Elm Tree Court – Care Home 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 Tree Court – Care Home provides accommodation and personal care to a maximum of 72 people including those people who may be living with dementia. The building is single storey and purpose built. It is divided into three separate bungalows that surround a courtyard. Each bungalow has its own communal areas, bedrooms and bathrooms.

At the last inspection in June 2017 the service did not meet all of the regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection the service was rated ‘Requires Improvement’. This was because the provider was in breach of three regulations, for which we made requirements and the service was in need of other improvements, for which we made recommendations. Breaches related to failure to work under the Mental Capacity Act 2005 legislation, inaccurately written care plans and ineffective auditing. Improvements were needed in staff deployment, using best interest decisions, maintaining medicine records and care for people living with dementia.

Following the last inspection we asked the provider to complete an action plan to show what they would do to improve the key questions is the service safe, is the service effective, is the service responsive and is the service well-led, to at least good? The provider sent us an action plan.

This comprehensive rated inspection of Elm Tree Court – Care Home took place on 20 and 21 March 2017 and was unannounced. We checked that the action plan had been followed. We rated the service as ‘Good’ because previous requirements and recommendations had been met. The rating is based on an aggregation of the ratings awarded for all 5 key questions.

The provider was required to have a registered manager in post. When we inspected there was a manager that had been in post since November 2017 and registered since January 2018. 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.

Staffing numbers were sufficient to meet people’s needs and they were effectively deployed. People were protected from the risk of harm. Accidents and incidents were appropriately managed, risk assessed and mitigated. The management of medicines was safely carried out. Systems in place demonstrated there was a safe audit trail for handling drugs, which protected people from harm. The premises were safely maintained. Systems in place detected, monitored and reported any potential or actual safeguarding concerns, staff were trained in this area and understood their responsibilities in respect of managing them. Infection control practices were safely and effectively followed and were underpinned by good infection control management policies and procedures. Recruitment policies and procedures were safe and carefully followed to ensure staff were ‘suitable’ to care for and support vulnerable people. When events went wrong the provider and staff learnt lessons so that mistakes were not repeated. These were documented and discussed as part of the process.

People’s mental capacity was appropriately assessed and their rights were protected. People were supported 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. Consent for all things to take place was respected so that staff always sought people’s cooperation and agreement before completin

Elm Tree Court provides accommodation and personal care to a maximum of 72 people who are living with dementia.

The building is single storey and purpose built. It is divided into three separate units that surround a courtyard. Each unit has individual communal areas, bedrooms and bathrooms.

This inspection took place on 27, 28 and 30 June and was unannounced. The service was last inspected May 2016 and was found to be in breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Need for Consent; a requirement notice was set for the provider to comply with. Part of this inspection included checking whether the provider had taken the necessary action to comply with the requirement notice.

At the time of the inspection 72 people were living at the service.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like providers, they are ‘registered persons’. Registered persons have a 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 asked the provider to make improvements to way the service applied the principles of the Mental Capacity Act (MCA) and the use of Deprivation of Liberty Safeguards (DoLS) to keep people who need this level of support with their care and decision making safe; at this inspection we found the application of the principles of the MCA and DoLS was not consistent across the service. This meant people were not always protected by the use of relevant legislation and their liberty was unlawfully restricted. We found the quality monitoring of the service had not identified the issues we found during the inspection and did not ensure people received safe, compassionate care and that the service was well-led. You can see what action we have asked the provider to take at the end if this report.

We found that people’s care plans did not always reflect their needs or had been up dated to demonstrate when people’s needs had changed. This meant people who used the service were at risk of receiving care which was not person centred and which did not effectively met their needs. We found some low level physical interventions were used which had been not been discussed or assessed as being the least restrictive option or in the person’s best interest. This meant people who used the service were exposed to the risk of harm and inappropriate care. During the inspection when we spoke to staff they told us people who used the service were up and dressed very early in the morning. An out of hours visit confirmed this, we found over 40% of the people were up and dressed at 6am. This limits people choices and does not respect their dignity. We found staff were not always deployed around the building effectively and this had an impact on the people who used the service particularly on the night shift. We have made recommendations about these issues and these can be seen in the main body of the report.

We found there were some medicine errors; these were report to the manger to rectify and monitor. This meant people were at risk of not receiving their medicines as prescribed by their GP. We found the meal time experience for some people was not conducive to them eating a good, balanced diet with support from staff. We have made recommendations about these issues and these can be seen in the main body of the report.

People were cared for by staff who had received training in how to recognise abuse and how to report this to the investigating authorities. Staff had been recruited safely.

Staff received training which equipped them to meet the needs of the people who used the service. People were supported by staff to access health care professionals when needed.

People were able to participate in a choice of activities and staff took the time to sit and talk to people and engage them i

Elm Tree Court provides accommodation and personal care to a maximum of 72 people all of whom are living with dementia. The building is single storey and purpose built. It is divided into three separate communities that surround an inner courtyard. Each community has its own communal areas, bedrooms, bathrooms and a courtyard with plants and seating.

The service had a registered manager in post as required by a condition of registration. 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.

We undertook this unannounced inspection on the 10 and 11 May 2016. At the time of the inspection there were a total of 72 people living in Elm Tree Court. At the last inspection on 16 January 2014, the registered provider was compliant with all areas assessed.

We found there was inconsistency regarding the application of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered provider and registered manager had not always followed best practice regarding assessing people’s capacity and discussing and recording decisions made in their best interests. We found there were people who met the criteria for DoLS but applications to deprive them of their liberty lawfully had not been made to the local authority. You can see what action we have asked the registered provider to take at the back of the full version of the report.

We found there was a quality monitoring system which consisted of audits, surveys and meetings and practice had been changed as a result of suggestions by people. However, the registered provider and registered manager had a responsibility to ensure any member of staff who worked in the service was able to fulfil their role and tasks. All permanent staff received training, support and supervision but there was limited audit regarding the skills of agency staff employed for one to one support tasks with people. We have made a recommendation about this in the well-led section.

We found people who used the service were protected from the risk of harm and abuse. Staff had received safeguarding training and knew what to do if they witnessed abuse or if it was disclosed to them. People had risk assessments which helped to analyse any risk of harm, for example with moving and handling and falls and how it could be minimised. We found staff knew what to do in cases of emergencies and each person who used the service had a personal evacuation plan.

We found staff were recruited safely with all employment checks carried out prior to new staff starting work. New staff received a full induction and shadowed more experienced staff until it was felt they were competent to work alone with people. We found there were sufficient care staff on duty to meet people’s current needs; there were ancillary staff for tasks such as activities, laundry, catering, domestic work, maintenance and administration so care staff could concentrate on looking after people.

We observed staff had a patient and caring approach. There were positive comments from relatives about the staff team. People who used the service and their relatives were provided with information on notice boards, in meetings and in newsletters. Staff treated people with respect and maintained confidentiality. Personal records were stored securely.

We found people received their medicines as prescribed and had access to a range of health care professionals in the community, when required to meet their health needs.

People enjoyed the meals provided to them. The menus enabled people to have choice and special diets when required. People’s weight, their nutritional intake and their ability to eat and drink safely was monitored and referrals to dieticians and speech and la

We found that staff involved people in their care. People who used the service and their relatives told us staff treated them with respect. Comments included, “The staff are very kind and patient” and “I prefer to spend time in my bedroom but I go through for meals."

People had assessments and care plans to guide staff in meeting their needs. People told us they saw their GP when required and records showed us people saw other health professionals. Two relatives told us they felt health needs were met and they were always kept informed of important issues. Comments included, “They keep me informed and get the doctor when necessary” and “I want to see him cared for and they do that here.”

People spoken with liked the food provided. They said they had enough to eat and drink. Comments included, “The food is very good”, “I like to have muesli for breakfast and I get it” and “The food suits me.” Relatives said, “The food is like mother used to make” and “They liquidise all her meals. She has put weight on since coming here.”

We found the home was clean and tidy and free from unpleasant odours although a carpet in one of the communal areas was in need of replacement.

We found there were enough staff to meet people's assessed needs. People who used the service and their relatives were complimentary about the staff team. Staff received training and supervision.

Accurate records were maintained of the care provided to people who used the service and of staff.

We spoke to two people who lived at the home and a relative. People who lived at the home told us that they could make decisions about their day to day lives, such as a choice at mealtimes, what time to get up and go to bed, what to wear and where to spend the day. They said that they were supported by staff to be as independent as possible and one person told us that they had been out with their relative that day.

People told us that staff were caring and kind and that they spoke to them in a respectful manner. They said that the home was clean, including their bedroom.

A relative told us that any minor concerns expressed had been acted upon by staff.

We left comment cards at the service for several days and responses have been included in this report.

The service had 71 people resident at the time of inspection, 45 of whom had a diagnosis of dementia and 23 had dementia type symptoms. Three people did not have dementia but they had chosen to be admitted to the service to accompany a relative or they had been happy with the care a relative had received in the past.

We found the manager and staff team provided care that was focussed on people’s dementia care needs. All staff were aware of good practice guidelines and all had completed in-house dementia care training facilitated by HICA’s training section. The manager, deputy manager, personal care manager and senior care staff had completed ‘dementia ambassador’ training with the Dementia Academy in Hull. This meant the staff team had skills and knowledge to use when supporting people with dementia.

We found people with dementia had their needs assessed prior to admission to the service. The assessment was kept under review and the information was used to develop individualised care plans. This provided staff with information on how to support people with dementia and enabled them to recognise when their behaviour changed and they required additional care and treatment.

We found people with dementia received care and treatment from a range of health and social care professionals. Staff within the service worked well with people from other agencies to ensure care was coordinated. For example, they provided information and escort when a person with dementia was transported to hospital.

We found there were systems in place to monitor the quality of the service people with dementia received. This included supporting people to make their views heard, completing audits and ensuring the environment was suitable for people with dementia.