We carried out a review of the data available to us about The Elms Nursing Home 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 The Elms Nursing Home, you can give feedback on this service.
The Elms Nursing Home is registered to provide accommodation for up to 48 people. The home provides both personal and nursing care support to older people including those living with dementia. The home also provides short term rehabilitation support for people. At the time of the inspection the home accommodated a total of 41 people.
People’s experience of using this service and what we found
People were happy living at The Elms Nursing Home and spoke positively about the care they received and the running of the service.
We received mixed views from people and relatives in relation to the staffing levels. However, throughout the inspection we observed staffing levels were appropriate to meet people's needs and staff were available to people and responsive to people's requests for support in a timely way. Following our feedback on people’s views about staffing levels, the management team agreed to investigate this. Recruitment practices were safe and effective.
Although people told us they were involved in their care, some of the feedback we had from relatives highlighted they did not always feel involved or included in people’s care and were not always updated of changes in people’s needs. This had been identified by the management team prior to the inspection and plans were in place to address this.
The home was clean and there was a homely, welcoming and happy environment. Environmental risks had been considered and acted on where required. There were up to date policies and processes for the management of infection, prevention and control and the provider, management and staff adhered to the latest government guidance.
People's care plans and risk assessments contained information about their needs and how these should be managed. People's health and wellbeing was monitored in line with information highlighted in their care plans and risk assessments.
Safe systems were in place in relation to medicine management and people received their medicine as prescribed.
People were protected from avoidable harm. 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.
Staff had received appropriate training and support to enable them to carry out their role safely. They received regular supervision to help develop their skills and support them in their role. People were provided with enough to eat and drink.
People's needs were met in a personalised way. Staff knew the people they supported well and had a good understanding of their needs.
People were supported to partake in a range of activities centred around their particular interests. There was a person-centred culture within the service.
The service worked in partnership with other agencies to aid joined up, person centred care provision.
Effective and robust quality assurance systems had been developed and implemented to continually assess, monitor and improve the quality of care people received.
Throughout the inspection the management team showed a commitment to wanting to provide people with person centred, safe and effective care. They were open, transparent and responsive throughout the inspection.
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 overall rating for this service was requires improvement (published 19 November 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was prompted due to the previous rating of the service. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Elms Nursing Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
The care home was clean, and staff were observed to have plentiful supply of cleaning products and personal protective equipment, which they were re-stocking as they moved around the home. Cleaning staff had a programme of continuously cleaning high touch surfaces, such as light switches, grab rails and door handles. We also saw communal areas were kept uncluttered so cleaning could take place effectively. There were appropriate laundry processes in place.
The provider had implemented a robust visiting process, which had been shared with people’s relatives. Visits were by appointment only and the service ensured visits were spaced out, to help ensure social distancing could be maintained. There was a visiting pod available, which relatives entered from the garden and included a full screen to facilitate safe visits. However, at the time of our site visit the home was still closed to visitors, due to a recent outbreak of COVID-19. Visits for people who were at the end of their life were still supported and there was clear instructions and appropriate PPE for visitors, to manage risks. In addition, people were supported to have contact with their relatives using video calls and telephone calls.
Individual risk assessments were completed for each person in relation to them receiving visitors. These gave clear guidance for staff on how visits should be managed to ensure safety for all. In addition, there were detailed and robust risk assessments in place to manage and minimise the risks Covid-19 presented to people who used the service, staff and visitors.
Staff were using PPE correctly and in accordance with current guidance and had received training in relation to Covid-19 which included, infection control and use and donning and doffing of PPE. Staff infection control practices and PPE use was closely monitored by the management team, to ensure correct procedures were being followed.
Staff were required to change into clean uniforms in the home at the start of their shift and back into home clothes at the end of the shift. Staff uniforms were laundered in the home to ensure they were washed at the correct temperature.
The provider routinely tested people and staff for Covid-19. Staff had access to rapid response lateral flow tests (LFT) as well as standard Polymerase Chain Reaction (PCR) tests.
The registered manager and provider had systems to ensure there was clear oversight in relation to infection prevention and control. There were robust infection control audits in place.
The Elms Nursing Home is registered to provide accommodation for up to 48 people. The home provides both personal and nursing care support to older people including those living with dementia. The home also provides short term rehabilitation support for people. At the time of the inspection the home accommodated a total of 38 people.
People’s experience of using this service and what we found
Since the last inspection there had been a number of improvements made to the service. These improvements included, more effective staff deployment, increased management oversight, more robust monitoring of the quality of care provided and the upskilling of staff. This had resulted in safer care being provided to people living at The Elms.
People and relatives told us they felt safe and were happy with their care. They confirmed staff were kind and caring and we observed positive interactions between staff and people.
We observed sufficient numbers of staff available to meet people's needs. Staff were available to people in a timely way. Safe and effective recruitment practices were in place and followed.
People's care plans and risk assessments contained consistent and detailed information in relation to people’s needs and how these should be managed. People’s health needs and wellbeing was monitored in line with the information highlighted in their care plans and risk assessments.
People received their medicine as prescribed. Medicine administration care plans and ‘as required’ (PRN) plans provided staff with clear and detailed information on how people liked to receive their medicines and when these medicines should be given.
People, relatives and staff were positive about the running of the service and the support they received from the management team and providers. People and staff felt there had been improvements in all aspects of the service since the last inspection.
The management team were open and transparent. They understood their regulatory responsibilities. People and their relatives said the management team were open, approachable and supportive. There were effective governance systems in place to identify concerns in the service and drive improvement.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 19 November 2019) and there were multiple breaches of regulation. The provider was issued warning notices telling them they must make improvements and send us an action plan stating how this would be achieved within our timescales. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We undertook this focused inspection to ensure that the Warning Notices we previously served to the service in relation to, Regulation 18 (Staffing) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.
Currently CQC is undertaking inspections to ensure services are safe and well-led. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. We have rated the Key Questions for safe and Well-led as Good. However, the overall rating for the service has remained as Requires Improvement. This is based on the findings at the previous comprehensive inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Elms Nursing Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The Elms Nursing Home is registered to provide accommodation for up to 48 people. The home provides both personal and nursing care support to older people including those living with dementia. The home also provides short term rehabilitation support for people. At the time of the inspection the home accommodated a total of 43 people.
People’s experience of using this service and what we found
There were not enough staff available to meet people's needs. Improvements were needed in relation to delegation of staff to make sure people received the support they needed in a timely way. There was a task focused approach to care which did not always ensure that care was provided in a person- centred way. People were left waiting for care and support when it was required.
Systems for auditing the safety and quality of the service were not effective in identifying issues which could affect people's safety. Risks to people's health and wellbeing were not consistently well managed. Care records did not always provide sufficient detail to guide staff on how to look after people safely.
People were not protected in a safe environment. We identified risks in the environment which had not been recognised or addressed by staff or the management.
People were not always treated with dignity and respect. Due to staff shortages, staff did not always engage with people in a respectful and meaningful way.
Systems and processes designed to identify shortfalls and to improve the quality of care were not effective. Our previous inspection rated the service as Requires Improvement and identified breaches of regulations 18, 17 and 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service continued to be in breach of regulations 17 and 18 and actions the service had taken to improve had not been effective or sustained.
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 22 September 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified the following breaches at this inspection.
Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider failed to ensure sufficient staff were deployed to meet people's needs at all times.
Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure risks relating to the safety and welfare of people using the service are assessed and managed.
Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider failed to operate effective systems to assess, monitor and improve the service.
Full information about CQC's regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.
Follow up
We will continue to monitor the service to gain assurance that appropriate measures are put in place to address concerns. We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The Elms Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The Elms Nursing Home is registered to provide accommodation for up to 48 people. The home provides both personal and nursing care support to older people including those living with dementia. The home also provides short term rehabilitation support for people.
At the time of the inspection the home accommodated a total of 37 people. Accommodation was arranged over three floors with lift access to all floors. There were several communal areas and places for people to sit quietly and meet with their families or friends. There were accessible outside spaces for people to access. There were also small bungalows in the grounds where some people lived. However, we were told that the home does not provide any regulated activity to the people living in the bungalows so these were not considered as part of this inspection.
There was a registered manager who was present throughout the inspection. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.
This service was last inspected in November 2015 when we found that the provider had not ensured that there were detailed person-centred care plans for people. At this inspection we found that although some action had been taken to address this issue, additional improvements were required.
At this comprehensive inspection we found six breaches of regulations. Failures to provide safe care, person centred care, provide enough staff to meet people’s needs, good governance and failing to act in accordance with the Mental Capacity Act 2005 were issues we identified during this inspection.
Quality assurance systems were not sufficient to monitor and review the quality of the service which was provided. These had not been used effectively to identify concerns we found or drive improvement in the service.
There were not enough staff to meet more than people's basic personal care needs. Staff were task orientated and did not always engage with people and support them to be involved in meaningful activities.
Care plans were not consistently person centred and contained conflicting information. Risk assessments that related to people's health and safety did not ensure that all risks were effectively assessed. This exposed people to a risk of neglect and unsafe or inappropriate care or treatment.
Records of the assessment of people's ability to make some informed decisions had been undertaken. However, these had been recorded as generic decisions and were not decision specific. The principles of the Mental Capacity Act 2005 were not being applied in respect of best interest decisions to provide care or use least restrictive practices. This led to people being unlawfully deprived of their liberty.
Staff had received training to meet people's needs; however, this had failed to ensure that safeguarding processes were followed.
Peoples' wellbeing was not promoted due to a lack of person centred activities. We observed, and people told us, that activities were limited and did not take place as detailed in the schedule of activities.
People had mixed views about the food and choices were not offered in an effective way for people living with dementia.
We received some positive feedback about the staff and their approach with people using the service. However, some staff showed a lack of consideration for people's dignity, for example in the lack of communication when supporting people to eat or moving them to a different area.
People felt that the staff were helpful. However, several people told us that at times they had to wait a long time for support.
Most staff told us they were happy working at the home and felt supported in their roles by the registered manager. However, some felt that concerns they had were not listened to or not investigated thoroughly.
Staff had received regular supervision.
Staff completed pre-admission assessments before people moved to the home and people had access to healthcare services.
People and relatives told us they felt safe. The administration, safe management and security of medicines were in line with best practice.
We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Care Quality Commission (Registration) Regulations 2009. You can see at the end of this report the action we have asked to provider to take.
The Elms Nursing Home is registered to provide accommodation for up to 48 People. The home provides both personal and nursing care support to older people including those living with dementia. The home also provides short term rehabilitation support for up to five people. At the time of the inspection the home accommodated a total of 45 people.
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.
The inspection was unannounced and was carried out on the 03 and 05 November 2015.
There were appropriate systems in place for the management of medicines. However, there was no guidance to support staff with the administration of ‘when required’ (PRN) medicine. We pointed this out to the registered manager and by end of our inspection this guidance was included in people’s care plans.
Care plans were generic in style and focussed on people’s clinical needs. However, they did not identify how staff should support people on an individual basis.
People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.
The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided enough information to allow staff to protect people whilst promoting their independence.
People were supported by staff who had received the appropriate training and professional development to enable them to meet their individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner.
Staff sought verbal consent from people before providing care and when appropriate followed legislation designed to protect people’s rights and ensure decisions taken on behalf of people were made in their best interests. We found the home was meeting the requirements of the Deprivation of Liberty Safeguards.
Staff developed caring and positive relationships with people, were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain their family relationships. People, and where appropriate their families, were involved in discussions about their care planning, which reflected their assessed needs.
People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people in a patient and friendly manner.
There was an opportunity for people using the service and their relatives to become involved in developing the service and they were encouraged to provide feedback on the service provided. They were also supported to raise complaints should they wish to.
People and their families told us they felt the service was well-led and were positive about the registered manager who understood the responsibilities of their role. The providers were fully engaged in the development of the home and had developed links with external organisations and professionals to enhance the quality of the service provided. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the service.
There were systems in place to monitor quality and safety of the service provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.
We looked at ten care plans and saw they were individualised and included the necessary information to inform staff as to the specific care people required. We saw these were reviewed on a regular basis. We observed care in the communal areas of the home and saw staff generally interacted with people in a positive way. One person said 'staff are ever so helpful. They pop in for a quick chat and check I am alright'.
We found the home had effective systems in place to protect people from abuse. One person said 'I do feel safe here. The staff would never let any harm come to me'. A relative told us 'I am so grateful he is here. I can relax knowing he is well looked after'. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We found the provider had an effective quality assurance system and they sought the views of people who used the service and their families through regular surveys.
We spoke with visitors and met with external professionals who were visiting the home at the time of our inspection.
External professionals stated that they had no concerns about how people's health and care needs were met. Professionals were complimentary about the way the service met people's physical and cognitive needs.
Everyone we spoke with confirmed that people's privacy and dignity were maintained at all times and that people were able to make day to day decisions such as what time they got up and how and where they spent their time.
We observed that people were enjoying their lunch time meal and those able to respond told us meals were good and that alternatives were provided.
People said that they had no concerns about how their personal care needs were met. They also told us that if they were unwell then staff would contact a doctor for them. They told us that staff were available when people needed them and knew what care they required.
Visitors said that they felt staff were available whenever their relatives needed assistance. They also said that staff were very pleasant and had the necessary time to meet people's needs.
People and relatives said that if they had any concerns or complaints they would raise these with the manager or provider. Nobody had any concerns when we spoke with them.