We carried out a review of the data available to us about The Elms on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Elms, you can give feedback on this service.
The Elms is registered to accommodate up to four people. At the time of our inspection four people with learning disabilities lived at The Elms; two of whom were away when we visited.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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 2008 and associated Regulations about how the service is run.
Staff cared about the well being of people living in the home. We received positive feedback from relatives and people about the kindness of staff.
People were supported by safely recruited staff and there were enough trained and experienced staff to support people in ways that suited them.
Staff understood how to identify and report abuse and were well supported in their roles. Staff received training to enable them to carry out their roles competently.
People were supported to make choices about how they spent their days. Staff had a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and promoted independence and choice. Where people were not able to make a specific decision, staff acted in accordance with the MCA.
People’s health care needs were met and staff supported them to see healthcare professionals when appropriate. They were supported to take their medicines safely by staff who had received the appropriate levels of training.
People were supported to develop and maintain their interests and relationships both within the home and the local area.
People and their relatives knew how to make a complaint if the needed to and felt any concerns would be taken seriously and action taken straight away.
There were quality assurance systems in place to drive improvement and ensure the home offered a safe, effective, caring and responsive service.
The Elms had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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 2008 and associated Regulations about how the service is run.
The house had a homely and friendly feel. Staff and people looked relaxed and staff supported people in an unhurried friendly and reassuring way. A family member told us, “It’s quite a laid back house, it’s very homely”.
People were safeguarded because staff had been trained in the protection of vulnerable adults and knew what they needed to do in the event of a safeguarding concern. Medicines were managed safely to make sure people received their medicines as prescribed.
There were sufficient staff on duty to meet people’s needs, however the numbers of staff on duty in the evening were reduced and did not enable the service to provide a flexible response to peoples wishes and activity preferences. The manager agreed to review the numbers of staff on duty during the evening.
Staff told us they felt supported and could gain informal advice or guidance whenever they needed to. Staff were trained to make sure they were able to meet the individual needs of people living at the home.
Where people were able to make their own decisions staff sought their consent before they supported them. However, where people may have lacked capacity to make a specific decision staff were not acting in accordance with the Mental Capacity Act 2005. We have made a recommendation to the home to ensure they protect people’s rights by acting in accordance with the act.
Our observations showed people were treated with kindness and compassion in their day-to-day care. Staff knew the people they were caring for and supporting, including their preferences and personal histories.
People had support plans that reflected their personal history, individual preferences and interests. Staff had read people’s support plans and used the information to make sure they helped the individual in the way they wanted or needed to be supported.
People had a keyworker. A key worker is a named member of staff that was responsible for ensuring people’s care needs were met. This included supporting them with activities and spending time with them.
Staff undertook a variety of audits such as fire safety, medicines, infection control and health and safety to check the service people received was of a good quality. Different staff took a lead role in aspects of people’s care. For example, one staff member was the lead for fire safety and medicines. This ensured that there was consistent oversight by a specific member of the team to pick up on any issues.
The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.
We considered our inspection findings to answer questions we always ask:
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well-led?
This is a summary of what we found.
Is the service safe?
People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We saw that there were up-to-date care plans, and risk assessments and management plans, for all four people. These had all been reviewed and updated in January and February 2014 and were scheduled for review in June and July 2014.
People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People living at the home felt safe with the staff who supported them. Staff were aware of how to report vulnerable adult safeguarding concerns. There were arrangements to safeguard people against the risk of financial abuse.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS), which apply to care homes. The registered manager told us they were in the process of completing applications to the local authority to authorise DOLS for each person living at The Elms, to ensure the home met legal requirements. The registered manager was aware of the 2014 Supreme Court judgement about DOLS and how this might affect people living at The Elms. They confirmed that all four people required supervision whenever they were out because of their vulnerability.
There were enough qualified, skilled and experienced staff to meet people's needs. Everybody who lived at The Elms needed staff support when they went out to ensure they were safe. They all said they had plenty of activities and often went out. The records for the two people whose care we looked at showed that they regularly did things outside the house. Staff rotas reflected adequate staffing. Staff received training relevant to their roles.
Is the service effective?
People told us that they liked their bedrooms and that they had plenty of things to do, at home and in the local community. Both relatives told us their family members were happy living at The Elms. One said, 'They're very happy' and the other told us, 'We're very happy with it and [person] seems very happy.' They both told us their family members were always glad to return to The Elms after a visit.
People had access to regular community activities and contact with families and other people that were important to them. One person told us about their various activities, and relatives said that their family members were active. For example, one explained that their family member had a choice of activities and said, 'There seems to be always something going on.'
We also observed that people were clean and neatly presented, which showed they had been supported to maintain their personal hygiene.
Is the service caring?
We observed that staff spoke with people in a friendly and respectful manner, acknowledging their preferences.
Is the service responsive?
People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans reflected people's individual needs and preferences, such as activities they enjoyed and the routines they liked to follow throughout the day. They addressed people's mental health, relationships and physical health issues, and detailed the support people needed from staff with aspects of their daily lives.
Both people had up to date risk assessments and management plans in place. These reflected their individual health and activities inside and outside the house, covering risks such as weight gain, handling money, hazardous substances and using public transport.
Care records showed that staff had taken the necessary actions to meet people's needs. For example, both people whose care we looked at in more depth had dietary requirements. Their care records showed they ate a varied diet that met their individual requirements.
Is the service well-led?
The provider had an effective system to regularly assess and monitor the quality of service that people receive. People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. People told us they could talk to the staff and we observed them doing so informally during our second visit. A relative said of the staff, 'They are very approachable.' There had been a meeting in February 2014 for people who live at The Elms. The minutes showed that people had had an opportunity to raise any issues they wanted. A support worker told us they were able to raise any concerns with management, who were responsive to any issues raised.
We spoke with one relative who told us their children "are very happy here, that's the main thing". One member of staff told us "the care here is good".
We saw that people's religious needs were met by staff with regard to worship and dietary requirements. People were supported to take part in a range of activities in accordance with their wishes.
However there had been several staff changes recently and we saw that this sometimes left people with staff who were not experienced nor skilled enough in the setting to care for them effectively. In addition several records relating to people and staff had not been reviewed.
We saw that people experienced safe and effective care which was based on comprehensive person centred care plans and risk assessments.
People using the service were protected from abuse as they were supported by staff who had recent and relevant training on safeguarding adults. People told us if they had any concerns they would report them to the manager or contact the local authority safeguarding team.
We spoke to staff and saw records which showed that staff were suitably experienced and qualified to support people living in the home. A staff member told us "I feel very supported and I enjoy my job here".
There were processes in place to monitor the quality of service being provided and we saw that people using the service were involved through quality assurance questionnaires.