Elmwood Residential Home Limited

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to consent.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. Care plans were reviewed on the provider’s electronic care planning system, but there was no evidence of who was involved in reviewing the care plan to ensure it reflected people’s current needs and preferences. A relative said, “I am aware the [person] has a care plan. However, I have not seen anything in writing” and “I have not been invited to view or review [person’s] care plan.” We noted reviews had been undertaken.

Advance care plans were incomplete, and many people were unaware of their care plans or not involved in their development. Families were not consistently included in care planning and were only contacted when there was a health concern, leaving them uninformed about important changes.

However, families and relatives shared positive experiences about the care their loved ones received. One relative expressed their family member felt at home, had gained weight, and was happy, praising the staff for their dedication.

The manager planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.However, some shortfalls were identified, and improvements were required.

People’s personal routines, preferences and important information were not consistently recorded in care plan guidance for staff. For example, whilst some care plans reflected in detail the person’s routines and what was important to them, others did not. This meant people were at risk of not receiving personalised care and treatment.

People shared what they appreciated about the home, such as the majority of people having personalised rooms, which they enjoyed as it added comfort and familiarity.

The manager worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

One staff member told us, “Everything is fine here, and we are all comfortable, there are some changes as we have had a change of manager, but I think she needs some time to settle in, and we will have the staff meeting so hopefully things will improve.” The management team and staff confirmed improvements had been made and were ongoing. This showed the management team were being responsive in identifying where improvements were required and taking action.

There were systems and processes to share information with external health and social care professionals. Care records confirmed referrals to external healthcare professionals for further assessment and or guidance were made in a timely manner, and recommendations made by others were implemented. There was effective communication and a good handover process to ensure information was distributed in a timely fashion and issues dealt with promptly.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. During the inspection, concerns were raised regarding thequality and choice of foodprovided to people. People also reported: Food is sometimes hard to chew, particularly meats. Menus are selected in advance, but people oftendo not rememberwhat they chose on the day, there is alack of variety and choice, which limits their ability to make meaningful decisions about their meals.

People reported they often spent their time either in the lounge or in their bedrooms, primarily watching television. Several people stated they would like togo out more than once a week, indicating a desire for greater community involvement and variety in their daily routines.

However, some people said they enjoyed sitting outside in the garden, “It’s peaceful outside, and the seating is comfortable. I love spending time in the fresh air." People valued the well-maintained outdoor space with shaded seating and level access.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive and consistent, or met both clinical expectations and the expectations of people themselves.

For example, people’s care plans showed some of their needs were documented, although records were not always comprehensive. This meant ongoing review risked being incomplete in some cases. The manager had already identified most of the issues we found. They had introduced a new electronic care management system which provided tools to help staff document how they monitored and improved people’s outcomes. It was not possible to check how effective this new electronic care management system was since it had just been introduced and was not yet embedded into practice.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met.

The inspection found people did not always have full choice and control over their lives, with inconsistent support in decision-making and gaps in mental capacity assessments and Deprivation of Liberty Safeguards. This meant there was a risk people received care which did not uphold their rights. For example, one person was recorded as not having capacity to make certain decisions and required further assessments. These follow up assessments had not been completed. Without the correct assessments in place, decisions might not be made in the right way or in the person’s best interests.