Elm Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Elm Lodge can accommodate up to 64 people in one adapted building, over two floors. At the time of our inspection there were 57 people living there.

There was a registered manager 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.

At the last inspection in May 2016, we rated the service as Good. During this inspection, which took place on 15 August 2018, we identified some areas requiring improvement. Consequently, we have changed the rating from Good to Requires Improvement. This is the first time the service has been rated Requires Improvement.

Why we rated the service Requires Improvement:

People did not always receive their medicines in a safe way. Staff had missed the fact that one person had not been given an essential medicine on two occasions. We also found that staff were not maintaining accurate records in terms of stock levels for certain prescribed medicines or how often people were being given homely remedies, such as paracetamol.

In addition, audits were being carried out to check the quality of records being maintained by staff and the service provided to people. However, these checks were not always effective and had failed to identify areas that required improvement, or result in robust action to address these in a timely way.

We did find that the service continued to provide a good service in other areas that we checked. For example, there were processes in place to protect people from avoidable harm and staff were aware of their responsibilities to report potential concerns. Risks to people were assessed and managed appropriately. People were protected by the prevention and control of infection and the provider had processes in place for when things went wrong, so that lessons could be learnt, in order to improve the service.

Staff had been recruited using a robust recruitment process. They had attended a variety of training to keep their skills up to date and were supported with regular supervision. There were enough trained staff to support people with their needs.

People had enough to eat and drink. They could make choices about what they ate and were provided with support when required.

People had access to additional health care professionals, to ensure they received effective care or treatment when required.

Staff gained consent to care before supporting people; this was sought in line with legislation. People were enabled to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff treated people with kindness and compassion. People were treated with dignity and respect, and had the privacy they required.

People’s needs had been assessed prior to admission. Care and support plans were personalised and reflected people’s individual requirements. People and their relatives were involved in decisions regarding their care and support needs.

There was a variety of activities on offer and people were supported to follow their interests. They were able to make decisions about how they spent their time.

The provider had a clear vision, and was open and transparent. They involved people and their relatives in developing the service. There was a complaints procedure in place and people knew how to complain if they needed to. People also knew who the registered manager was and could see them when they needed to.

Further information

This inspection was carried out 10 May 2016 and was unannounced. During our last inspection in January 2014 we found that the service met the legal requirements in the areas we looked at.

Elm Lodge Nursing and Residential Home provides care and accommodation for up to 64 people. Some people may require nursing care and people living at the home may have dementia. At the time of our inspection there were 61 people living at the home, 22 of whom required nursing care.

The home had a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 received their medicines as they had been prescribed.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home, and these were reviewed regularly. Accidents and incidents were recorded and the causes of these analysed so that preventative action could be taken to reduce the number of occurrences.

There were enough skilled, qualified staff to provide for people’s needs. Robust recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. They received training to ensure that they had the necessary skills to care for and support the people who lived at the home and were supported by way of supervisions and appraisals.

People’s needs had been assessed before they moved into the home and they had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People had a variety of nutritious food and drink available to them. There were freshly made, home cooked meals from a menu that had been devised using people’s likes and dislikes. Snacks and fruit were available to people throughout the day.

Staff were kind, caring and protected people’s dignity. They treated people with respect and supported people in a way that allowed them to be as independent as possible.

There was an effective complaints system in place. Information was available to people about how they could make a complaint should they need to and the services provided at the home. People were assisted to access other healthcare professionals to maintain their health and well-being.

People and staff were encouraged to attend meetings with the registered manager at which they could discuss aspects of the service and care delivery. People were asked for feedback about the service to enable improvements to be made. There was an effective quality assurance system in place and the provider was an active participant in the day to day running of the service. .

When we inspected Elm Lodge Nursing and Residential Home on 15 January 2014, they provided care, support and treatment to 62 people who use the service. We looked at the care records for 10 people, and we found their care needs were appropriately met. People's consent was sought before they received any care or treatment. An expert by experience spoke with people or their relatives about the care they received. One person who uses the service said, "The care staff have always been helpful, always been kind. I’ve never had any trouble with them."

We noted that people were cared for in safe and adequately maintained premises. One person told us they liked their bedroom because they had a good view out of their window.

We found the provider had effective staff recruitment processes, and people were supported by staff who were a trained and received regular supervision. We observed that the staff were knowledgeable and responsive to people's needs.

The name of a registered manager appears who was not in post at this location at the time of the inspection. Their name appears because they were still on our register at the time.

During our visit on 17 December 2012 we observed staff interactions with people living at the service. We saw that staff were responsive to the needs of people and offered assistance when required. We spoke with two people at the service. One said "I am very comfortable here." We saw choices were offered and most people chose their meals the day before or up to 10.30 on the day.

We saw that care plans had been reviewed and a document had been introduced to record the consent and agreement of people or their representative with the proposed care plan.

An activities co-ordinator had been appointed and they were able to take people on short outings to the local shops. We saw information about events organised to take place during the Christmas period and there were photographs on display of a group outing in September 2012.

We noted that the premises were free from offensive odours and were clean. We spoke with a member of cleaning staff who informed us that the team worked hard to manage the cleanliness, and had made changes to their ways of working do this.The majority of staff had completed infection control training.

We found that five additional care staff had been employed since our last inspection on the 19 May 2012 along with an activities co-ordinator and two nurses.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not all able to tell us their experiences.

During our visit on 19 May 2012, we spoke to seven people about their experiences and observed the care and support being provided to nine people. We also spoke to one relative and nine members of staff.

People told us that they were not always offered basic choices, such as what to drink and they said there there was not a lot to do - activity wise.

Some people told us about a strong odour in one of the home's lounges.

But we were also told that people had a choice of meal each day. People told us that the portions were sufficient and that meals were served at a temperature that was appropriate for them.

People told us that they knew what to do if they had any concerns about the service provided.

We did not speak in detail, with people who used this service during this visit. This was because this review was conducted to specifically follow up on concerns which had been raised with CQC regarding medication practices and related records in the home.

However we noted that there was a relaxed atmosphere in the home, and that people looked clean and comfortable. The staff were interacting confidently with people, and showed patience and understanding when assisting people to meet their needs.

The staff were friendly and professional in their approach to people.

During our visit to Elm Lodge Nursing and Residential Home on the 01 November 2011 we spoke with four people with a diverse range of needs, about their experiences whilst living in the home.

People that we spoke with told us that there was always plenty of staff on duty, and that if they pressed their call bell, staff would respond to help them immediately.

They said that the staff were generally kind and patient and helped them when they could not manage on their own and they needed support or assistance. We noted that people were relaxed and comfortable in the company of the staff, and we observed staff interacting confidently with people, showing patience and understanding, and encouraging people to be independent. They were friendly and professional in their approach to people.