Archived: Elm Tree

Elm Tree is a residential care home providing personal and nursing care for up to 46 older people aged 65 and over; and people living with dementia. At the time of the inspection, 38 people were living at the service.

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

The leadership, management and governance arrangements did not provide assurance the service was well-led. Quality assurance and governance arrangements were not reliable or effective in identifying shortfalls in the service. The management team and provider did not understand their responsibility to ensure notifications relating to specific incidents and safeguarding concerns had been made to the Care Quality Commission. Relatives stated the arrangements to communicate with them were not effective. Lessons were not consistently learned to improve the quality of care for people using the service.

Suitable arrangements were not in place to ensure the safe management of medicines and this placed people at risk of harm. Information relating to people's individual risks were not always recorded or mitigated and did not provide enough assurance that people were safe. Appropriate measures were not in place to prevent and control the spread of infection. Staffing levels were not always being maintained to meet people's care and support needs

Not all staff had received up to date training and not all staff felt supported or valued. People were not always 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. People had access to healthcare services and support when needed however this was sometimes delayed and not all relatives were informed and updated about their family member's healthcare needs.

Care plans covered most people's individual care and support needs. However, further improvements were still required to ensure each person's care plan was updated and accurate. People were not routinely supported and encouraged to take part in social activities.

Staff were recruited safely. People's comments about the quality of the meals provided were positive. Arrangements were in place for gathering people’s views of the service they received, those of people acting on their behalf and staff employed at the service.

We have made recommendations about safeguarding, training, staff induction, communication with relatives and complaints management.

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 rating for this service was Good (published 28 April 2020).

Why we inspected

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 coronavirus and other infection outbreaks effectively.

We received concerns in relation to staffing levels, the management of medicines and training. As a result, we undertook a focused inspection to review the key questions of Safe, Effective, Responsive and Well-Led only.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elm Tree on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk, including infection, prevention and control, medicines management, staffing and quality assurance.

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 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.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

Elm Tree is a care home providing personal and nursing care to people aged 65 and over at the time of the inspection. The service can support up to 30 people.

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

Medicines were not being managed safely which placed people at risk of harm. Quality assurance and governance systems were not effective and had failed to identify poor medicines management at the service. Measures to manage infection control were in place, however, further improvement was needed to ensure systems were robust.

We made a recommendation about infection control 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 inadequate (17 February 2021) and there were multiple breaches of regulation. At this inspection we found some improvements had been made but the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met in regards to safe management of medicines and infection control practice. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safe management of medicines at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.

Elm Tree is a residential care home providing personal care for up to 46 people aged 65 and over. At the time of the inspection, the service was supporting 44 people.

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

People were positive about the care provided at Elm Tree and there were enough competent staff to support people safely according to their needs and preferences. Risk assessments were in place to keep people safe. Medicines were managed safely. People received care from staff who understood how to recognise and report issues of concern.

People's needs were assessed before they moved into the service to ensure they could receive the care they required. Staff received training and support to carry out their roles and responsibilities. People enjoyed a varied and nutritious diet. Staff worked with external professionals to promote people’s health and wellbeing. 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.

The staff were kind and caring. Staff knew people well and supported people with dignity and respect. People were encouraged to be as independent as possible.

Care plans provided information for staff to follow to support people effectively. People had the choice to participate in activities which promoted a good quality of life. People knew how to raise a complaint and their views were listened to and investigated. Plans were in place to support people at the end of their lives.

We received positive feedback about how the service was managed. There were systems in place to monitor the care people received. The management team were proactive in promptly addressing any concerns and committed to ensuring the service continuously improved.

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

Rating at last inspection: Good (published 12 July 2017).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

At the last inspection, in April 2015 the service was rated Good. At this inspection we found the service remained Good.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

People were kept safe. Staff had a good understanding of what constituted abuse and knew what actions to take if they had any concerns. Staff were effective in identifying risks to people's safety and in managing these risks.

There were enough staff to care for the people they supported. Staff received a comprehensive induction into the organisation, and a programme of training to support them in meeting people's needs effectively.

People received medicines from trained staff, and medicines were administered safely.

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 supported this practice. The service operated within the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were supported with their nutritional needs. People were also assisted to manage their health needs, with referrals to other health professionals when required.

People and relatives told us staff were caring and had the right skills and experience to provide the care required. People were supported with dignity and respect and people chose how they spent their time.

Care plans contained information for staff to help them provide personalised care, were up to date and accurately reflected people's care needs.

Staff encouraged people to be independent. People had activities provided to keep them occupied and staff supported people with their individual interests.

People knew how to raise a concern and were encouraged to share their views and opinions about the service they received. There were formal opportunities for people and relatives to feedback any concerns through surveys.

People and relatives were positive about the management of the service. Staff told us the management team were approachable and responsive, and they could raise any concerns or issues with them. There were formal opportunities for staff to do this at team meetings and individual meetings.

There were processes to monitor the quality of the service provided. There were other checks which ensured staff worked in line with the organisation's policies and procedures. Environmental checks were completed and staff knew the correct procedures to take in an emergency.

Further information is in the detailed findings below and you can also see our previous comprehensive inspection report for this service.