The inspection team consisted of one adult social care CQC inspector. On the day of our inspection ten people used the service. We spoke with three people who use the service, three people's relatives, two care workers, two assistant managers and the registered manager. The Elms is one of a group of residential homes providing care and support to people within a village environment known as Ravenswood Village. It was run primarily for those of Jewish faith, but people and staff did not have to be Jewish to live or work there. People were supported to practice their faith, and the village celebrated Jewish rituals and festivals. People had the choice of whether they wished to attend the synagogue or follow Jewish rituals.
We observed how staff supported people, and looked at documents including care plans and management reports. We had found areas of non-compliance with the Health and Social Care Act regulations at a previous CQC inspection on 10 September 2013. This was in relation to record keeping and monitoring and assessing the quality of service provision. As part of this inspection we considered if the service was now compliant with these outcomes, and also looked at consent to care, care and welfare of people, and cleanliness and infection control. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;
' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well led?
This is a summary of what we found.
Is the service caring?
We found staff were caring. Relatives described care workers as 'absolutely devoted' and 'approachable and friendly'. One relative stated 'I am thankful X is in The Elms. They can't do enough for' X.
We observed staff were respectful of people, and included them in all aspects of their care and support. Care workers ensured they supported people as they wished, and promoted people's independence and wellbeing. People told us they liked the staff.
One care worker told us 'The service is full on, vibrant, always on the go. It's demanding, but it can be a joy to work here'. Another said 'We work for the benefit of the people who live here'.
Is the service responsive?
We saw staff were responsive to people's changing needs, and supported people at the pace they required. People's care plans reflected their needs and wishes, and care workers updated these to ensure information was current. Care workers sought support from health professionals to meet people's health needs, such as guidance for diets appropriate for people with swallowing difficulties.
We saw care workers used assistive technology to alert them of people's location or night activities. They understood actions to follow when this technology did not work to ensure people were not at risk of harm. One care worker told us 'It's all about the residents'.
Is the service safe?
We found the service was safe. One relative told us 'overall I'm really thrilled [with the care provided], particularly in regard to cleanliness and care'. One person told us 'Staff keep me safe'.
We found people were supported to ensure risks to their health and wellbeing were minimised. Risks were identified and assessed to promote people's safety without restricting their activities. Care workers followed guidance in people's care plans to ensure they were supported safely.
The home environment was clean, and staff were aware of actions required to protect people from infections, such as the use of protective clothing and hand hygiene protocols. Confidential records, such information about people and staff, were mostly stored securely. The registered manager was aware of the importance of secure storage and disposal of records, and described the process they followed to meet the required standards. There was a risk-assessed balance between protecting people's records and prompt access for staff to read and update information such as care plans.
Is the service effective?
People were supported effectively to help them understand options and choices, and the consequences of their decisions. One care worker told us 'We put them at the centre of decision-making, and offer alternatives'. Staff involved people in all aspects of their care and the running of the home. For example, we saw one person assisted staff with testing the fire alarm during our inspection.
Care workers recognised they could only assist people with their consent, and understood people had a right to make their own decisions, even if staff felt these were poor decisions. One care worker explained 'We have to follow what they want. We can't deny them an opportunity. We have to put our own reservations to one side'.
Is the service well led?
We found the service was well led. One relative told us they could think of 'No faults whatsoever'. One care worker told us 'The management team are strong', and another said 'There is good management, they always have time to listen, and act appropriately. We get lots of back up here'.
People's views and feedback were sought, and staff took actions to meet their requests. Relatives told us staff listened to their comments and kept them informed. People were involved in planning their care, support and activities, and agreed house rules to reduce disruptions within the home.
Senior staff and the provider carried out checks and audits to be assured of the quality of the care provided. For example, we saw summaries of accidents and incidents were compiled quarterly to analyse trends for each person. This meant the registered manager was able to identify changes required to promote people's health and welfare.
People were aware of the complaints process, and were supported to make complaints. The opportunity to discuss concerns was promoted in residents' meetings.