Elm House

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. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us that they were happy at Elm House and that it felt like home to them. One person told us “I’ve been here years. I love it”. People told us they felt safe and supported by the staff, and they had plenty of activities available to them. People said they could make independent choices and could rely on staff to support them if needed.

Relatives were positive about the care their family members received. They told us their family members were safe and the provider met their needs. Relatives said communication from the provider was good, with regular updates and involvement in care planning when people consented to this. Relatives told us leaders were approachable and would respond to any concerns they had. Relatives told us the transition of their family member to living at the care home was a positive experience where the provider ensured they got to know people, and could meet their needs before they came to live at Elm House.

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.

The provider documented all incidents, accidents and near misses using a form with prompts such as, “Have any patterns or trends been identified?” and “Are there any identified training needs for staff?” This allowed staff and leaders to reflect on any incidents that occurred and learn from them, in order to improve the care provided to people. The recorded incidents were then analysed by leaders as part of a regular auditing process, with changes being made to staff practice if opportunities for improvement were identified.

All staff completed a comprehensive training programme upon induction, with refresher courses and new mandatory training being introduced by leaders in order to ensure staff were equipped with the skills to support people effectively.

Staff told us they felt comfortable to approach management with any concerns, which led to a positive culture of learning and improvement. One staff member said, “We are given lots of training and we can always tell leaders about any concerns we notice, so we can learn from this as well”.

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.

People received regular visits from external professionals who were involved in their care such as social workers, nurses and GPs. Staff documented visits from professionals and any communication between staff and the visiting professional. This meant any changes in people’s care and support could be communicated to all staff.

When the provider was assessing people for potentially coming to live at the home, there was a robust process in place to ensure their needs were identified. If it was agreed a person would come to live at the care home, care plans were put in place before their arrival. Handover information from the person, their relatives, professionals involved in their care and previous care providers were all recorded and used to inform decision-making. This meant people were supported effectively from the moment they arrived and gave their move the best chance of success.

Each person’s care plan contained a document called, ‘Schedule of expected health appointments’, which advised staff about various health appointments such as visits to the GP, hospital scans, or dentist appointments. This information advised staff on what to expect from each appointment so that they could support people effectively.

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. The provider shared concerns quickly and appropriately.

Staff and leaders knew how to identify safeguarding concerns and report them appropriately to the local authority and CQC. Any safeguarding concerns were recorded as incidents and analysed to identify any actions needed to protect people. The registered manager made detailed observations, and created an action plan, to safeguard people and ensure incidents were not repeated.

All staff received training in safeguarding, with regular refreshers to keep them up to date with current practice. One relative told us, “Staff have training in safeguarding, which reassures us that [person] is safe”.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s care plans contained detailed information about their individual risks. These were written in the first person and used positive, non-judgemental language. Each person had an easy read ‘About me’ document which contained detail about risks in an accessible format. We observed staff following people’s individual care plans and adapting their approach to supporting people based upon this information. For example, staff adapted their communication style to speak with a person who could become anxious in communal areas by speaking with them in a quieter area of the care home. This was in line with the information in their care plan.

Where appropriate, people were consulted about risks related to their care and invited to comment. If people consented, their relatives were also involved in discussing risk management. The provider involved people in managing risks by spending time talking to them and using easy-read documents to aid their understanding. One relative told us, “Staff are brilliant and very enthusiastic. During a recent hospital visit the staff stayed with [person] and kept us informed”.

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

The environment was appropriate and met people’s needs.

Environmental checks were carried out on a regular basis so that the building, garden and equipment were all safe to use. For example, gas and electrical appliances were safety tested by external professionals. A maintenance worker carried out repairs and completed regular safety checks – a comprehensive system of audits ensured all areas of environmental safety were covered.

People told us they felt safe at the care home and this was their home. One relative told us “[Person] feels safe. Doors are locked so that intruders cannot get in”.

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.

Staff were knowledgeable, skilled and approachable. They demonstrated knowledge of the provider’s policies and procedures and the people they were working with.

The provider had systems in place for safely recruiting, inducting and training staff. Staff received comprehensive training which supported them to carry out their roles, including training modules in dignity in personal care, learning disability and autism awareness and mental health awareness.

Staff told us there were always enough colleagues to cover each shift, and agency care staff were rarely used because established staff members were usually willing to pick up extra shifts to cover any absences due to holiday or sickness. We observed positive interactions between people and staff, and people told us they liked the staff and felt comfortable to ask them for help.

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.

Support staff carried out regular cleaning tasks which were set out in checklists and ticked off when completed. This meant all areas of the care home were clean and tidy. The cleaning checklists were audited by leaders, who also carried out a separate audit in which they inspected the levels of cleanliness themselves. This meant leaders did not just rely on what staff had documented and checked the level of hygiene themselves.

Staff were observed prompting and supporting people to tidy up in the kitchen area and taking responsibility to ensure it was clean. This showed people were involved in cleaning their own home, helping them to develop their skills.

One relative told us: “The house is spotless”.

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.

All staff were trained in administering people’s prescribed medicines and demonstrated knowledge of how to administer and store medicines safely. The registered manager was a qualified nurse, meaning they were able to provide the benefit of their experience and skills to staff. Leaders completed regular medicine audits, with processes in place to identify and investigate medicine administration errors should they occur.

The medicine cupboard was clean and organised. Medicines were labelled appropriately with the name of the person the medicine was prescribed for and the date it had been opened. medication administration record (MAR) sheets were clear to follow and understand and were up to date. Staff completed spot check counts of people prescribed medicines. This showed the provider’s systems to monitor medicine stock levels were effective. People were treated as individuals with regards to the administration of their prescribed medicines. Those who were able to administer their own prescribed medicines themselves were encouraged to do so, and those who required support were asked for their consent for staff to help them, which was recorded in their care plan.