Archived: Elm Farm Residential Home

Elm Farm Residential Home is a residential care home providing personal care for up to 12 older adults. There were 11 people living in the home at the time of our inspection visit.

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

Environmental risks were not always identified and mitigated which placed people at risk of harm. The provider’s quality assurance systems required improvement to ensure the checks undertaken were always effective to keep people safe. Action was taken to improve risk management following our inspection visit.

We had not been informed, as required, when important changes to the provider partnership had occurred in 2017. Following our visit, the provider was taking action prompted by CQC to address this which has caused the publication of this report to be delayed.

The management of people’s medicines was not consistently safe. Prompt action was taken to address the issues we identified. 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. Action was taken to address this by the deputy manager.

Staff were recruited safely, and staff were available to meet people’s needs in a timely way. People felt safe and had confidence in the ability of the staff team to deliver their care effectively.

Staff enjoyed their jobs and spoke fondly about the people they cared for. Most people’s care records were written in a personalised way and provided staff with the information they needed about people's likes, dislikes and preferences. Staff understood how people preferred to communicate and the information provided to people was being reviewed by the deputy manager to ensure people could understand it.

People's right to privacy was respected and people received dignified care from staff who understood the importance of promoting their independence.

People enjoyed the range of social activities provided to occupy their time. People had enough to eat and drink and had access to health professionals when needed. People were supported to practice their religion and people's end of life wishes were documented if they had chosen to share this information.

People had opportunities to feedback their views on the service they received. Recent feedback showed people knew how to complain and they were happy with how their home was run. The environment was clean and infection prevention and control measures were effective.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Following our inspection, we notified the local authority commissioners about the areas of concern we

identified.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated

Activities) Regulations 2014. These were:

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment

Regulation 17 Regulated Activities Regulations 2014 - Good governance

Rating at last inspection

The last rating for this service was Good (published 22 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

People continued to receive safe care and there were enough staff to provide support people’s needs. People were protected from the risk of harm. People received their medicines as prescribed. Staff were suitably recruited to ensure they were able to work with people who lived at the home.

People made decisions about their care and staff sought people’s consent. Where people lacked capacity they were helped to make decisions. Where their liberty was restricted, this had been identified and action taken to ensure this was lawful. People received supported to stay well and had access to health care services. They were able to choose what to eat. Staff received training to meet the specific needs of people who used the service.

People were treated with dignity and respect. People were asked their preferences about how they wanted to be supported and cared for. These details were recorded in people’s care plans including their end of life wishes.

People and their family members were involved in the planning and review of care and support provided. People knew how to make a complaint or raise a concern.

Systems were in place to assess and monitor the quality of the service. People and staff were encouraged to raise any views about the service on how improvements could be made. The registered manager promoted an open culture which put people at the centre of the service.

Below is a summary of what we found. The summary describes what people told us, what we observed, the records we looked at and what staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff were aware of the provider's whistleblowing policy.

Staff knew about people's risk management plans and we saw they were supported in line with those plans. This meant people were cared for in a way that protected them from harm.

The provider worked well with health care providers to ensure people's health needs were met and they were protected against harm.

Systems were not in place to make sure the manager and staff learned from events such as accidents and incidents, complaints and checks made on the service. This increased the risk to people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People's care needs were assessed with them. We saw evidence that people were involved in their care planning and reviews. We saw care plans were regularly updated. One person told us, "The staff always ask what I need."

Where people had complex needs that required the input of specialist health care services, assessments had been made by the appropriate professionals. Their recommendations were carried out by staff. This meant the provider worked well with other services to ensure people's health care needs were met.

Staff were appropriately supported and trained to ensure they effectively met people's needs.

People were cared for in a clean, comfortable and appropriate environment which afforded them privacy.

Is the service caring?

People were supported by kind and caring staff. We saw staff were patient and encouraged people to be independent. One person told us, "The staff are wonderful, very caring and kind."

People's preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People had the opportunity to plan and engage in a range of different activities each day.

People were asked their views about the service and the provider acted on comments that people made.

Where care staff had noticed people's changing needs, their care plans were updated to reflect this. We found staff discussed people's care needs with them on a regular basis.

Is the service well led?

The provider did not have risk management systems in place. We found the provider had not checked that risks were managed effectively.

The provider sought the views of people who used the service. Records seen by us indicated that people were not asked about all aspects of the service. For example, people were not asked what meals they would like to see on the menu.

Staff told us they were clear about their roles and responsibilities. Staff told us the service was well organised and they felt supported by their manager.

People living at Elm Farm told us,

Staff were, 'Very nice.'

The food was, 'Very good, like home, and you get plenty.'

'I love it'I'm happy here, the girls are very nice and the food is nice...no complaints.'

We observed a very good rapport between people living at Elm Farm and staff supporting them.

We looked at the care provided to people living at Elm Farm. We were satisfied that people were having their care needs met by staff who knew them well.

We looked at cleanliness and infection control. The home was very clean and had good systems in place to minimise the spread of infection.

We looked at how people living at Elm Farm were safeguarded from abuse. We were satisfied that staff and management knew what to do if they had any safeguarding concerns. People living at Elm Farm told us they felt safe living at the home.

We looked at the level of staffing and the skills staff had to undertake their role. We were satisfied there were sufficient staff to meet the needs of people living at the home. Staff had received appropriate training to help them undertake care effectively.

We observed staff being kind and considerate to people. We saw people being treated with dignity and respect. People were seen to have developed good relationships with each other, and with staff.

We looked at the care records of three people. These demonstrated the care needs of people were appropriately assessed and updated as soon as care needs changed. The service worked well with other health care professionals.

We looked at menus. We saw that people were provided with a good range of meals which met their dietary needs. During our visit we observed people having breakfast and their main lunch time meal. They were seen enjoying the food provided and the experience of sitting and eating together.

We checked the administration and management of medicines. We were satisfied the service administered medicines safely to people living at the home.

We noted the service had a good activities programme. On the day of our visit people were seen joining in with a visiting singer and accordion player. They enjoyed singing and dancing along with him.

We checked staff recruitment processes and were satisfied that relevant checks were made to keep people safe.

We looked at the formal and informal complaint processes and were satisfied that people felt able to tell staff if they had any concerns, and these would be acted upon.