Elm Case Management Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this previously unrated service. This key question has been rated Good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Incidents and events within the service were recorded, recognised and then acted on. The service effectively monitored for themes and trends. We found the management team were open and transparent and were taking action to drive improvement at the service.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service made sure there was continuity of care, including when people moved into hospital for prolonged periods of time. The service had hospital passports that were constantly updated. The service worked with external professionals to support the people in the service’s care. There were good working relationships with psychology, GPs, and the Local Authority commissioning and assessment teams.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Staff had received safeguarding training, and staff and managers were aware of safeguarding processes to use if necessary.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within their community service.We found all those who used the service, and did not have capacity to make informed choices, had an application made for a Community Deprivation of Liberty Safeguards (DoLS).

The provider worked with people to understand and manage risks. Staff always provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. The service did not always have enough detail recorded in people’s risk assessments.

Risk assessments relating to the health, safety and welfare of people using the service were completed. However, there was a lack of detail in these documents to demonstrate what the risks were and how they were mitigated.

Relatives were present and involved in the regular Multi Disciplinary Team (MDT) care planning and risk review meetings. At these MDT meetings people and their relatives were involved in the discussion of how to manage and mitigate people’s risks.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Risk assessments were in place for people’s accommodation to ensure a safe working environment for staff to deliver care in. Where people had equipment in their homes for staff to use, the service ensured staff were trained to use this equipment safely.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Recruitment, training and supervision of staff was taking place as appropriate and systems to deliver these activities were adequately managed.

The registered manager and other senior professional staff had given information sessions to the care staff on various areas of need of the people using the service. Staff had received the necessary information to provide appropriate skilled support. However, staff had not completed formal training, in areas such as acquired brain injury and psychological support. The registered manager said they would address this.

Each person had a staff team individually supporting them. The number of support hours required and when these were to be delivered was designed on an individual basis to support each person. There was a careful staff recruitment and matching process. This supported consistent staffing and a low level of staff turnover.

There was an accurate record of care staff arrival and leaving times. Staff were arriving at the planned times, although there were occasions where short notice replacement staff caused delay, for example, sudden staff sickness.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff were supplied with Personal Protective Equipment (PPE) to carry out their roles. For example, there were stocks of PPE in each person’s home for staff to use. Generally only gloves were used by staff but if there was a higher risk from infection then face masks were available. The service had taken a decision to attempt greater levels of protection from infection for some people by staff having used Lateral Flow Tests to check they were not infectious with Covid 19 before arriving for work.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Where the service was responsible for the administration of people’s medication, records showed they were given safely and as prescribed. Staff received regular training in the administration of medicines.There was an electronic medicines administration system in use which was used to ensure the safe administration of all medications whether they came in tablet form or through another route such as medication patches applied to the skin.