Elm View Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Call bell wait times were high which could impact on people’s care. Risk assessments were not always available or reflective of people’s current needs to guide staff in providing safe care and support. Staff were aware of peoples support needs, however, were not able to detail how they would raise a safeguarding concern to external agencies as required. Records evidenced not all staff had completed the necessary training as outlined by the services learning directory. Management had not conducted competency checks and supervisions with staff to ensure they were competent for their roles and could meet people’s needs. During our assessment of the safe key question, we found documentation held for staff training and staff competencies was not up-to-date which resulted in a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People using the service felt safe and cared for. There had been challenges with staffing however, people felt there were usually enough staff to meet their needs. However, there were often delays with staff answering call bells. People told us "I feel safe overall, I think it is a good home" and “I feel safe, I always have 2 staff”. People praised staff, we heard they were, “Brilliant, [staff] go over and above”, and “Some of the staff I couldn’t do without [staff member] is so wonderful and nice.” Relatives told us they felt their loved ones were safe, "The care and love they have given [relative] has transformed [relative]. The staff are caring and supportive."

Records indicated not all staff had received or were up to date with training in relation to safeguarding adults from abuse. The service’s safeguarding processes did not always sufficiently document how people using the service were safeguarded. Processes did not support staff to learn lessons from safeguarding referrals. The service had a safeguarding tracker; however, this did not always contain outcomes and lessons learned. Incident reports did not always contain enough information around what action staff had taken to safeguard people. The service had a clear process to support staff to report concerns. This included having safeguarding and whistleblowing policies for staff to refer to. However, we were not assured the service had the correct guidance to support staff with understanding people’s mental capacity. During our on-site assessment we also discussed a recent safeguarding concern with the home manager where the CQC were not notified as required by our regulations.

Staff were aware of risks associated with people’s care and knew how to support people safely. However, staff were not always able to demonstrate an understanding of safeguarding and who they would report concerns to externally. Staff understood the Mental Capacity Act and told us how they would gain consent and offer people choice around clothing. The home manager explained their process around managing safeguarding and gave examples where they acted on recent allegations of abuse and the action they took.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service used a dependency tool to calculate whether there were enough staff to support people. We heard competency assessments were in place for new starters. However, no further competency assessments or spot checks following this. The home manager told us evening spot checks were carried out monthly, however there were no records to evidence these checks had been carried out. Regular staff supervisions were not carried out to ensure staff were competent for their role and support staff and their wellbeing. The home manager did have regular contact with staff, however this was not formally recorded. We found some staff were missing from the training records tracker. Training records did not contain all the relevant training documentation as identified in the services learning and development handbook. Not all staff had received training to enable them to provide safe care. This included training in moving and handling, diabetes, seizure, basic life support, nutrition and hydration and safeguarding. The home manager had submitted appropriate Deprivation of Liberty Safeguard applications for people however, we found that people’s capacity was not always adequately assessed in line with guidance which could put people at risk. The service followed appropriate procedures and had suitable systems to recruit staff safely. This included gathering references and ensuring all staff had undertaken a Disclosure and Barring Service (DBS) check. The DBS check identifies any convictions a person has or whether they are barred from working with vulnerable adults. Sufficient processes such as training, supervision, competency checks and records to assess, monitor and improve the safety and effectiveness of staffing at the service in the carrying on of the regulated activity were not in place. This was a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People using the service and their relative’s felt staffing was not always safe, and there was not always a sufficient staff skill mix. However, people told us “Yes they [staff] are all confident, if someone isn’t then they go and get someone that is more experienced.” Call bell wait times were often long due to reduced staffing levels and this had a potential impact on the level of care people received. One relative said, "Sometimes it is understaffed, care can be a bit patchy, when it comes to support with repositioning, sometimes [repositioning times] are longer than this when they [staff] are under pressure." Call bell wait times was something the home manager had identified and was in the process of implementing actions to improve this.

On the day of our onsite assessment, the home had enough staff to facilitate care. Both floors were staffed in line with the home’s dependency tool. Positive interactions were seen between staff and residents throughout the day. We saw staff treated residents with kindness. However, staffing at lunch time appeared to be lacking on the first floor, with 1 person having to wait an hour for their food.

Most staff told us staffing levels were well managed however, there were often delays to people’s care due to limited delegation of care and staff were unaware which people they were responsible to care for. This could result in people’s needs not being met in a timely manner, for example increase in the risk of unwitnessed falls as people with limited mobility tried to get up by themselves. The service used minimal agency staff however, used regular agency staff to ensure continuity of care. Staff felt they had received enough training and were able to request additional training. However, training records we reviewed indicated training was overdue. Following our inspection, the home manager told us they had now identified some staff training was overdue and had planned for time to be set aside for staff to complete the required training. One member of staff told us they had requested further training, and this was arranged in a timely manner. Staff told us they felt supported by the management team, that the home manager was approachable, but they did not receive formal documented supervision.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.