Elmcroft Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked at all quality statements for Effective at this assessment. The service was not effective. This showed a decline since the last inspection. Assessments were completed by the service, but this did not translate to person-centred, effective care plans. This included a failure to assess the impact of specific health conditions and need for social and emotional support, including in relation to people’s mental health needs. There were insufficient staff available to support people to eat at mealtimes, and care was task-led. Whilst people without capacity received an assessment on their ability to make decisions, there was a lack of choice more widely for all people living at the service. This impacted on people’s quality of life. During our assessment of this key question, we found concerns relating to staff support and training, resulting 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.

People and those important to them were not always involved in the planning of their care and support needs. Feedback showed there was a lack of consistent user-involvement in the assessment and care planning process.

We gave feedback that assessments and care plans were not sufficiently detailed, accurate or personalised to people’s needs. A staff member told us, “We would like to know more about the backgrounds of each of our residents, like what they did for a living where they are from, children, interests and so on and what activity they would like but I haven't seen anything like that yet.” The provider told us they would give care planning training to staff and sought to update care plan documents, including seeking input from people and their relatives on interests and life history.

Assessments completed by the service failed to demonstrate effective, safe, and person-centred care planning. This included for people with highly-specific needs relating to their mental health or dementia conditions, which required specialist support and guidance. We raised concerns relating to a lack of assessments for people at risk of suicidal ideation or self-harm. The provider had also not robustly assessed whether they could meet the needs of people with higher support needs they had admitted into the care home setting. This placed people at risk of their needs not being met. Oversight processes failed to identify when care plans were not updated in a timely way, for example to record if there had been a safeguarding concern.

Although some people gave positive feedback about the quality of meals, people’s nutrition and hydration needs were not consistently met. A person’s relative said, “I don't think [my person] is getting much water and not eating much. So, like the other day [person] was given the choice of 2 meals and chose omelettes. Well [person] is not able to make those choices anymore. Anyway, [person] really doesn’t like eggs and of course didn't eat it. [Staff] should be aware of things like that, and they don't seem to encourage [my person] to eat, they just take the food away.” Another person told us, “I would sometimes just like a cup of plain water, but you can't find any here, there's only squash on offer.” Menus were not always accurate and were decided at corporate level without evidence of people’s input. A person’s relative said, “[My person] is not getting what’s on the menu.”

Staff expressed concerns about food provided for people. A staff member told us, “[People] had fruit today, but this is today because you (CQC) are here. I don’t remember when we last had proper fresh vegetables.” The staff member also told us, “Diabetic people often go without a pudding. There are no snacks for people at risk of choking. We have to pour tea on a biscuit and scrape it up with a spoon.” Another staff member told us monitoring of food eaten was completed inaccurately after meals had been cleared away, as “[Staff] should leave the plate on the table. It is done from memory; it is not seen.” The provider told us they had purchased adapted crockery and cutlery to support people to eat.

We observed there were not enough staff to support and interact with people left to eat independently, and therefore they did not receive the encouragement or practical help they needed to eat more. As a result, some people ate very little of what they were served. Concerns with mealtime experience were identified at our last inspection in 2022 and had not been resolved. This had not been identified by the provider through processes such as mealtime audits.

People did not experience effective care, as staff did not have the information required to consistently work well with one another or other system partners. This included in relation to appropriate escalation of concerns and referrals to other professionals. For example, a person’s relative told us, “My [person] was recently admitted to hospital after I noticed [they] didn’t look well, and [person] was diagnosed with pneumonia and sepsis. I worry if staff would have noticed if I had not visited that day. However, staff are good with calling out a doctor.”

Staff did not have access to the information they needed to assess, plan and deliver people’s care, treatment and support. Staff described a lack of information sharing and fractured internal staff teams, which impacted on people’s continuity of care. A staff member told us, “We don’t have proper handovers, its word of mouth. I was dishing up breakfast for one resident and got told, ‘Oh no, they’re in hospital’.”

We received consistently poor feedback from other stakeholders about the service, both in terms of staff working with external parties and with one another. A professional who works with the service told us, “Staff: They seem, very vague when entering the building, preoccupied in what they are doing and not very willing to help. When asked, will reluctantly assist, point you in the right direction and quickly scurry off in another direction before being asked another question. The Actual Area I Needed: No-one knew what anyone was doing, or where anyone was. No job structure, very mish mash. The staff on duty didn’t know what the others were doing. ‘Where is so and so?’ and ‘What is so and so doing?’ could be heard.”

Processes were not in place to ensure accurate information about people’s health, care and support needs were recorded so this could be shared with the staff team and health and care professionals when required. Systems did not support staff to work together to provide safe care. A staff member told us, “When you get new staff, they should have moving and handling [practical training]. This is why we are getting lots of bruises. There is no manual handling person here.”

People were not empowered and supported to manage their own health, care and wellbeing needs. A person’s relative said, “When [person] first came here [person] was walking with a frame, but because [person] was left in their room and bed for so long, they are no longer walking at all. I've asked [staff] to get [person] out of their room more and walking but it hasn't happened and now we've noticed how weak [person] has become.”

Whilst the provider made referrals to other professionals to support people with their health needs, information and recommendations were not always documented in people’s records to guide staff. This included recommendations from professionals such as specialist Parkinson’s Disease nurses, or the community mental health team.

Processes were not in place to focus on identifying risks to people’s health and wellbeing early on, or how to support people to prevent deterioration. For example, staffing calculations did not consider any extra support required for people’s emotional and psychological health.

People did not consistently experience positive outcomes including in relation to their quality of life. For example, whilst we saw some evidence of group activities for people led by the activities co-ordinator, other people such as those cared for in bed did not have the same experience. Some people’s relatives expressed concerns about a lack of enrichment and stimulation for people, including those living with dementia. A person’s relative told us they felt people were, “Just sitting.” Another person’s relative said, “I come in every day except Sundays and have noticed [my person] get no stimulation at all and [person] needs it because they are in their room all the time, but [staff] never seem to come in.”

The provider told us they reviewed metrics relating to aspects of people’s health and care needs at daily flash meetings, such as fluid intake. However, there were no effective approaches to monitoring and supporting people’s wellbeing or the impact of wider health needs.

There was a lack of effective processes for monitoring people’s care, treatment and outcomes to ensure continuous improvements. This included in relation to daily care notes, which were task-led and did not provide any opportunity to review and improve metrics relating to quality of life. People did not have the opportunity to set out and document their own aims, ambitions or metrics for success and a good quality of life to ensure consistently positive outcomes.

People did not always experience care in a way which upheld their right to privacy, freedom of movement and human rights. This included people with 24 hour 1:1 care being observed at all times, including when asleep or in the bathroom, without a robust plan in place setting out why this level of restriction was necessary.

Staff told us they were committed to seeking people’s consent and offering choices. A staff member told us, “Residents are given choice of what to eat and where to eat. Some people like to be in their rooms, or in the lounge, so we ask every day.” However, we found staff did not always have the training, support or guidance from the management team to provide care to people living with dementia, or with mental health needs, in a person-centred way. This was particularly the case for people with higher support needs and impacted on people’s quality of life.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. The service was not working within the principles of the MCA. Mental capacity assessments were in place for people where required, and there was evidence DoLS had been applied for. However, the provider’s own systems failed to identify indicators of staff practice which did not represent the least restrictive option or could constitute institutionalised care.