The Elms

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 newly registered service. This key question has been rated requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 62 (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.

A relative said, “I have no safety concerns. I am confident that concerns would be addressed. The home has been fantastic with my relative.’’

A staff member told us about the process they followed if there was an accident or incident. They said, “We record [accidents and incidents] on the online system. The team leader will take over any emergency. We complete an accident form/post-accident form. Management takes it seriously. I am confident to raise concerns with the manager.” Another staff member confirmed, “If things go wrong, we learn from these things. We are a friendly team and work well together.”

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.

A relative told us, “My relative came from hospital incontinent and not walking. Two weeks later my relative was walking again with a frame and not incontinent anymore. The staff are fantastic.”

One professional we spoke with told us, “There are effective senior carers. A senior was good at handling a situation when a person wasn’t well. The senior carer escalated it, and paramedics came.” Another professional said, “They [staff] do what I ask them to. They are very pleasant, knowledgeable, they have the backgrounds [of people]. Staff are able to give me information. They [staff] put things in context, it’s useful to know people’s family situations.”

A staff member told us, “We have a care plan in place before a new resident comes to the home. We read the care plan to make sure we know how to care for the new resident.”

The registered manager told us hospital passports were in place to support people if they needed admission to hospital. Care plans detailed each person’s health and support needs.

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.

A relative said, “The home is very safe. I have never needed to raise a concern.” Another relative told us, “When my relative first went to The Elms I was very observant. The staff are brilliant and keep my relative safe. If I had concerns, I know how to raise these, but I have not 1 concern about the care home.”

Staff understood their responsibility to recognise and report abuse. Staff could describe different types of abuse and what action they needed to take if they had concerns. The registered manager said they discussed safeguarding with staff during team meetings.

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 the service. We found that the home was working within the principles of the MCA.

Staff understood what DoLS were. One staff member said, “We also have safeguarding training and DoLS, DoLS will need to be in place to protect people who cannot make their own decisions.” They went on to say, “A restraint could be not letting somebody out the door if they had capacity.” DoLS applications were submitted when required and this was evidenced in people’s care plans. The provider had an appropriate policy in place to guide the use of DoLS in their service.

The provider worked with people to understand and manage risks by thinking holistically; however, there were some omissions in the care planning around this. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Two people had continence plans outlining how often they needed support. However, both plans contained out-of-date information. One plan stated support was needed every 6 weeks, but records showed this timeframe was exceeded, even though the plan had been reviewed by the provider. Staff were unclear about the correct frequency the person should be supported. If people are not supported at the right intervals, their health could be at risk.

Some people’s Personal Emergency Evacuation Plans (PEEPs) did not contain sufficient information to guide emergency services about people’s mobility or how they would evacuate the building, if needed. We fed this back to the registered manager who updated the PEEPs.

One person had a special piece of equipment to help keep their skin healthy. We saw this was in use, but their care plan did not reflect what setting it should be on so there was a risk it may not always be on the correct setting. The registered manager added this to the person’s care plan following our feedback. We checked it was in place on our second visit, and it had been added but had not been visible to care staff on the system. This was resolved during our second visit. Other care plans were in place for people which described their needs and how staff should support them with these needs.

Despite these omissions, feedback was positive about people’s safety. One person said, “I feel safe. If there were total strangers, maybe not, but there aren’t.” The same person told us about the equipment they used to help them get around the home. A visiting professional said, “I would say people are well looked after.”

Staff knew people well. They were able to tell us about people’s individual needs and how they liked to be supported.

We observed safe moving and handling by staff, so people were supported safely with their mobility. Staff explained manoeuvres to people. Equipment to keep people safe was also in place, such as sensor mats and moving and handling equipment, when needed.

The registered manager told us about supporting people to take positive risks; they said, “Life doesn’t stop when you go into a care home.” We observed people moving freely around the home and outside spaces independently.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

We found concerns with a fire door not closing which had not been addressed. This meant it may not afford the protection it was designed to do in a fire, which could put people at risk.

People had been left at risk as the hot water temperatures were not checked to ensure they remained a safe temperature to use. The Health and Safety Executive (HSE) have guidance in place about the temperature water should be in care homes. We checked the temperature of a hot water tap in a bathroom used by people and it was dangerously high. Following our feedback, the provider and registered manager acted to address this and put a system in place to monitor the hot water temperatures, and we saw when remedial action had been taken when some water temperatures were still too hot.

There had been exposed hot pipes in some areas of the home and grounds. Following our feedback, these were swiftly addressed, and we observed these protections were in place on our second visit.

The lift had no signage to stop people using it in the event of a fire. This is a legal requirement. These signs were put in place immediately following our feedback and we saw these remained in place on our second visit.

The provider took action to resolve a communal bathroom which was in a poor condition.

Other checks had been made on the environment such as gas safe, electrical checks and water hygiene checks.

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.

When we asked people about staffing levels, 1 person said, “It’s ok. If it got overflowing with people it may be an issue, but at the moment its steady.” The same person went on to say, “There’s always someone here. Before I was on my own, but there’s always someone here.”Another person said, “I think there needs to be more [staff]. They’re walking around, they seem so busy.” A relative told us, “There are plenty of staff when I visit.’’

One staff member said, “We always have enough time to spend with residents.” A staff member told us, “We have enough staff.” Another staff member said the same thing. A visiting professional felt the staffing levels were ‘ok’ and there was no neglect due to staffing levels. Our observations showed people did not have to wait long for support and communal areas had staff available for people when needed. As well as care staff, there were also activity and other ancillary staff present to have oversight of people and to get support from care staff if this was needed.

Staff were trained to be effective in their role. One relative said, “The staff are competent and do their job very well.’’ Staff confirmed they received training and the registered manager tracked staff training on a training matrix. Staff had not completed the Care Certificate, which is a nationally recognised set of standards to train and support staff. Despite this, there were a number of courses staff were expected to complete, such as mandatory courses about safeguarding, moving and handling and multiple supplementary courses including training about learning disabilities.

Staff were recruited safely. Checks were made on staff suitability to support people who used the service, such as on their employment history, references, identity and on their criminal records.

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

There was an instance of a growth in a bathroom which could have posed a risk to people, but this was resolved by our second visit. The rest of the home was clean and tidy, generally without malodours.

People, relatives and a professional told us they felt the home was kept clean. One person said, “Yes [it is clean and tidy], generally speaking I don’t expect people to be behind me [cleaning up after me], it’s better than the average.” Another person told us, “Its clean and its tidy.” A relative told us, “I have seen staff using gloves and aprons when I visited my relative. The home is spotless.’’ A visiting professional said the home was clean when they visited.

Staff also felt infection control was effective in the service. One staff member said, “I make sure PPE [Personal Protective Equipment] is worn when doing personal care. I wash my hands when handling food. I feel the home is a clean and tidy standard.”

Records showed staff had training in infection control.

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.

One person said, “I have [my medication] every day.” One medicine prescribed as ‘when required’ was being administered regularly, even though records indicated the person did not need it. This change had not been identified by staff, and they could not find evidence the prescription had been updated. After we raised this, a staff member contacted the prescriber to confirm administration instructions. Stock levels matched records, so people were receiving medicines as prescribed. The registered manager told us they had medicine audits and competency checks in place to monitor medicine management. Staff confirmed they had their competency checked.

A staff member was able to tell us what action they would take to try to reduce the risk of medicine errors, but also what action to take if an error did occur including reporting it and seeking medical advice.