We carried out a review of the data available to us about Elmwood on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Elmwood, you can give feedback on this service.
We found the following examples of good practice:
Safe arrangements were in place for relatives to visit people at the home. Some relatives maintained contact with family members through video and telephone calls. All visitors, including health and social care professionals were screened for symptoms of COVID 19 before being allowed to enter the home. They were supported to follow national guidance on wearing personal protective equipment (PPE) and social distancing.
The home was clean and hygienic throughout and was following the current government guidance in relation to infection prevention and control. The layout of the premises and use of space promoted safety and good hygiene practice. We observed that dining tables and chairs were well-spaced out. We observed some windows on the ground were left open to improve ventilation at the home.
The provider had appropriate arrangements to test people and staff for COVID 19 and was following government guidance on testing. Training records confirmed that staff had received training on COVID 19, infection control and the use of PPE. We observed staff wearing appropriate PPE and socially distancing throughout our visit. COVID 19 risk assessments were carried out with people and staff to ensure they could live and work safely at the home. Staff were provided with a laundry service so they could wash their clothes and change into clean uniforms when they came on duty.
The home had business continuity, COVID 19 contingency plans and risk assessments that made provisions for safe care in the event of an emergency, or outbreak of COVID 19. The registered manager told us they received good support from the provider and the senior management team. The registered manager and staff worked closely with health and social care professionals to provide good care outcomes for people using the service.
People’s experience of using this service:
¿ The home had safeguarding policies and procedures in place and staff had a clear understanding of these procedures.
¿ Appropriate recruitment checks took place before staff started work and there was enough staff available to meet people’s care and support needs.
¿ Risks to people had been assessed and reviewed regularly to ensure people’s needs were safely met.
¿ People were receiving their medicines as prescribed by health care professionals.
¿ The home had procedures in place to reduce the risk of the spread of infections.
¿ Assessments of people’s care and support needs were carried out before they moved into the home.
¿ Staff had received training and support relevant to people’s needs.
¿ People were supported to maintain a balanced diet.
¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.
¿ Staff treated people in a caring and respectful manner.
¿ People and their relatives [where appropriate] had been consulted about their care and support needs.
¿ People were supported to participate in activities that met their needs.
¿ The home provided end of life care and support to people and their family members when required.
¿ The home had a complaints procedure in place. People and their relatives told us they knew how to make a complaint if they were unhappy with the service.
¿ The manager had effective systems in place to assess and monitor the quality of the service.
¿ The manager had worked in partnership with health and social care providers to plan and deliver an effective service.
¿ The provider took people and their relatives views into account through satisfaction surveys and meetings. Feedback from the surveys and meetings was used to improve on the service.
¿ Staff enjoyed working at the home and said they received good support from the manager. Management support was always available for staff when they needed it.
Rating at last inspection: Requires Improvement (Report was published on 24 January 2018).
Why we inspected: This was a planned inspection based on previous rating.
At our last inspection of the service 14 December 2017 we found a breach of regulations in that risks to people were not always managed safely. Improvement was required to ensure staff treated people with dignity, respect, care and compassion. Improvement was also required in the providers systems for monitoring the quality and safety of the service.
At this inspection we found the provider had taken steps to make sure that risks to people were managed safely, we saw staff treated people in a dignified and respectful manner and the provider’s systems for monitoring the quality and safety of the service were operating effectively.
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.
This inspection took place on the 14 December 2017 and was unannounced. Elmwood is a 'care home'. People in care homes receive accommodation and nursing, or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 70 people in the London Borough of Bromley. There were 63 people living at the home at the time of our inspection.
There was registered manager in place. 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.
At this inspection we found a breach of regulations because environmental risks were not always safely managed. The provider had not acted to address all of the fire safety risks identified in the care home’s fire risk assessment within the recommended timeframe. Work was still outstanding to address this issue at the time of our inspection, placing people at risk in the event of a fire. Substances hazardous to health were not always securely stored to prevent accidental harm, and call bells were not always positioned appropriately to enable people to use them if required. Whilst we noted examples of other areas of risk having been appropriately assessed and managed safely, an appropriate assessment of the bed rails on one person’s bed had not been conducted and the bed rail protector on one side of their bed had not been fitted correctly to prevent the risk of injury.
You can see what action we told the provider to take at the back of the full version of the report.
Improvement was required to ensure any safeguarding concerns were consistently identified and reported to the local safeguarding team in line with the provider’s procedures and pan-London guidance. We also found further improvement was required to ensure staff consistently treated people with dignity and respect, and with appropriate care and compassion, and to ensure that the provider’s systems for monitoring the quality and safety of service provision were effective in identifying issues in order to drive improvements.
There were sufficient staff deployed to meet people’s needs and the provider followed safe recruitment practices to ensure new staff were suitable for their roles. People’s medicines were received, stored, administered recorded and disposed of appropriately and safely. Staff were aware of the action to take to prevent and control the risk of infection. Accidents and incidents were reported when they occurred and accident and incident records were monitored by the registered manager to ensure action had been taken to reduce the risk of repeat occurrence.
Staff respected people’s privacy. People were involved in making decisions about their care and treatment. The provider sought people’s views through residents meetings and an annual survey, and acted upon any feedback received in order to make service improvements. Staff spoke positively about the management of the service and told us they were supported by the registered manager. They were aware of the responsibilities of their roles, which were discussed with them during regular staff meetings. The registered manager followed up on any areas discussed at staff meetings to ensure improvements were made in performance where required. They also worked with external agencies when appropriate in support of the people living at the service.
At this inspection we found the provider had safeguarding adult’s procedures in place and staff had a clear understanding of these procedures. Staff had access to a whistle-blowing procedure and said they would use it if they needed to. Appropriate recruitment checks were carried out before staff started working at the home and there were enough staff to meet people’s needs. Risks to people using the service were assessed, reviewed and managed appropriately. People received their medicines as prescribed by health care professionals.
All staff had completed mandatory training in line with the provider’s policy; they were receiving regular formal supervision and, where appropriate, an annual appraisal of their work performance. The registered manager and staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and acted in accordance with this legislation. People were being supported to have a balanced diet and they had access to health care professionals when they needed them.
Staff had a good understanding of peoples care and support needs. They knew people well and had developed positive caring relationships with them. The environment was designed and adapted to meet people’s individual needs. People using the service and their relatives, where appropriate, had been consulted about their care and support needs. They were also provided with appropriate information about the home in the form of a service user guide and people’s privacy and dignity were respected.
People’s care plans and risk assessments provided guidance for staff on how to support them with their needs. Where people’s needs had changed, their care records were being updated to reflect the changes. There was a wide range of appropriate activities available for people to enjoy. People and their relatives knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.
There were appropriate arrangements in place for monitoring the quality of the service that people received. The provider took into account the views of people using the service and relatives through meetings and surveys. The registered manager carried out unannounced visits to the home to make sure people where receiving appropriate care and support. Staff said they enjoyed working at the home and they received good support from the registered manager and senior staff.
We carried out a comprehensive inspection of this service on 28 and 29 July 2014. Two breaches of legal requirements were found. This was because aspects of the service were not safe. The service did not always follow good practice around the storage and recording of medicines. There were no personalised emergency evacuation plans available to guide staff or emergency services in the need for any evacuation in an emergency.
After the comprehensive inspection, the provider sent us an action plan to say what they would do to meet legal requirements in relation to this breach. They told us they would complete the action required by 31 January 2015. We undertook this focused inspection on the 01 July 2015 to check that they had followed their plan and to confirm that they now met legal requirements.
This report only covers our findings in relation to the focused inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Elmwood’ on our website at www.cqc.org.uk.
Elmwood provides accommodation nursing and personal care for up to 70 people. There was a registered manager in place. 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. The registered manager understood their responsibilities as a registered manager.
At this inspection on 01July 2015 we did not ask people for their views about these legal requirements. We looked around the premises and saw there were personal emergency evacuation plans in place. We looked at the systems for the storage and recording of medicines and found the issues identified at the previous inspection had been rectified.
While improvements have been made we have not been able to revise the rating for this key question; to improve the rating to ‘Good.’ This was because at the previous inspection we found, although the provider met legal requirements, we did not inspect all areas of the key question ‘is the service safe?’ at this inspection and our previous inspection had been almost 12 months ago. We will review all of our ratings at the next comprehensive inspection.
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.
This was an unannounced inspection. There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.
Elmwood provides accommodation and nursing care for up to 67 people who have nursing or dementia care needs. The provider had submitted an application to increase the number of people they could provide regulated activities for, to 70 people. This application was being processed at the time of our inspection. The home was built over three floors. The first and second floors were primarily for people who were elderly and frail and or required nursing care. The third floor had been a floor for nursing needs but since March 2014 had changed to support people with dementia.
At our inspection on 7 February 2014 we found that the provider breached regulations relating to people’s care and welfare. People's care plans and risk assessments had not always been implemented in the way that had been planned and we had observed some unsafe manual handling techniques. Following this inspection the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we checked to see if these improvements had been made.
We found that the breach in regulations identified at the last inspection had been addressed. We observed safe and respectful manual handling techniques and found that all staff had received refresher manual handling training. People’s care plans had all been reviewed and risk assessments updated and we saw that they reflected people’s current needs and the care provided.
However people’s safety was being compromised in some areas. We found the provider was not meeting the regulations in relation to the management of medicines and in their arrangements for emergencies. You can see the action we have asked the provider to take at the end of the full version of this report.
There were 63 people using the service on the day of the inspection. People told us they were happy and well looked after. We observed good relationships between staff and people at the service and with their relatives. Staff took time to interact with people in a meaningful way.
The provider had systems in place to ensure that people were protected from the risk of potential harm or abuse. We saw the home had policies and procedures in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, safeguarding and staff recruitment. Staff had received training and understood these policies and procedures. Risk assessments were in place and reflected current risks for people at the service and ways to try and reduce those risks. Equipment at the service was well maintained and monitored and regular checks were undertaken to ensure the safety and suitability of the premises.
Staff knew people’s needs and preferences well and interacted positively with people. There were a range of suitable activities in place for individuals and groups. The service had sought views of dementia specialists about the environment and managing aspects of behaviour safely. Staff had received training on dementia and behaviour that may challenge. People and their relatives were supported sensitively in end of life care.
People’s nutritional needs were met and they told us they enjoyed the food. Staff had a comprehensive range of training and told us they were well supported to carry out their role. People had access to a range of health and social care professionals when required. There were systems in place to monitor the quality of the service and learning was identified and acted upon.
People that we spoke with told they were happy living at the home and the care they received. One person told us 'I receive the care I need and I cannot fault anything', and other people told us staff were polite and friendly. Relatives told us they happy with the care provided to their family member's and staff were available to address their concerns. We observed staff providing people with care in a compassionate manner and the atmosphere within the home was relaxed. However, we observed inappropriate manual and handling practices which were raised with the Registered Manager to investigate and address.
People we spoke with told us that overall, they were happy with the standard of care they received and that the staff treated them respectfully. One person told us "the staff here are very good" and they received all the support they needed. Another person told us that the staff were "polite and friendly" and that they "encourage me to be as independent as possible." One relative told us there had been "ups and downs" with the care their loved one had received over the last few years but that they currently had no real concerns and knew who to speak to if they had any issues that needed addressing.
We found that people were supported to maintain their independence and were treated with dignity and respect. Improvements had been made to the way in which people's needs were assessed and care was planned and delivered in line with their individual care plans in such a way as to ensure their safety and welfare.
We found the records relating to people's care were accurate and fit for purpose and we stored securely on each unit of the home. People were involved in the way their care was planned and delivered. However the provider had not always ensured that people's needs had been adequately assessed and care was not always planned and delivered in such a way as to ensure their safety and welfare. Staff were supported in their roles through supervision and training, including training in the safeguarding of vulnerable adults and overall we found there were enough staff available to help meet people's needs.
On our visit we found concerns with the way care was planned and delivered, lack of involvement of people in their care, insufficient safeguarding arrangements, inadequate staffing levels and supervision and support provided to staff and the inaccurate documentation of care plans.
People were encouraged to make their own choices as much as possible. People were happy with the size and cleanliness of their bedrooms and communal and treatment areas. The home encouraged people to have personal belongings and photos in their rooms. Family and friends were encouraged to visit.
At times it took longer than people would have liked for staff to respond to bedside buzzers. Where people had raised this issue with staff, staff had apologised and thanked them for raising the issue, and since then response times had been faster.
People were given assistance to move and mobilise and mobility aids and physiotherapy were made available. People receiving physiotherapy as part of their care praised this service as excellent.
People said that food at the home was okay to very good and snacks were available between meals on request. There were set times for the three main meals, but people were not rushed to finish meals and could choose to eat either in the dining room or their bedrooms, though they were encouraged to eat in the dining area. Staff gave one to one assistance to people to eat and drink when required.