Archived: The Elms

Updated 26 March 2021

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 Care Act 2014.

Inspection team

The inspection team consisted of two inspectors.

Service and service type

The Elms is a ‘care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided; and both were looked at during this inspection.

The service had two managers registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. For the purpose of this report, we will refer to the managers as ‘registered manager one’ and registered manager two.’

Notice of inspection

We announced the inspection one hour before our arrival at the property because the service is small, and people are often out and we wanted to be sure there would be people at home to speak with us.

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 and a professional who worked with the service. The professional we spoke with was unable to give any relevant feedback as they had not visited the service for some months prior to the pandemic

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

During the inspection, we reviewed five care plans and associated risk assessments and daily notes. Three medicines records. Information relating to the health and safety of the home. Audits to monitor and improve the service, the recruitment of staff and policies and procedures to support the service. We spoke with five people who lived at the home, the registered manager, the provider, the senior carer and two care workers. We also spoke with a health and social care professional.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service.

Updated 26 March 2021

About the service

The Elms is a residential care home providing accommodation, personal and nursing care to six people whom have learning disabilities or autistic spectrum disorder. A maximum of six people can be accommodated at the home.

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

The condition of the home had deteriorated. There was evidence of leaks and damp throughout the home. There were risks to people’s health and safety as fire safety procedures were unsatisfactory and regular health and safety maintenance had not been carried out as required. Accidents and incidents were not always recorded. Parts of the home were unclean and infection control had not been considered in the cellar of the home. Recruitment was not always safe. Staffing levels had not been adequately assessed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. A blanket ban was placed on people leaving the home without staff support during the pandemic without individually assessing people. There was one shared bathroom which gave access to bath and shower facilities for six people to access and garden area stored waste which could put people at risk. The home required an update in its décor as well as internal improvements such as fixing a hole in wall and damaged windows.

People felt frustrated as they were unable to leave the house without staff. Records in care files and daily notes reflected a lack of person-centred care and dignity with people being referred to as ‘attention seeking’ or ‘unfragrant’. People were not involved in their care and treatment and staff did not effectively support people with their anxieties.

Care plans did not describe positive strategies to support people. Care plans did not capture goals and did not involve people and their representatives. People were not supported to undertake meaningful activities and during the pandemic, had been socially isolated as the provider had not explored safe ways of supporting people. End of Life care was not provided at the home with people being moved to other care homes, should they be at the end of their life. There had been no complaints received.

The provider and registered managers did not understand legal requirements. Lack of robust governance procedures meant little improvement was being made at the home. There was poor oversight of dignity and equality by the management team and no action had been taken following the lack of person-centred recording in people’s records. The lack of oversight from the management team meant any improvements were not identified in a timely manner.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

Most people in the home were independent and prior to the pandemic, were able to leave the home unsupported. During the pandemic, a decision had been made by the providers to issue a blanket ban on people leaving the home without the support of staff. Individual choices had not been explored. People had limited options within the home environment. There was one communal lounge and a separate lounge which doubled up as a staff room which was not always accessible to people. There was a kitchen / diner area where people gathered to eat and watch television. The front and back gardens were unsafe and posed risks to people. Two people were sharing a bedroom where one person had no access to natural light.

Right care:

Care was not person-centred and care plans did not support people to work towards goals and they were not written in a dignified language. Peoples needs were not regularly reviewed. Where further support was required in the night, this had not been considered by the provider. There was only one bathroom which meant people had to wait for others to use the facilities. The décor of the home required further improvement to ensure it was suitable for people to reside in. People commented on the home’s disrepair.

Right culture:

Staff did not treat people with dignity and respect. People were referred to as attention seeking or denied medical intervention after falls. The leadership of the home lacked oversight and did not understand how the lack of person-centred care planning and documentation did not promote people’s confidence and empower their lives.

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 30 April 2019).

Why we inspected

The inspection was prompted in part due to a safeguarding concern received which may have put people living in the home at risk of harm. A decision was made for us to inspect and examine those risks.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection, we will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.