The Elms

Updated 23 May 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

Two inspectors and 2 Expert by Experience carried out this inspection. 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 provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

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 information we had received about the service since the last inspection. We sought feedback from the local authority. 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 all this information to plan our inspection.

During the inspection

We spoke with 10 people who used the service and 10 relatives to gather their views of the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with 8 members of staff which included, the deputy manager, team leader, 3 care staff, chef, activities co-ordinator, maintenance person and a member of the housekeeping team. We spoke with the registered manager who is also the nominated individual and spoke with another representative of the provider. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with 1 visiting healthcare professional.

We reviewed 4 staff recruitment files, 2 people’s care records and 6 people’s medicine records. We reviewed records relating to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We reviewed 7 staffs’ medicine competency records and the service’s training record. We reviewed cleaning records and maintenance records. We reviewed records related to the management of the service which included a selection of audits and the service improvement plan. We reviewed the provider’s policies and procedures related to infection, prevention, and control.

Updated 23 May 2023

About the service

The Elms is a residential care home providing personal and nursing care to up to 29 people. The service also provides support to people who live with dementia. At the time of our inspection there were 28 people using the service. People are accommodated in one adapted building across three floors. There is access to an elevated garden space accessible from the first-floor communal room.

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

Processes for identifying and managing risks had not been maintained sufficiently to ensure risks were always effectively assessed, managed, and mitigated.

The provider’s quality monitoring system was not always effective in identifying where improvement to the service’s processes and systems was required, for example, processes for the assessment and management of risks.

People told us they felt safe knowing the staff were around to help. People said although sometimes they have to wait for help, they were never left unsafe.

People told us they were always treated with kindness and had never been treated badly. People told us they had never seen or heard anyone be abused in any way. People’s relatives also confirmed staff treated their relatives and others in a kind and respectful way.

People told us they received support to take their medicines and relatives confirmed their relative’s medicines had been reviewed when required.

People told us their bedrooms were cleaned regularly. There were arrangements in place to keep the environment clean and processes in place for effective prevention and control of infection.

We observed staff taking action to reduce risks to people, for example, when supporting them to walk, at mealtimes and when people who lived with dementia became confused or distressed. People’s relatives had been informed of any accidents or incidents and told about the action taken to keep their relative safe.

The management team promoted and supported a person-centred approach to care, meaning people’s individual preferences and wishes were listened to when delivering support to them.

Staff were provided with the support and leadership they needed to carry out their tasks safely and to work as one team when supporting people’s needs.

People and their relatives felt able to raise concerns and had the confidence that these would be addressed. The views of people, their relatives and the staff were sought and used to improve the service. People, their relatives and the staff told us the registered manager was approachable and helpful.

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

The last rating for this service was good (published 9 May 2022).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about staffing numbers, the moving and handling of people, medicines administration and visiting arrangements. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the processes in place for assessing and managing risks and medicines administration. There were also concerns with the provider's quality monitoring and management of those processes, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

The provider took immediate action during the inspection to reduce risks to people.

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

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.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Elms on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to assessing and managing risks, medicines and the provider’s quality monitoring arrangements 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 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.