Elm Lodge Residential Care Home

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls.
 

This service scored 30 (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 did not ensure people were consistently treated with kindness, compassion or dignity. Staff did not always recognise or respond to people’s needs in a respectful or person-centred way.
We observed people were not always supported appropriately during mealtimes. One person was attempting to eat their meal using only a knife, and another was using their fingers. Staff did not intervene to offer assistance or encouragement, which meant people were not supported to eat in a dignified manner.
People’s dignity was not maintained in relation to their continence needs. We observed poor oversight and support from staff throughout the day. During a lunchtime period, 1 person was visibly incontinent in the dining room and had to walk away in front of others without staff support. Another person, who was unable to access the toilet independently, began to undress in the communal lounge and stated they were “desperate.” Staff had not identified or responded to their need for support.
These people had not been offered timely assistance with their continence needs since getting up and coming downstairs earlier in the day. This demonstrated a lack of responsive, compassionate care and failed to uphold people’s dignity and respect.
These concerns showed the provider had not ensured people were consistently treated with dignity, compassion and respect, resulting in poor experiences and potential distress.
 

The provider did not consistently ensure people were treated as individuals or that their preferences were respected in practice. Care was not always delivered in line with people’s assessed needs or documented wishes.
Some care plans identified how people wished to present themselves; however, this was not consistently upheld. For example, some people’s records stated they preferred to maintain a ‘smart appearance,’ yet we observed this was not always supported. Some people were not wearing appropriate underwear, and overall presentation did not reflect the preferences outlined in their care plans. This impacted on people’s dignity and sense of self.
People’s individual needs relating to nutrition were also not consistently met. One person’s care plan stated they should be supported to have at least 5 portions of fruit and vegetables each day; however, the provider was unable to demonstrate this was being followed in practice.
We also observed occasions where people’s personal preferences were not respected. For example, 1 person indicated that a cup provided to them was not their own; however, staff told them their usual cup was not available, without seeking an alternative that aligned with their preference.
There were some examples of people being supported in line with their individual wishes. One person remained in their bedroom, behind a locked door, in accordance with their expressed preferences and safety needs. A married couple were also observed maintaining their routine of attending church groups and going out for meals together; however, this was done independently of staff support or provider involvement.
 

The provider did not promote people’s independence, so people did not know their rights and have choice and control over their own care, treatment and wellbeing.
People were not routinely offered meaningful choices. On the first day of inspection, there was no choice of meals available. People were provided with drinks without being asked how they preferred them, and the television was turned on without discussion or consideration of what people would like to watch. At lunchtime, people were not consistently asked where they would like to eat their meal. Some people were taken to the dining room, while others remained in the lounge, with no clear evidence that this was based on their choice.
People were not supported to maintain their independence or access the community. There was no evidence people were routinely supported to go or engage with their local area. One person repeatedly expressed a wish to go outside; however, this was not acted upon by staff. This demonstrated people’s preferences and choices were not listened to or respected.
People were not supported to have choice and control in their daily lives, which resulted in a loss of independence and poor experiences for people.
 

The provider did not listen to or understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.
Staff did not consistently recognise or respond appropriately to people’s immediate needs or distressed behaviours. For example, 1 person became distressed, but staff ignored or dismissed what the person was saying. The person became increasingly distressed, shouting ‘I hate this place’ and displaying physical behaviours. Staff responses were not supportive or effective. When an inspector engaged with the person in a calm and person-centred way, their distress reduced quickly. This demonstrated missed opportunities to respond early and prevent escalation.
Staff did not respond appropriately to changes in people’s health or wellbeing. We observed 1 person who was visibly unwell and experiencing significant breathing difficulties. No referral had been made to a GP, and there was no record of their deterioration within care records. Staff were unable to explain how long the person had been unwell. Due to the severity of the deterioration observed, an ambulance was required, and the person was admitted to hospital.
Another person’s needs were not responded to appropriately as their condition deteriorated. The person was receiving end of life care, but they had not received their prescribed medication for several days, and no referral had been made to healthcare professionals.
However, 1 person who could use the call bell and had capacity to request what they needed told us, “If I want anything all I do is ask the staff.” However, this was not consistently the experience for all people, particularly those who were unable to independently request support, which meant some needs were not recognised or responded to in a timely way.
 

The provider did not ensure staff were adequately supported, developed or enabled to provide person-centred care. There was a lack of leadership, structure and support for staff working within the service.
Staff were not supported by the provider and there was no clinical guidance or managerial oversight available. Senior staff were often left leading shifts without access to additional support or escalation routes, which placed increased pressure on them and impacted their ability to deliver effective care.
Staffing pressures were evident. During the assessment, there were insufficient staff available, resulting in some staff working more than five consecutive days. Staff told us they were unable to complete all required tasks during their shifts, which affected the quality of care provided.
The provider did not demonstrate a commitment to staff wellbeing. There was no evidence of staff meetings, supervision, or appraisal processes in place. This meant staff did not have formal opportunities to raise concerns, reflect on practice or discuss their wellbeing. We also saw no evidence of initiatives to recognise or support staff.
These concerns demonstrated the provider had not created a supportive or well-managed working environment, which had a negative impact on staff wellbeing and their ability to provide compassionate, person-centred care.