About the service:

Elmsfield House is a residential care home that has recently changed it’s registration to include nursing care. It provides nursing and residential care for up to 28 older people, some of whom are living with dementia. At the time of this inspection no one was receiving nursing care and there were 19 people receiving personal care. The home is a Georgian property that has been suitably extended to accommodate people with nursing care needs. There is a large garden that includes a separate social club house for people living there and car parking.

People’s experience of using this service:

We have made a recommendation that the provider reviews all the policies and procedures to ensure they include current legislation.

There were sufficient numbers of suitably qualified staff to meet people’s needs in a timely manner. People and their relatives told us there were always enough staff available to assist them. One person told us, “If I use my call bell staff come within the minute.” Staff had completed training that enabled them to deliver good care and support to people effectively.

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.

Medicines were stored and managed safely and people received their medicines as they had been prescribed.

People’s individual preferences for food and drink were catered for and this included people’s specific health and dietary requirements. Staff gave the right level of support to those who required extra help with eating and drinking. One person told us, “The food varies but is quite good overall and you can get something else if you prefer to.”

Care provided to people respected their privacy, dignity and promoted their independence. It was clear from our observations that staff knew people's needs well. Kind and friendly interactions were observed taking place. One person told us, “It’s a lovely place to live, I feel safe and comfortable.” A relative told us, “Things have greatly improved and we cannot fault the place.”

The home employed an activities coordinator and there was a varied activity programme that people could partake in if they chose to. There was a purpose built outdoor building that had been furnished to provide a social club for people.

There was a particularly strong emphasis on continuous development and improvement of the service by the provider and registered manager that included the environment and the recent implementation of electronic care records.

The provider used a variety of audits that demonstrated the service was monitored and safe for people to live in. Feedback about the service was regularly collected and the home produced a regular newsletter to keep people and their relatives informed.

Rating at last inspection:

At the last inspection the service was rated requires improvement published 4 April 2018.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

This inspection took place on 6, 7 and 12 February 2018 and was unannounced on the first day. At the last inspection in July 2017 the service was rated overall as Requiring Improvement as we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 key questions of safe, effective, responsive and well-led to at least good.

At this inspection we found those actions required had been completed and the provider was no longer in breach of the regulations. However during this inspection we found areas that still required improvement and we have made three recommendations.

Elmsfield House is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides personal care and accommodation for up to a total of 28 people. On the day of the inspection there were 19 people residing at Elmsfield House. Accommodation is provided over two floors and the building has been extended and adapted for its purpose. The home is located close to the small village of Holme.

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There was a registered manager in post. A registered manager is a person who has registered with the (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.

On the days of the inspection there were deemed to be sufficient numbers of staff but we observed some people were left unattended for short periods in the communal lounges and dining areas. However we saw most people had their needs met in a timely manner.

We have made a recommendation that the provider reviews the dependency needs of people living in the home to ensure the numbers of staff on each shift are sufficient to meet people’s needs at all times.

People told us they had a good choice of foods made for them and that they enjoyed it. We saw some people were not always sufficiently supported during the breakfast time. People who were at risk of not having their nutritional needs met had been referred to the appropriate health professionals.

The processes used for identifying how best interest decisions were made for people who lacked the capacity to make complex decisions for themselves had not always been recorded. We also saw that consent to care and treatment had not always been obtained from the relevant persons with the legal authority to do so.

We have made a recommendation that the provider review their best interest decision making process to ensure it follows guidance outlined in the Mental Capacity Act 2005 in order to gain the appropriate authority for consent.

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.

Since the last inspection the provider had improved areas of the home. The laundry room had been fully renovated and a room in the home had been adapted to provide a new treatment / medication storage facility. Records for the administration of topical medications had improved. We saw medicines were being administered and recorded appropriately and were being kept safely.

Where safeguarding concerns or incidents had occurred these had been reported by the registered manager to the appropriate authorities and we could see records of the actions that had been taken by the home to protect people.

Staff had completed a variety of training that enabled them to improve their knowledge in order to deliver care and treatment safely.

People were only deprived of their liberty if this had

This unannounced comprehensive inspection took place on the 9 May 2017. We last inspected Elmsfield House Limited on 30 December 2014 and 5 January 2015. At that inspection we rated the service as good overall.

Elmsfield House is registered to provide accommodation for up to 28 people older people. At the time of our inspection 23 people were using the service, some of whom were living with dementia.

The home is a Georgian property that has been extended and appropriately adapted for its present use as a care home. The home has a large garden with patio areas and ample car parking. It is set in a very rural location close to the village of Holme in Cumbria.

There was a registered manager in post at the time of the 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.

During this inspection we found a breach of Regulation12 Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This was because we found some risks associated with the delivery of safe care and treatment including the management of falls, weight loss and the safe use of some equipment had not always been recognised. Even when these risks had been identified they were not always recorded accurately or managed safely. Medicines and records relating to their administration were not consistently being managed in a safe manner.

In the event of an emergency evacuation having to be implemented we did not see that individual people had been assessed to ensure they could be evacuated safely.

We found some areas of the home required deeper cleaning and the external building housing the laundry was unclean and posed a risk to cross contamination. The high level of dust and debris behind machines contributed to an increased risk and was deemed to be hazardous should a fire occur.

We also found when accidents and incidents had occurred these had not always been reported to the appropriate authorities. Some of these incidents related to keeping people safe from abuse. We alerted this to the registered manager during the inspection and she took immediate action to inform the local safeguarding authority. This was a breach of Regulation 13 Safeguarding service users from abuse and improper treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because people had not been protected from harm or the risk of harm.

We also found that some of the incidents should have been reported to us (CQC) but the provider had not done so. We have addressed this later in the report under the domain of well led.

On the day of the inspection there were deemed to be sufficient numbers of staff but we observed times when staff were not always available when people most needed them. Staff had completed training that enabled them to improve their knowledge in order to deliver care and support safely. When employing new staff the necessary checks had been completed.

We observed good humoured and supportive interactions between staff members and people living at Elmsfield House. People living in the home were supported to access activities that were made available to them and pastimes of their choice. However records about people’s participation in activities were not consistently completed.

Some care records we looked at did not contain all of the relevant and appropriate information relating to current health and care needs. This meant that information recorded did not always provide staff with accurate and up to date information about how to support individuals.

We have made a recommendation that records relating to care and treatment are consistent in providing accurate information to enable staff to fol

The people we spoke to during our visit told us they were happy living in Elmsfield House and were glad that they had decided to move in. One person said, “I came to live here because I could bring my dog and she is as happy as I am". Another said,"It is lovely to be looked after by lovely staff".

Visitors also told us they were happy with the care and support provided to their relatives. They said “I am more than happy with the care my [relatives] receive. They have been so much better having company when they want it”.

We saw that staff treated people with dignity and respect, always asking them what they wanted to do and where they would like to sit.

Care plans gave guidance to staff so that people's needs were met. Risk assessments were in place and reviewed regularly. This meant that this service was a safe place for people to live and work in.

People who lived in the home saw healthcare professionals when necessary so that their health and wellbeing was monitored.

Staff training was up to date which ensured that those that provided the care and support were able to care appropriately for people living in Elmsfield House.

Everyone we spoke with was complimentary about the home. The people who used the service were treated with kindness and respect by the staff. Staff knew the needs of the people who used the service very well and were able to meet the callenging needs of those people who suffered with varying stages of dementia.

One person who used the service told us; "The staff are really lovely."

Another said; "The staff are extremely good I am well looked after."

A relative we spoke with told us; "I am kept up to date about my mum's condition. She is well looked after."

One lady had moved to the home because they were happy for her to bring her dog to stay with her. She was able to look after her dog and walk her in the grounds which helped maintain her independence and mobility.

This inspection took place on 30 December 2014 and 5 January 2015 and was unannounced on the first day. Elmsfield House is registered to provide accommodation for up to 28 people who have personal and care needs, and dementia. At the time of our visit 20 people were using the service, most of who were living with dementia. The home is a Georgian property that has been extended and appropriately adapted for its present use as a care home. It is set in a very rural location close to the village of Holme, three miles from Milnthorpe in Cumbria.

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.This is a family run home and the registered manager is also the registered provider.

At our last inspection inSeptemebr 2013 we found that the provider was compliant with all six of the regulations of the Health and Social Care Act 2008 that we looked at.

People told us they were very happy at the home. They said they felt well cared for and safe.

We saw that accurate records for some people were not always being maintained in relation to the care provided. However, this did not impact on people’s care.

People who required specific support with their meals received the personalised support they needed. The cook was very aware of people’s individual dietary requirements and knowledgeable about their food preferences.

Throughout our visit we observed caring and supportive relationships between people living at Elmsfield House, their relatives and the care staff. People were treated in a caring way that demonstrated a positive, caring and inclusive culture existed in the home.

All of the people we spoke with knew how to make a complaint and we saw that procedures for managing complaints were in place.There were sufficient numbers of appropriately trained staff on duty to support people. The registered manager used a dependency tool that informed the levels of staff required on a daily basis.

People we spoke with made positive comments about staff. We saw how staff respected people’s privacy and promoted their dignity. Activities were enjoyed by people and we saw that most people participated. A variety of choices of activities were offered to accommodate people’s different needs.

The home was clean and free from malodours. Cleaning schedules were in place and were being followed. The registered manager was responsible for infection control and acted as a source of information for other staff.

Some senior care staff we spoke with had knowledge of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). At the time of our visit no one was subject to a (DoLS) application. This is where an application can be made to lawfully deprive a person of their liberties where it is deemed to be in their best interests or for their own safety. The registered manager told us that further training had been identified for all care staff.

Care staff received training that enabled them to appropriately support people. The registered manager provided records to show that further training in specialist areas was due to be implemented. Recent dementia training provided in the home was extended to all the relatives of people living in the home. The feedback from relatives who attended this expressed it had been very informative and useful.

People were supported to maintain good health. People had enough to eat and drink and appropriate referrals were made. For example, to GPs and Speech and Language Therapist (SALT) referrals were made where people were identified as being at risk of choking due to swallowing problems. People received support from the community nurses with regards to their tissue viability. Where people were at risk of pressure sores measures were put in place to reduce and manage the risk.