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The Elms Residential Care Home Requires improvement

We are carrying out a review of quality at The Elms Residential Care Home. 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 22 November 2018

This inspection took place on 21 August 2018 and was unannounced. The last inspection was in June 2017, where we found five breaches of regulation relating to governance, staffing, consent, person-centred care and premises and equipment. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least good. At this inspection in August 2018, we found improvements had been made and the service was no longer in breach of regulations.

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

The care home accommodates up to 20 people in one adapted building. At the time of this inspection there were 18 people living in the service, most were older people some of whom were living with dementia.

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.

Improvements had been made to ensure the governance arrangements identified where quality and safety were being compromised. Though further work was necessary to embed new systems and processes, it was clear the provider and registered manager had taken steps to improve and build upon their existing governance arrangements.

People’s medicines were generally managed well by staff who were trained to administer people’s medicines. However, we found that further improvement was needed with the application of creams, documentation, and more robust auditing processes.

There was a new person centred electronic care planning system in place which was replacing paper records. This system was still quite new and not all information had been transferred over. We found some errors in transfer of risks such as choking, and the registered manager took action to ensure these were put onto the system promptly. We advised them to prioritise those people most at risk to ensure safe delivery of care.

Further work was required to ensure that people’s end of life wishes were known. Care records contained only very basic information. However, advance care plans were in the process of being completed.

There was not a dedicated activity co-ordinator working in the service, but staff delivered activities. A schedule of activities had been implemented, but people preferred a less structured approach. Some people we spoke with indicated that at times they felt bored and would like more to do. We have made a recommendation that the service ensures it is meeting people’s individual and specialist needs on a day to day basis.

Staff were seen to be kind and caring towards people, however, our observations and feedback received from people indicated that further work was needed to ensure that the staff and management approach was consistent and people’s dignity was respected.

Staffing levels and deployment of staff had been reviewed and new processes implemented which ensured that staff knew their roles and responsibilities.

Staff took appropriate precautions to ensure people were protected from the risk of acquired infections, and the services’ cleaning regimes were more robust.

Staff had regular supervision and they had been trained to meet people's individual needs effectively. Staff were encouraged to progress in their roles, and higher level qualifications were offered.

The requirements of the Mental Capacity Act 2005 were being met, and staff understood their roles and responsibilities to seek people's consent prior to care and support being provided. However, further improvements in relation to care p

Inspection areas

Safe

Requires improvement

Updated 22 November 2018

The service was not consistently safe.

Risks relating to people’s care were in place, however, records were being transferred across to a new electronic system and not all had been carried over accurately. The registered manager promptly addressed this and agreed to prioritise transfer of information based on those most at risk.

Improvements were needed in the auditing and documentation relating to medicines.

There were sufficient staffing levels in the service and staff were deployed effectively.

Effective

Good

Updated 22 November 2018

The service was Effective.

Deprivation of Liberty Safeguards (DoLS) had been applied for when people who lacked capacity to consent, had their liberty restricted. The service was following the principles of the Mental Capacity Act 2005, however, some further improvements could be made to ensure staff have relevant guidance.

People were supported to maintain good health and had access to healthcare support in a timely manner.

People told us the food was satisfactory and that they had a choice. The dining experience had improved.

People’s fluid intake was not always accurately recorded, but plans were in place to address this.

Staff were trained in subjects relevant to the people they were caring for, and had opportunities to increase their learning and qualifications.

Caring

Good

Updated 22 November 2018

The service was caring.

Staff were observed to be kind and caring in their interactions with people, however, some feedback indicated the approach of staff could vary.

People were asked for their views in 'resident' meetings.

Relatives and visitors could visit at any time and there were no restrictions.

Responsive

Requires improvement

Updated 22 November 2018

The service was not consistently responsive.

Activity provision was still not at a level which would meet the individual and specialist needs of all people using the service.

Care plans were in the process of being transferred to a new electronic system. Information reflected people's needs and how they would like their care to be delivered. The new system will allow for a greater level of detail to be included.

End of life care planning needed improvement, but advance care plans were in the process of being completed.

The service had systems in place for receiving, handling and responding appropriately to complaints.

Well-led

Requires improvement

Updated 22 November 2018

The service was not consistently well-led.

The registered manager and provider had responded to the previous concerns identified at the last inspection. They had implemented new systems and processes to support and drive improvement. However some quality checks needed further improvement to ensure all areas for improvement were identified. These needed to be sustained and fully embedded into practice.

The service provided an open culture. People and staff were encouraged to contribute to decisions to improve and develop the service.