You are here

The Elms Requires improvement

We are carrying out a review of quality at The Elms. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary

Overall summary & rating

Requires improvement

Updated 6 December 2019

About the service

The Elms is a residential care home providing personal care to 30 people aged 65 and over at the time of the inspection. The service can support up to 37 people, some of whom may be living with dementia.

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

There was a concern the initial assessment for two people was not as thorough as it should be, and they had been admitted to the home when they may have needed a more specialist service. Some people had not consistently received their medicines as prescribed, which had the potential to impact on their treatment.

There was a new manager in post, who had started to implement the provider’s quality monitoring system. However, for several months the system had not been wholly effective in identifying the issues we found during the inspection or shortfalls had not been addressed in a timely way. When reviewing incidents that had occurred in the service before the new manager took up their post, we found several had not been reported to the Care Quality Commission (CQC). It is important we know about these incidents, so we can check what action has been taken.

Staff received training and induction. There were gaps in staff supervision and appraisal. However, these had been identified and we have been assured an action plan will address the shortfalls. We have made a recommendation about keeping the supervision and appraisal under review to ensure staff receive support and guidance.

The provider had been quick to respond to a safeguarding incident when they became aware of it and took appropriate action. Staff had received training in how to safeguard people from abuse and knew how to report incidents.

The provider had a safe system of staff recruitment. There had been a need for the use of agency staff recently, which, although not an ideal situation, had ensured there were always enough staff on duty.

People’s health and nutritional needs were met. Staff ensured people received care and treatment from health professionals when required. People who used the service liked the meals provided.

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. Staff ensured relatives were welcome to visit at any time and provided activities daily, so people could choose to participate if they wished. Staff were described as friendly, kind and caring.

For more details, please see the full report which is on the CQC website at

Rating at last inspection

The last rating for this service was requires improvement (published 17 May 2018).

At this inspection, enough improvement had not been made and the provider was now in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.


We have identified breaches at this inspection in relation to assessing people’s needs in a thorough way, management of medicines, monitoring and improving quality, and ensuring CQC is notified of incidents affecting people’s welfare. Please see the action we have told the provider to take at the end of this report.

Since the last inspection we recognised that the provider had failed to notify us of incidents that affected the safety and welfare of people. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection areas


Requires improvement

Updated 6 December 2019

The service was not always safe.

Details are in our safe findings below.


Requires improvement

Updated 6 December 2019

The service was not always effective.

Details are in our effective findings below.



Updated 6 December 2019

The service was caring.

Details are in our caring findings below.



Updated 6 December 2019

The service was responsive.

Details are in our responsive findings below.


Requires improvement

Updated 6 December 2019

The service was not always well-led.

Details are in our well-Led findings below.