality of the service. Whilst these had not resulted in the manager dealing with the specific issues we found in Blythe unit, we found that in other instances audits and checks had been used to drive improvements.

People were supported to maintain good physical health. Staff ensured people had enough to eat and drink. We made recommendations around supporting people with dementia with their nutrition and hydration needs, in line with best practice.

Across the service, staff focused on keeping people safe. There were effective processes to manage risk. There were sufficient, safely recruited staff to meet people’s needs. Medicines were administered safely by well qualified staff.

The service was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of capacity had been undertaken and applications for Deprivation of Liberty Safeguards (DoLS) had been made diligently to the relevant local authority. Assessments and care plans within the GNU were complete and reflected people’s needs and preferences. Staff knew people well and were caring and person centred in their approach.

The Inspection took place on the 8 June 2015.

Elmcroft Care Home provides accommodation, personal care and nursing care for up to 54 people. Some people have dementia related needs and require nursing care. The service consists of two units: The General Nursing Unit and Blythe Unit. At the time of our inspection there were 10 people living at the service and the service was only using one unit.

The registered manager had left the service at the beginning of November 2014. A new manager has been recruited and was going through the process to be registered with the CQC. 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.

At our previous inspection on the 28 and 29 October 2014 we had concerns that the service was not meeting requirements in relation to a number of regulations. These included care and welfare of people, safeguarding people, levels of staffing, supporting staff, maintaining privacy and dignity and response to complaints. The provider sent us an action plan detailing what steps they would take to address these issues and how they would meet the relevant legal requirements. During this inspection we looked to see if improvements had been made and progress sustained.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager was up-to-date with recent changes to the law regarding DoLS and knew how to make a referral if required.

People had sufficient amounts to eat and drink to ensure that their dietary and nutrition needs were met. The service worked well with other professionals to ensure that people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including a doctor, tissue viability nurse and mental health professionals.

Staff were attentive to people's needs. Staff were able to demonstrate that they knew people well. Staff treated people with dignity and respect.

People were provided with the opportunity to participate in activities which interested them. These activities were diverse to meet people’s social needs. People knew how to make a complaint; complaints had been resolved efficiently and quickly.

The service had a number of ways of gathering people’s views including talking with people, staff, and relatives. The manager carried out a number of quality monitoring audits to help ensure the service was running effectively and to continually make improvements.

We undertook a comprehensive unannounced inspection on the 28 and 29 October 2014. We found the provider did not have suitable arrangements in place to effectively monitor, assess and continuously improve the quality and safety of the service. We served a Warning Notice to the provider on 30 January 2015 requiring them to become compliant with Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 by 22 February 2015. The provider sent us an action plan saying how they were going to meet these legal requirements.

We undertook this focused inspection on the 23 March 2015 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Elmcroft on our website at www.cqc.org.uk.

Elmcroft Care Home provides accommodation, personal care and nursing care for up to 54 people. Some people have dementia related needs and require nursing care. The service consists of two units: The General Nursing Unit and Blythe Unit. The service was only using one unit due to the number of people living at the service only being 11.

The service does not currently have a registered manager in post however the provider was in the process of appointing one. 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.

At our last inspection we found the manager was not carrying out robust quality monitoring procedures. At this inspection we found that the provider had taken action to ensure systems were put into place and closely monitored to improve the quality of the service.

At our inspection on 06 and 07 February 2014, we found that Elmcroft Care Home was not compliant with two standards. The provider sent us an action plan on 28 February 2014 and 25 March 2014 telling us what actions they would take to improve the service. Our inspection of 25 April 2014 was to check if improvements had been made.

On the day of our inspection, 38 people were living in Elmcroft care Home. We spoke with nine people during our visit and spent time observing the staff and people who used the service interact together. We also spoke with ten staff. A new manager had started work at Elmcroft Care Home and was undertaking their induction on the day of our inspection.

Many people were not able to talk to us verbally about their experience of the service so we used observation to understand their experiences. We looked at a range of records which included six people's care plans and daily records, staff training, staffing rotas, health and safety and quality checks.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found;

Is the service safe?

Improvements had been made to people’s safety and welfare. The care plans had been reviewed and updated with clear information about people’s needs.

Where people were unable to make day to day or significant decisions, we saw that Mental Capacity Act (MCA) 2005 assessments had been undertaken and reviewed. Where it was necessary, Deprivation of Liberty Safeguard (DoLS) were in place. We saw that these had been completed appropriately in full consultation with relevant professionals in order to keep people safe from harm.

The provider had reviewed the dependency levels of people using the service since our last inspection. Staffing levels, as if for a full occupancy, had been retained in order to give people a quality service. Recruitment and training for staff was underway to improve their skills and to meet people's needs safely.

Staff knew about safeguarding people who used the service and what they should do if they suspected or witnessed abuse. This kept them and those around them protected from harm.

Is the service effective?

People's assessments showed that their care, support and treatment was planned and delivered in a way that ensured that their needs were being met.

People told us that they had access to health and social services. Health professionals were involved in providing specialist advice to ensure people who used the service received care that was planned and coordinated.

Is the service caring?

We observed the interaction between staff and people who used the service. People were relaxed and comfortable. Staff spoke with people in a kind and caring way, offering choices and encouragement. People who could tell us verbally said, “They are all lovely (the staff), can’t fault them.” Another person said, “There is always a smile when they come into me, so friendly.”

Is the service responsive?

The monitoring and review of people’s care needs had been improved. We saw staff interacted well with people and knew how to meet their individual needs. For people with one to one support, new ways of working had been implemented to enhance their independence and wellbeing. We saw staff responded appropriately to people's changing needs, wishes and interests.

The range of individual activities and entertainment had improved with the introduction of a programme based on people’s interests and preferences. One person said, “I like to be with everyone in the afternoon, it makes a change.” Another person said, “There is a lot more to do now that we have that lady (the activities coordinator).”

Staff, residents and relative’s meetings had been held after the last inspection to discuss the findings. People were able to express their views and the provider responded by drawing up a plan of changes. This meant that people felt listened to and valued.

Is the service well-led?

There had been some changes to the management at Elmcroft since our last inspection in February 2014. The area manager and clinical lead nurse were jointly managing the service to implement the necessary changes to care planning and delivery, training and quality assurance to ensure people were cared for appropriately and to a high standard.

The staff we spoke with were positive about the changes being made to the service for the people who used the service as well as themselves. One staff member said, “The atmosphere is nicer, calmer and we have more time with people. It’s so much better for them and us.”

The service had a quality assurance system in place and records seen by us showed that identified shortfalls were now being addressed. As a result the quality of the service was continuingly improving.

We undertook this inspection as a result of information we received about the management of the home. On the day of our inspection there were 48 people living at the home and received care from the service. During our inspection we spoke with twelve residents and six relatives of people using the service. We looked at nine care plans.

People had clear assessments of their needs and plans and strategies were in place to meet them. We saw that care workers interacted with people in a relaxed and respectful manner.

We found that people who were able to communicate with us felt they always had their consent to care and treatment sought, felt they were in control of their care and were having their choices and preferences respected. However it was unclear how consent to care and treatment was obtained from people with more complex needs. We found that people’s care plans were sufficiently detailed however staff on both units told us they did not always have time to consult the care plans to see what treatment had changed. This placed people at risk of receiving care that was not appropriate or safe.

We found the staffing ratios were adequate most of the time on both units however the skills and experience of these staff did not always meet people’s needs. People told us they felt there was not enough staff to see to their relatives needs and we observed that staff did not have time to spend with people.

When we visited Elmcroft Care Home on 6 February 2013, we spoke with four people about the care and support they received from staff. People told us they were happy with the home environment and the intervention they were offered. One person said, "I like it here." Another told us, "It's good here. I like the staff and they care for me well."

Due to the complex needs of some people, we also spent some time observing people and saw that they were actively engaged in activities of their choice and at a level that was appropriate to them. Although no formal activities were taking place during our visit, we observed staff interacting positively with people and supporting them to listen to music, read the newspaper or watch television. One person told us, "It's my home and I do what I want to."

We noted that staff were respectful in their approach to people and treated them with dignity and respect, addressing them in a manner that was appropriate to them and which corresponded with their preferred method of address documented in their care records. People appeared content in the presence of staff and there was a friendly and calm atmosphere. Care records showed that relatives were encouraged to participate in people's care reviews and were kept updated with any changes in condition.

We did not receive any comments from people using the service during this follow up visit. However on our initial inspection visit to the service people with whom we spoke were generally satisfied with care and attention provided by staff. It was reported by the people using the service that if they required assistance staff would respond promptly.

This was confirmed by the visitors with whom we spoke on our initial visit who said that they felt involved with the care provided to their relative and that if they had any concerns they were able to meet with senior staff to discuss these.

People with whom we spoke confirmed that they were listened to and respected by staff. They felt that staff were patient and supportive.

This was supported by those visitors with whom we spoke who confirmed that they were satisfied with the level of respect and involvement shown by staff to their relative or friend.

People with whom we spoke were generally positive about the care and attention that they receive in this home. One person said “I find the staff kind”. Other comments included “if I need help the staff always come quickly”.

This was confirmed by visitors with whom we spoke who reported that they were satisfied with the level of care and attention shown by staff to their relative or friend. They said that staff always made them feel welcome when they visit and that they were kept informed about any issues as appropriate.

Two people with whom we spoke were unhappy with the choice and quality of the meals provided. Other people were generally positive about the meals provided. Visitors with whom we spoke confirmed that they had observed staff assisting people with eating and drinking as necessary.

People with whom we spoke confirmed that they felt safe in the home and that if they felt concerned about anything they could approach staff who were happy to assist.

Visitors with whom we spoke confirmed that if they had any concerns they were able to approach staff and were confident that these would be addressed in a prompt manner.

People with whom we spoke were generally satisfied with their bedroom and felt that staff worked hard to keep things clean and tidy.

Elmcroft Care Home provides accommodation, personal care and nursing care for up to 54 people. Some people have dementia, dementia related needs and require nursing care. The service consists of two units: The General Nursing Unit and Blythe Unit.

The unannounced inspection was completed on 28 October 2014 and 29 October 2014 and there were 31 people living in the service when we inspected.

A registered manager was 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.

The last inspection on 24 June 2014 and 2 July 2014 found that the provider was not meeting the requirements of the law in relation to the care and welfare of people who used the service and records management. They had also failed to ensure there were sufficient numbers of staff to meet people’s needs and to implement a system to effecitively monitor the quality of the service. An action plan was provided to us by the registered manager on 11 September 2014. This told us of the steps taken and the dates the provider said they would meet the relevant legal requirements. During this inspection we looked to see if improvements had been made and progress sustained.

People did not always feel safe or feel that the care and support provided to them was appropriate to meet their needs. People’s needs were not met by sufficient numbers of staff. The latter remained outstanding from our previous inspection to the service in July 2014.

Suitable arrangements to safeguard people against the risk of abuse were not in place. Safeguarding concerns and complaints had not been managed effectively. This remained outstanding from our previous inspection to the service in July 2014.

Staff had not received a comprehensive induction and suitable arrangements were not in place to ensure that staff were appropriately supported in relation to their roles and responsibilities.

Suitable arrangements were in place for supporting people to take their medicines safely.

People were positive about the quality of the meals provided. The dining experience for people within the service was variable and not always positive.

People did not consistently receive a service that was caring or that treated them with respect.

People’s care plans did not always reflect current information to guide staff on the most appropriate care people required to meet their individual and assessed needs.

Not all people were supported to participate in meaningful activities to meet their needs.

People and those acting on their behalf did not have confidence that the service was well-led or managed in the best interests of the people living there. An effective and proactive quality monitoring and assurance system was not in place to ensure that the service functioned safely and to an appropriate standard so as to drive improvement. We found that the majority of improvements required from our last inspection in July 2014 remained outstanding and had not been addressed.

The registered manager was up-to-date with recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS) and at the time of the inspection they were working with the local authority to make sure people’s legal rights were being protected.

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