The inspection took place on 28 June 2018 and was unannounced. New Elmcroft 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.

New Elmcroft is situated in Shoreham, West Sussex and is one of a group of homes owned by a national provided, Shaw Healthcare Limited. New Elmcroft accommodates 60 people across separate units, each of which have separate bedrooms with ensuite shower facilities, a communal dining room and lounge. There were also gardens for people to use and a hairdressing room. The home provides accommodation for older people, those living with dementia and people who require support with their nursing needs. At the time of the inspection there were 49 people living at the home. The home had 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.

At the last inspection the home was rated as Good. At this inspection we found the evidence continued to support the rating of Good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Most risks were assessed and managed well. There had been several incidents whereby people had accessed areas of the home that had the potential to cause them harm. Preventative measures had immediately been put in place, such as installation of locks to the doors. One of the doors to the sluice toom, which had a key pad lock installed, had not been closed. There was a potential that a person could access the room and cause themselves harm.

External healthcare advice had not always been implemented by staff. Two people had been assessed as needing to have their drinks thickened to minimise the risk of choking. Neither of the people were provided with thickened drinks. One of these people began to cough on an un-thickened drink and there was a potential that they could have come to harm as there were no staff with the person when this occurred. These incidents were immediately fed back to staff who ensured that the people’s drinks were thickened.

People told us that staff made them feel safe. They felt that there was sufficient staff, that they were well-trained and knowledgeable to meet their needs and assure their safety. People and staff were aware of the importance of raising concerns about people’s wellbeing and safety. People were protected from abuse and made aware of their right to complain. Incidents had been reflected on and practice changed in response.

People were protected from the spread of infection. Registered nurses and external healthcare professionals ensured that people’s heath was maintained. Medicines were provided when people required them. People told us that they were confident that staff would summon assistance if their health condition deteriorated. There was a coordinated approach to people’s healthcare. People received good need of life care.

People had a positive dining experience. They told us that they were happy with the food and had access to drinks and snacks throughout the day and night. One person told us, “Food is okay, helpings are fine, it is enough for me”.

People were asked their consent before being supported and were involved in their care. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Staff demonstrated respect. People’s privacy and dignity were maintained and they were supported by staff in a sensitive and dignif

We previously carried out an unannounced comprehensive inspection at New Elmcroft on 6 & 8 January 2015. Breaches of legal requirements were found. After that comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the management of medicines, providing adequate staff training, maintaining a clean and hygienic environment; ensuring care plans were relevant and up to date; Ensuring people were receiving appropriate nutrition; Ensuring audit identified areas for improvement and consequent actions. At this comprehensive inspection, we found that improvements had been made and that breaches in regulations had now been all addressed.

The inspection took place on the 9th December 2015 and was unannounced. New Elmcroft is part of the Shaw Healthcare group and is a purpose-built home situated in a residential area. It is registered for a maximum of 60 people. There were 56 people living at the home on the day of our inspection. The home consists of a nursing unit on the ground floor where people who have nursing needs lived. On the first floor there is a residential care unit for people living with dementia, nursing care is not provided on this floor but people also needed support with physical healthcare needs.

The home had 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. The registered manager had been registered with CQC in February 2015 and started with the organisation just before the previous inspection in January.

Consent was sought from people with regard to the care that was delivered. Staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation, which they put into practice. Referrals had been made for Deprivation of Liberty Safeguards (DoLS). On one care record we could not see what the outcome of the DoLS assessment was and whether there were conditions in place. This meant that staff would not be aware of any actions that they may need to take in depriving a person of their liberty in their best interests. This remained an area that needs improvement. 

We observed lunch, people had enough to eat and drink. They were given choices of food from a menu. Drinks were available throughout the day. One person told us “The food is excellent…if anything you get too much”. People were encouraged and supported to eat and drink enough to maintain a balanced diet. Staff monitored people’s weights and recorded how much they ate and drank to keep them healthy. However we found in one of the eleven records we viewed that there had been a delay in accessing dietician support for someone so accessing timely support around people’s nutritional needs remained an area that needs improvement.

People’s care plans were up to date and contained information about their individual preferences and needs. These plans were reviewed regularly to ensure the most up to date information was available. There was a programme of activities and work had been carried out to provide meaningful activities for people living with dementia. Equipment and strategies were in place and the registered manager told us of the plans in place to embed these in practice.

People told us they felt safe. One person said “I could speak to any of the staff about anything really”. People were safe as they were supported by staff that were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. There were systems in place that ensured this knowledge was checked and updated. Medicines were managed and administered safely. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager. The environment was clean and there were systems and equipment in place that ensured this.

Staff received training that was relevant to their roles and received specific training around areas such as supporting people living with dementia and end of life care. Staff were supported through regular supervision with a manager which ensured they were able to discuss any areas for development and identify training needs.

People told us that staff were kind, caring and approachable. One person told us “The staff are just really lovely”. We observed staff treating people with dignity and respect and involving them in their care. Another person said of staff “ I like it here, they do lots for you and seem happy to do it for you”

The complaints policy was available and complaints were responded to in a detailed and timely way. There were relatives meetings and we were told that information was shared with people and staff by the registered manager. One relative said of these “Yes and if I can’t get there, they always email me the minutes”.

People and relatives commented on the fact that the home had improved under the new management team. One relative said “It’s generally much improved since [the manager] has been here. She’s very receptive and the communication has got much better”. A positive culture was promoted and staff had a good understanding of how to communicate with people in an accessible way. The management team were transparent with people and relatives about the improvements that had been needed to be made and ongoing improvements that were being implemented. There was a range of audit tools and processes in place to monitor the care that was delivered and the registered manager worked in partnership with visiting professionals to the home.

We looked at the processes, procedures and records held by the service relating to the use and management of medicines. We observed that medicines were not stored securely or at the correct temperatures at all times.

We shadowed a member of staff administering medicines to people cared for by the service, they administered medicines to people in a manner which suited the individual. We sampled the administration records and supporting information, the records were in the main complete, however most supporting information lacked sufficient detail to ensure staff less familiar with the people would administer the medicines in a consistent manner

We spoke to a number of people cared by the service who told us that they “get their medicines when required”.

During our inspection we spoke with four people who used the service and five relatives. We also spoke with two managers, two team leaders, three care workers and a visiting optician. We used a structured observation tool to help us better understand the experience of people who could not speak with us.

People’s care needs were assessed and care was planned and delivered to meet those needs with regard to their personal preferences. People’s health was monitored appropriately. One person told us, “I think the staff are very patient; I am very well treated.” A relative said, “I’m completely satisfied with the way they are handling my wife’s care.”

We found there were efficient systems for ordering, storing and accounting for medicines. People were supported to take their medicines on time and with kindness when help was needed.

We found there were sufficient staff with the right qualifications skills and experience to meet people’s needs. However, there were occasions when late notice absence could not be covered although the home had systems to manage staffing shortfalls. A team leader said “Nothing is left intentionally.” A typical comment from a person who used the service was, “They can get very short handed.”

The provider had systems for gathering feedback from people who used the service, their families and from staff. There were systems of audit and risk assessment to ensure the service was safe.

There was an effective complaints system that was well publicised. The provider investigated and responded to complaints.

People’s comments included “Staff take good care of me. I don’t have anything to worry about”, “There’s always interesting things going on”, and “We’re quite happy here. Everything is good”.

People felt that staff were caring for them well and one person said to us that “Staff are marvellous”.

One person we spoke to was pleased that there had been a change to having more fresh vegetables with meals.

People said that the home was usually clean.

This inspection took place on 6 and 8 January 2015 and was unannounced. The service provides accommodation for up to 60 older people, including people living with dementia. There were 54 people living at the service when we visited. Accommodation is provided in two units with people requiring nursing care on the ground floor. People living with dementia are accommodated on the first floor.

At the last inspection in July 2014, we issued a warning notice for medicines for the provider to become compliant by 30 September 2014. Compliance actions were set for care and welfare of people using the service and assessing and monitoring the quality of the service provision. The provider sent us an action plan to become compliant by 31 December 2014.

There was no registered manager at the time of the inspection. The manager had commenced the process to register with the Commission and an interview had been booked for the end of January 2015. 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 service had been without a registered manager for a few months.

People did not always receive appropriate support with food and fluids and put them at risk of malnutrition. Nutritional care plans did not contain enough information about people’s food and fluid needs and the support people needed.

Infection control guidance had not been followed in relation to the environment and staff practices. Therefore, people were not protected from the risk of cross infection.

Care plans were not always developed in a timely manner following admission to the home which may impact on people initially receiving inconsistent care and not according to their assessed needs. Assessments of people’s needs were completed which included any risks.

People’s healthcare needs were managed appropriately and specialist advice sought although at times this was not done in a timely way.

The management of creams and ointments were not always managed safely and consistently. Other medicines were managed appropriately. Medicines were kept safely and securely and staff had completed training in medicines management.

Where people lacked the mental capacity to make decisions, the provider did not always follow the principles of the Mental Capacity Act 2005. Mental capacity assessments were not conducted and the provider could not evidence how best interests decisions had been made to protect people.

There were systems for monitoring the quality of service provision and regular audits were completed which included health and safety, care plans, medicines, accidents and incidents. However these were not always effective and did not identify risks and the shortfalls we found during the inspection.

There were arrangements including policies and procedures for safeguarding people from abuse. Staff had completed training in safeguarding adults.

Recruitment procedures were followed and all necessary checks were completed prior to staff commencing work to protect people.

People were treated with kindness and compassion by staff who knew them well and understood their needs. Staff practices promoted privacy and dignity of people they cared for.

There were procedures for responding to complaints. A complaint log was maintained for recording complaints which included details of investigations and feedback to complainants. Staff understood their roles in promoting the values of the organisation.

We have made a number of recommendations for the provider to consider when providing care to people.

We found a number of 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.