Archived: The Elms Care Home

Updated 29 June 2023

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 site visit was carried out by two inspectors. Calls were made to relatives following the inspection by an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

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 a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we held about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used information gathered as part of monitoring activity that took place on 1 September 2022 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.

During the inspection

During our inspection we spoke with two people and three relatives. We also spoke with the deputy manager and the provider. We spoke with three staff including, care staff, kitchen staff, senior care staff. We looked at the care records for four people and multiple medicine administration records. We looked at records relating to the management of the service, including audits carried out within the home.

Updated 29 June 2023

About the service

The Elms is a residential care home providing personal care for up to 13 people. The service provides support to older people, some of whom were living with dementia in one adapted building. At the time of our inspection there were ten people living in the home.

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

People did not always have risks to their safety assessed and planned for. We found where risks were known these had not been reviewed and where health needs had changed these were not reflected in people’s care records.

People did not have their medicines administered safely. People’s medicines administration records were not accurately completed and there was insufficient guidance for staff on how to administer some medicines safely.

People were not supported by enough staff to meet their needs at the times they required. People had to wait for their support and told us they had limited choice about when their care needs were met.

People did not have their individual needs and preferences considered and were not consistently supported to meet their nutrition and hydration needs in line with health professional advice.

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.

The building was not well maintained and clean. There were fire safety concerns which had not been addressed.

Staff were not consistently trained, and their competency was not checked on a regular basis. The provider did not have systems in place to ensure staff were recruited safely.

Governance arrangements in the home did not identify areas for improvement and where concerns had been raised about safety and quality actions had not consistently been taken to make changes to the service and drive improvements.

Rating at last inspection and update

The last rating for this service was requires improvement (published 27/01/2021) and there were 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 we found the provider had not completed the actions and remained in breach of regulations.

This service has been in Special Measures since 16 December 2020. During this inspection the provider did not demonstrate improvements have been made and the overall rating for this inspection is inadequate and the provider remains in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and was prompted in part due to concerns received about medicines, governance and staffing. A decision was made for us to follow up on past concerns and examine those risks.

We carried out an unannounced comprehensive inspection of this service on 19 November 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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 safe care, staffing levels, recruitment practices, person centred care, mental capacity act application and governance

Please see the action we have told the provider to take at the end of this report. For full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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