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 – 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 Requires Improvement. At this assessment the rating has changed to Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

The service was previously in breach of legal regulation in relation to consent. The provider had ensured the service was now being delivered effectively and this regulation was complied with.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

At our previous assessment we found staff did not always involve people and their relatives when assessing or reviewing their needs. At this assessment we found this was no longer the case.

Some people were unsure whether they had been involved in developing their care plan. Despite this we found care plans clearly reflected people’s preferences about how they wanted their care needs to be met, evidencing their input into the care planning process. The wellbeing co-ordinator was spending 1 to 1 time with people enabling them to review and give feedback on care plans. This helped care plans stay relevant and reflective of people’s needs and wishes as they changed.

Advance care plans were in place which meant people’s preferences would be respected and followed at the end of their lives.

The provider 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.

At our previous assessment we identified the need for improvements to ensure people’s personal routines, preferences and other important information were consistently recorded in care plan guidance for staff. At this assessment we found improvements had been successfully implemented.

Care plans now covered all aspects of each person’s support needs and clearly outlined how they wished their care to be delivered. People and their relatives were actively involved in the development and review of care plans, helping to ensure they remained current and accurately reflected people’s wishes and preferences.

Staff confirmed care plans contained the level of detail they needed to understand and deliver personalised care. A member of staff told us, “Care plans are kept up to date, and they clearly reflect each resident’s individual needs. They provide useful guidance on how best to support residents, including any risks and the safest way to deliver care. I feel that the information in the care plans and risk assessments is detailed and helps staff provide person-centred care.”

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People and their relatives spoke highly of the quality and variety of the food, and how much this had improved. The head chef took time to visit individuals personally, ensuring their needs and preferences were understood and fully met. Pictorial menus had been drafted to support people’s ability to choose.

We observed a lunch time and saw that meals were home cooked, looked appetising and were presented nicely. All preferences were listened to, respected and delivered. One person told us the food was “Very, very good. [Chef] is brilliant and a jolly good cook. If you want something you just ask. “A relative commented, “The food and menu choices have improved noticeably, and I have been invited to several opportunities to share special days with my parents, which is greatly appreciated. The quality of the food and presentation, and the thought given to making these occasions special is touching.”

Since the last assessment the provider had focussed on developing a person centred activities programme for people through the recruitment of a well-being co-ordinator. They were also working to develop greater community links. People’s goals and aspirations were being considered as well as how the activities were improving their quality of life. We received some positive comments from people and relatives about this. A relative said, “My [family member] was heavily involved in Britain in bloom and loves the garden. It is well tended and I understand that plans are in place to improve residents access to the grounds. This will further engage my mother in one of her favourite pastimes, spending time in the garden.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

All care plans were formally reviewed on a monthly basis and updated when any changes occurred. People had been consulted and their views documented.

Care plans were online documents, which were accessible to relevant professionals where appropriate. This meant they could also be reviewed by external health professionals to ensure they continued to meet people’s needs.

The provider told people about their rights around consent and respected these when delivering person-centred 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.

At our previous assessment we found inconsistent support in decision making and gaps in mental capacity assessments and DoLS. The provider had taken action to address this. They were proactive in reviewing and improving processes around MCA and DoLS to ensure people’s rights were upheld. This included the development of a tracker and database to provide oversight. Where people had variable capacity to make decisions about their care, this was reviewed every 3 months to ensure that capacity assessments remained accurate, best‑interest decisions continued to reflect their current needs, and any restrictions in place were both necessary and the least restrictive option.

Staff had completed thorough training in MCA and demonstrated an understanding of how to apply this in practice. A member of staff explained, “Here we have some residents that have some capacity to take decisions, and some, who due to dementia lack capacity. In that situation we go through the care plan for best interest decisions. People who lack capacity with dementia can still make daily decisions, and some people have hearing and speech problems. We will use visual things to help them choose. You can talk gently to them and encourage them to make sure they get what they want.”