The Elms

Updated 17 June 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by one inspector.

Service and service type

The Elms is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Elms is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post, a new manager started at the service during the inspection.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the service registered. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 10 members of staff including three care staff, two senior staff, a cook, two managers, a director and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with two people who used the service, six relatives and observed staff interactions.

We looked around the home to review the facilities available for people and the infection prevention and control procedures in place. We also looked at a range of documentation including care files and daily records for six people and medication administration records for four people. We looked at two staff recruitment files and reviewed documentation relating to the management and running of the service such as staff rotas, training and audits.

Updated 17 June 2022

About the service

The Elms is a residential care home providing accommodation and personal care for up to 37 younger or older adults, who may have a physical disability or be living with dementia. It accommodates people in one adapted premises with shared facilities. At the time of the inspection, 30 people were using the service.

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

People’s safety and wellbeing were compromised by shortfalls in infection prevention and control, the safe management of medicines, risks not always being assessed and staff not having specific training to meet the needs of some people who used the service.

Accidents, incidents and safeguarding concerns were appropriately managed by staff. However, there was no monitoring system in place to support learning and reduce the risk of them happening again. We have made a recommendation about safeguarding.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care plans were not always completed in a timely manner and lacked detailed guidance for staff to meet people’s needs. Care records did not clearly record advice from healthcare professionals which meant staff did not always have access to up to date information about people’s needs.

Quality assurance systems were not effective in maintaining the quality and the safety of the service. The provider was working with relevant professionals to improve the service.

There was a lack of activities for people to engage in at the service. We have made a recommendation about activities.

People were supported by sufficient numbers of kind, caring and attentive staff. Staff promoted people’s independence and maintained their privacy and dignity. People were supported to maintain their relationships with their families and friends. Staff were positive about the new provider and management team and felt listened to.

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

Rating at last inspection and update

The last rating for the service under the previous provider was requires improvement (published 10 August 2021). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last six consecutive inspections. At this inspection we found the new provider remained in breach of regulations.

At our last inspection we recommended that the provider review their processes for maintaining up to date and accurate records and that they review their deployment of staff. At this inspection we found continued shortfalls in care records. However, there was an improvement in the deployment of staff.

Why we inspected

The inspection was prompted in part due to concerns we received about medicines, infection control, training, person-centred care and leadership of the service. A decision was made for us to inspect and examine those risks.

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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines, risk management, staff training, consent and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.