Elmcroft Care Home

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked at all quality statements for Caring at this assessment. The service was not caring. This showed a decline since the last inspection. Staff reported a closed blame culture and told us morale was extremely poor. Staff told us they were frightened to speak up and did not believe action would be taken by leaders if they raised concerns. This impacted on their ability to provide a consistently caring service. Staff were observed to have positive interactions with people and spoke about them in a kind and caring way. However, people’s individual needs and preferences were not well understood. Staff also did not have sufficient guidance to respond to people’s immediate care needs, to reduce the risk of avoidable distress, pain, or discomfort. People’s dignity was impacted, as there were insufficient staff to facilitate regular showers in line with people’s preferences. There was a lack of user involvement in care planning, including information on people’s life histories, aims and ambitions. During our assessment of this key question, we found concerns about person-centred care, which resulted in a breach of the legal regulations. You can find more details of our concerns in the evidence category findings below.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although people and their relatives told us staff were kind, staff were unable to always treat people with compassion and dignity in their day-to-day interactions despite their best efforts, due to the poor management and running of the service. A person’s relative told us, “Care workers are so lovely, so passionate.” Another relative said, “Staff are genuinely kind.” However, 1 person told us they had not had a shower for 3 weeks as, “[Staff] are very bad for showers. Well basically, the basic care is okay but getting showers and my hair washed I have to fight for it.” Records confirmed what the person had told us. When asked by inspectors when they saw staff, another person told us, “Well, when I need changing. When I need feeding.”

Staff told us they were committed to supporting people kindly and respectfully, and expressed upset and demotivation following management decisions which prevented them from consistently doing so. A staff member said, “We are only giving the basic care. I can’t remember the last time we washed someone in the morning, and we had washed all their legs and their feet.”

Partners expressed concern at how people’s personal care needs were not always met to ensure their dignity. A professional who works with the service told us, “The nurse I spoke to today knew her residents. However, when personal care was discussed in detail if the resident gets agitated or worse and the resident declines a shower or bath, it would appear non-pharmacological approaches are not used. The resident I went to see had only had maybe 1 shower in the last couple of months according to the nurse.”

Whilst staff spoke about people kindly and with compassion, and we saw positive interactions where staff had time, systems were not in place to allow staff to deliver a consistently caring service. This included staff support, training and deployment at management level. We observed staff unable to spend meaningful time with people. This impacted on people’s dignity, for example lack of access to regular showers.

People’s individual needs and preferences were not always understood and reflected in their care, treatment, and support. A person told us, “You never know what's going on but nothing much, same today. Sometimes, not very often, we've been out in the coach to places but not recently.”

We raised our concerns with the provider about the lack of individualised care. The provider told us they had commenced work to understand people’s interests and backgrounds and were seeking additional dementia training for staff.

We observed care was institutionalised, and people did not have access to a wide range of leisure activities personalised to their interests. For example, on the first day of inspection there were colouring sheets placed in front of people, but there were not enough staff to support with this and people showed a lack of interest. Memory boxes outside of people’s bedrooms had not always been filled to show about the person’s character and interests or help them to orientate themselves to their own room.

Processes were not in place to promote and take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics such as disability. Care documents did not always accurately reflect how individual people preferred to communicate, and in some cases used negative and disrespectful terminology such as describing a person’s speech as ‘loud and shouting’.

Feedback did not demonstrate how people felt empowered and able to employ independence, choice and control over their own care and treatment. A person’s relative told us, “When [person] came here, we didn't really have any choice in the matter. [Person] had been in hospital and the staff there didn't feel [person] would be safe or able to be at home anymore and [person] really needed 1:1 care.” Another person told us, “This is not the care home for me.”

We informed the provider people’s care records did not have sufficient information to ensure they had access to relevant activities of interest and the local community, to promote and support their independence, health and wellbeing. The Nominated Individual told us they had asked people’s relatives for information on people’s interests but had not been given any information. This showed a lack of insight and accountability for the failure to explore people’s interests by the management team.

We saw people were able to have visitors in line with national best practice guidance, in order to maintain relationships with family and friends. However, people did not have choice and control in relation to flexible access to the community and leisure activities both inside and outside of the home.

There was a lack of user involvement evidenced in care planning. We also did not see people having a choice. Care plans did not provide detailed information on how staff should support people’s choices or to meet people’s ambitions and goals. Care records did not say how the service was supporting people to be more independent.

As there was a lack of understanding about how to meet people’s needs, staff did not have guidance to meet them to reduce distress or anxiety. Records showed staff did not have plans in place for people when extremely upset and expressing their emotions, and ad hoc attempts to comfort people did not always work. For example, we saw staff make promises to people that could not be kept, in lieu of any other guidance.

Staff told us there were not enough staff in place to meet people’s immediate needs, and they had raised this with leaders, but no action had been taken. Staff shared concerns about supporting people in a timely way if they rang the nurse call bell from their bedrooms, as well as ensuring the safety of people in shared spaces at the same time. The Nominated Individual told us they considered the service to be ‘overstaffed’.

There were insufficient staff suitably deployed to meet people’s immediate needs, which meant they were not always anticipated quickly to reduce discomfort or distress. We also found there were no homely remedies on site, so pain-relief was not readily available unless prescribed, delaying support for people in pain.

Staff did not feel valued, and reported bullying, harassment and racial discrimination by leaders, including threats to revoke Home Office Sponsorship Licences. A staff member told us, “Staff morale at the moment is very down because of new management, they are very unfriendly. I pray that I would not be in trouble. I’m here on a sponsorship so very worried about getting things wrong. One time the [management] said, ‘I don’t care about your sponsorship. If I can’t work with you, you can go, there’s the door’.” Another staff member said, “We are treated like the bottom of a shoe. We are frightened to report anything.” And “We have had 7-8 managers. They [the provider] puts so much on the new managers at once. [Managers] come in here, they were talking to us like we were ‘this big’, shouting at us. They were really rude; they still are rude. They are only nice when CQC are here.”

The provider set up a HR clinic in response to concerns raised by inspectors about staff culture and shared a helpline for staff. However, basic support systems were not in place for staff such as regular supervision or team meetings to help them share any worries. The necessary resources and facilities for safe working were not in place, including access to regular breaks. Records showed some staff routinely working 70-hour weeks. Some supervisions carried out by a previous manager showed a punitive approach to discussions with staff, with comments such as, ‘It is abuse to speak your language when looking after residents’ and ‘We should not tolerate bad practice amongst ourselves and don’t underestimate what will happen if you are caught.’ Records showed staff were regularly physically assaulted by people expressing their distress, but there was no support provided by leaders.