The Elms Residential Care Home

The Elms Residential Home is a residential care home providing personal care and accommodation for up to 27 older people, some of whom have dementia. The service is made up of a four-storey house with en-suite bedrooms and communal facilities. At the time of our inspection visit there were 21 people receiving care.

People's experience of using this service and what we found

Risks to people's health had been assessed and identified, but staff were not always aware of people's risks to keep them safe. Records did not demonstrate safe practice and enable effective monitoring of risks to take place. Staff had not always recorded that people’s topical medicines had been applied to provide assurance they were given in accordance with the prescriber’s instructions.

Staffing was maintained at the level the provider had assessed was needed. However, due to the high numbers of new and agency staff, shifts were not always staffed with care workers who had extensive knowledge of people's individual needs. The provider did not have effective systems to confirm the identity of agency staff and ensure they had the appropriate training and employment checks in place.

Staff understood their role in reporting any safeguarding concerns. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There had been recent and significant changes in managers and key senior staff at the service which had impacted on some quality standards. Systems and processes to monitor and improve the quality of care provided had not been effective in identifying the areas of improvement we found during our visit.

Despite the issues we identified, people and most relatives were happy with the care provided. Relatives told us they were kept informed about their family member’s health and that staff worked with other healthcare professionals to improve outcomes for people.

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

Rating at last inspection

The last rating for this service was good (published 6 December 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and the culture within the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Elms Residential Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches of regulations in relation to the management of risks and the governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow-up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Elms Residential Home is a residential care home providing personal care and accommodation for up to 27 older people living with dementia. The service is made up of a four-storey house with en-suite bedrooms and communal facilities. At the time of our inspection visit there were twenty-two people receiving care.

People’s experience of using this service

The registered manager was open and honest, and worked in partnership with outside agencies to improve the service. There were checks in place to ensure good standards of care were maintained, however improvements were required to ensure all checks were effective. The registered manager had not sent us statutory notifications to notify us of restrictions placed on people's care, as they were required to do.

People felt safe using the service. Staff managed the risks to people’s health, safety and well-being and understood how to recognise and report abuse. Staff recruitment processes included background checks to review their suitability to work with vulnerable adults.

People received support from staff when needed. People were supported to have enough to eat and drink to maintain their well-being. They were supported with their medicines and to obtain advice from healthcare professionals when required.

Staff had training to meet people’s needs and the registered manager shared guidance with staff on how to support people effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were treated with dignity and their independence was promoted wherever possible. They were encouraged to take part in activities which interested them and make new friends. Links to the local community were maintained and this improved people’s wellbeing.

People and their relatives were involved in planning care in their best interests. People and their families understood how to complain if they wanted to.

Rating at last inspection

The last inspection was a comprehensive inspection. The service was rated Good in all areas (report published 11 May 2017). We have used the previous rating to inform our planning and decisions about the rating at this inspection.

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 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

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.

Staff understood their responsibilities to protect people from the risk of abuse. The registered manager checked staff’s suitability for their role before they started working at the home and made sure there were enough staff to support people safely. Medicines were stored, administered and managed safely.

Risks to people’s individual health and wellbeing were identified and care was planned to minimise the risks. People and their families were included in planning how they were cared for and supported. The registered manager regularly checked the premises and equipment were safe for people to use.

People were cared for and supported by staff who had the skills and training to meet their needs. The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to eat and drink enough to maintain a balanced diet that met their preferences and were referred to healthcare services when their health needs changed.

People, relatives and staff felt well cared for. Staff respected people’s diverse needs and interests and encouraged them to maintain their independence in accordance with their wishes and abilities. Staff were happy working at the home because the registered manager cared equally about their wellbeing and understood that happy staff made people feel happier.

The manager and staff understood people’s individual needs, preferences, likes and dislikes. People were encouraged to maintain their interests and to take part in social activities in the home and in the local community. Staff knew people well and respected their privacy and dignity.

People and relatives knew the manager well and had no complaints about the service. Staff were inspired by the registered manager’s leadership, skills and experience to provide a quality service.

Further information is in the detailed findings below.

We spoke with three relatives, a visiting professional and one person who supported people to obtain their views about the home. We also spoke with the manager, three members of the care staff and the cook.

We observed staff interaction and talked with care staff about how they met the needs of people they supported.

Staff demonstrated a clear understanding of people's needs and engaged with people in a positive manner. People appeared relaxed and happy in the company of the staff and were not hesitant when they approached them.

The relatives and visitors we spoke with told us they were happy with the care at The Elms.

We looked at the care planning documentation and we found that care plans were detailed and demonstrated that staff treated each person as an individual based upon their needs.

We saw that people's nutritional needs had been identified and people were provided with a good choice of food. People told us they were happy with the choices available to them.

Systems were in place to ensure that medicines were managed appropriately on people's behalf.

Staff told us they were supported by the manager and had access to regular training.

We saw that information was available to enable people to make a complaint and a system was in place to record any complaints.

We saw that people were free to spend time how they liked. We saw a list of activities that people could join in with on the notice board. People who lived at the home told us what they enjoyed doing. One person said, 'There are meetings, but I don't want to go. I like to keep myself to myself.' Another person said, 'I enjoy doing nothing, living with my memories, little secrets of my own. I just like thinking about my life.'

There were enough staff to support everyone according to their needs on the day of our visit. We saw staff playing scrabble with four people and at lunch time we saw staff assisting one person who was not able to eat independently. The day's meal choices were shown in large, colour photos in the dining room. People we spoke with told us the food was very good. One person said, 'The food is very nice and I can choose what I eat.'

We spoke with three care staff and they all told us they enjoyed working at the home. One member of care staff said, 'I love working here. I love it. X is a brilliant boss,' and another said, 'It is good here, we are close, we work together as a team.'