The Elms Residential Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The registered manager had been in post since February 2023 and had established a staff team who worked well and effectively together. Staff spoke of a supportive and positive culture where they were encouraged to speak up and share their ideas and concerns. Staff told us equality and diversity were promoted and the registered manager listened to them to ensure reasonable adjustments were implemented to support their wellbeing at work. Improvements had been made to governance and quality assurance processes to ensure regulations were met. However, some checks needed to be more robust to identify areas for development and then used to create an action plan to further drive improvement at the service.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff described a supportive and positive culture where they worked collaboratively to provide good care. The registered manager told us that over the last 18 months their focus had been on building a staff team who knew what was expected of them and who encouraged people to live their best life possible. They explained how they had worked with staff to develop their skills and confidence and told us, “I want people to be happy and live well. There is definitely more to people’s lives than sitting in a chair all day. I have got staff to look at things from a different point of view to improve people’s lives.” A staff member told us how this approach had a positive impact on one person who now chose to spend more time in communal areas with other people. Another staff member commented, "We are a family through and through. We care for the residents; we celebrate their birthdays and for any resident I can tell you about their family and any significant life events. Everyone is well cared for and everyone is listened to.”

The registered manager spent time with people and observed staff to ensure they supported people in a person-centred way. Staff had regular supervision to review their practice and discuss any personal development. Staff also had staff meetings where they could share their views and opinions about the service. People and visiting healthcare professionals were asked for their feedback through quality assurance questionnaires. The last questionnaire demonstrated people were happy with the standards of care at The Elms.

Staff told us the registered manager was very knowledgeable and always approachable if they needed guidance or support. Comments included: "[Registered manager] is very supportive, a great manager, personal issues or work issues, she really knows what to say. She has helped me to improve as both a senior and a carer”, "Talking to the manager, she sorts everything out because she really wants you to be competent. She is one of a kind and I have learned a lot from her” and "I love my manager she is wonderful. When you have a manager who cares, you will like your job." The registered manager told us they felt supported by the provider and could contact them whenever they needed to.

The registered manager demonstrated a visible and knowledgeable presence within the home and supported staff to work well and effectively together. However, they acknowledged some checks and support systems were not formally recorded and therefore could not evidence actions taken to drive improvements within the service. For example, observations of staff practice. The provider had systems to support the physical and mental wellbeing of staff, such as a 24 hour confidential helpline for support in areas such as stress and anxiety, financial wellbeing and counselling. The provider also signposted staff to other organisations who could provide further guidance and support.

Staff told us they were encouraged to speak up and share their ideas and concerns. Staff told us the registered manager was fully engaged with them and listened to their opinions. However, they also told us they could escalate issues to the provider’s human resources (HR) manager if they needed to. Comments included: “[Registered manager] is very good at listening to us, and she comes to us and asks what we need and what things are working”, “If I have a suggestion or something to say, I don’t feel hesitant to go to [registered manager]. If there was a situation, where I felt I wasn’t being heard, I have always known I can contact [HR manager]” and, “We are encouraged to speak up because it is in the interests of the residents.” The registered manager told us, “They know it is an open-door policy. For staff meetings, I ask them if there is anything they want to put on the agenda.”

Processes were in place to enable staff to speak up. This included safeguarding training, so staff understood their role in speaking up on behalf of those less able to. The registered manager had an open-door policy and made time to listen to staff. Staff were invited to add agenda items for discussion at team meetings. The provider had a human resources department where staff could escalate concerns outside the service.

Staff told us equality and diversity were promoted and they had not experienced discrimination. One staff member described the reasonable adjustments put in place to support them after a period of extended leave from work. This included 'keeping in touch' days so they could meet staff and residents who had moved to the home during their absence. This staff member told us, "I wouldn’t have been able to come back to work if it wasn’t for [registered manager]. She has worked out a plan to make it as easy as possible for me." Another staff member told us how flexibility in the rota had enabled them to celebrate an important religious festival. Both staff told how these adjustments supported their wellbeing at work.

The provider had effective systems to support equality and diversity through recruitment, induction and training. Regular meetings enabled the registered manager to identify any reasonable adjustments staff required to support their practice and wellbeing in the workplace.

Staff with extra responsibilities told us they received support and training to ensure they had the knowledge and confidence to carry out their roles. One senior staff member told us, "Before I even started my first shift as a senior, I had shadowing with the other senior member of staff. I got that experience before I started.” The registered manager spoke enthusiastically about their actions to improve the service and acknowledged their focus had been on building an effective staff team who provided person-centred care. They acknowledged that they needed to improve checking and auditing systems and planned to work closely with the senior team to further develop their skill sets to achieve this.

Some improvements had been made regarding the governance, quality assurance and management at The Elms. However, some audits and checks needed to be improved to ensure they identified where improvements were required. For example, medication audits had not identified the issues we identified in the management of ‘as required’ and topical medicines. Reviews of care plans had not identified people’s risk assessment tools were not being reviewed regularly or in response to a deterioration in health or an accident/incident. Checks of daily records had not led to consistency in completing tools to evidence people's risk management plans were followed. Processes to quality assure the service needed to be improved to identify areas for development and then used to create an action plan to further drive improvement at the service.

Relatives spoke of good communication with staff and managers which enabled them to maintain a role in supporting their family member’s health and wellbeing. Comments included: “[Registered manager] is really good at updating me. When I go in, they are always explaining what is happening. I feel like [Name’s] daughter again and not her carer anymore” and, “I have got a voice. I can ring without any hesitation.”

Staff told us people were monitored and referred to other healthcare professionals when a need was identified. The registered manager encouraged community engagement, and several people attended a local coffee morning on the day of our visit.

Partners told us they had no concerns with the service people received and that staff contacted them for support when required. One healthcare professional told us that following feedback, the registered manager had implemented a new system to ensure effective information sharing prior to their visits. Another healthcare professional told us the provider took advantage of training opportunities to improve staff knowledge and understanding.

The provider had systems to ensure people’s physical, mental and emotional healthcare needs were reviewed with partners. The registered manager kept up to date with changes in local processes to ensure they continued to liaise effectively with partner organisations.

Staff spoke of an environment of learning and improvement where they felt able to share ideas and make suggestions. One staff member told us, "Because I worked as a carer and then became a senior, I know what needs to be done and what needs to be changed so I can make those suggestions.” This staff member told us there was a no blame culture and said, "If I have made a mistake, I would let [registered manager] know. I have never felt something would be held against me.” This was confirmed by a member of care staff who told us, "I tend to own up to my mistakes. If you hide it, it is not a mistake anymore. We discuss it and try not to do things like that in the future.” Another staff member told us, "[Registered manager] is very good at listening to us, she comes to us and asks what we need and what things are working. She listens and then we come up with a plan and try to get everything put in place as much as possible.” The registered manager told us they were committed to building a knowledgeable and confident staff team to improve people’s outcomes. They explained, "I had to work really hard with the staff when I came on board. I spent a lot of time on the floor, talking to the staff, getting to know the staff and seeing what was happening out there so I could introduce the changes that were needed.”

The provider had learned from previous inspections and quality assurance checks by other partner organisations. Further improvements were needed to evidence the provider was monitoring the service effectively to ensure improvements were made and embedded in the practice of the home.