Elm Lodge Residential Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment our rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The provider was in breach of legal regulation in relation to consent to care and treatment, meeting people’s nutritional needs.
 

This service scored 25 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.
People’s needs were not consistently assessed or understood to ensure safe and effective care. Staff did not demonstrate a clear understanding of people’s individual needs, including how to support those living with dementia who experienced distress.
During the assessment, we observed occasions where staff did not respond appropriately to a person who was visibly distressed and displaying behaviours that challenge. Staff did not demonstrate the skills or knowledge to de-escalate or reassure the person, which resulted in prolonged periods of distress.
Care records were not accurate, up to date, or reflective of people’s current needs. Although records had been reviewed regularly, this had not ensured the information documented was correct. For example, 1 person’s care plan described them as mobile, independent and socially active; however, they were receiving end of life care in bed. Another person had developed a potential pressure wound and required repositioning; however, this change in need was not recorded, and there was no guidance for staff on how to manage this risk.
Systems to ensure staff could access and use care records were not effective. Care staff did not have access to the electronic care planning system, as they had not been provided with the appropriate training or login details. This meant only senior staff could view and update records, increasing the risk that care was not delivered in line with people’s current needs.
 

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.
On the first day of the assessment, food provision was insufficient in both quality and nutritional value. We observed the planned evening meal consisted only of fruit loaf, with an option of butter or jam. This did not constitute a balanced or adequate meal. The provider did not provide assurance appropriate improvements would be made. Kitchen staff confirmed there were no products available for food fortification and told us this was not routinely undertaken for people who required additional nutritional support. This demonstrated a lack of understanding of how to meet people’s dietary needs.
People were not consistently offered choice. On the day of inspection, only 1 meal option was available at lunchtime, and no menus were in place to demonstrate how meals were planned or nutritionally assessed.
Staff did not consistently provide appropriate support to people during mealtimes. Care plans identified individuals who required support, monitoring of intake, or adaptive equipment such as plate guards; however, this was not reliably followed in practice. We observed people who required assistance did not receive encouragement or support to eat. For example, 2 people had their meals removed without having eaten, with no attempt by staff to support or prompt them.
The provider did not have effective systems in place to monitor people’s nutritional status. No records of weight monitoring were available and combined with concerns regarding food provision and mealtime support, we could not be assured that people were maintaining a healthy weight or receiving adequate nutrition.
These concerns demonstrated a failure to deliver care and treatment in line with best practice and placed people at risk of poor outcomes.
 

The provider did not have effective systems in place to ensure information was shared appropriately between staff, teams and external services. This impacted on continuity of care and placed people at risk of receiving unsafe or inappropriate support.
Handover processes were in place; however, these were not effective in ensuring key information was consistently communicated. Care records did not capture significant events, incidents or changes in people’s needs. This meant staff starting shifts were not always aware of important information, including injuries or changes in condition.
During the assessment, the provider’s electronic care system was not accessible due to a fault. Senior staff were unable to access care plans, daily records or contact information for people’s relatives. This meant staff did not have the necessary information or guidance to meet people’s needs safely.
Systems to support effective partnership working with other services were not in place. When people were admitted to hospital, there was no clear process for staff to maintain contact or request updates on their condition. As a result, staff were not kept informed and could not ensure they were prepared to meet people’s needs upon their return to the service.
Feedback from external professionals indicated communication was poor. Concerns shared with the provider had not resulted in improvements. Where healthcare professionals, such as district nurses, had provided care and treatment, records were not clearly maintained, and information or guidance was not effectively shared with staff.
 

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.
Records did not demonstrate people were supported with their personal hygiene needs in line with their preferences. For example, 1 person told us they had a shower once a week; however, most care records we reviewed did not evidence that bathing or showering was routinely supported or monitored.
People were not encouraged or supported to remain physically active or access the community. There was a lack of meaningful activity provision, and we observed prolonged periods where people were disengaged in communal areas. People who remained in their bedrooms or were cared for in bed received limited support to promote their wellbeing and prevent social isolation.
Staff did not demonstrate sufficient understanding of people’s health conditions or how to support them to live healthier lives. Staff showed limited knowledge of conditions such as Chronic Obstructive Pulmonary Disease (COPD) and were unable to describe what was normal for each person or identify signs of deterioration, such as increased breathlessness or reduced activity levels, that would require escalation.
Staff also lacked awareness of risks for people whose blood pressure drops when moving from sitting or lying to standing, and did not consistently support safe practices, such as encouraging gradual movement, monitoring for dizziness, or taking preventative actions to reduce the risk of falls or injury.
The provider had not ensured people were supported to maintain their health or wellbeing, placing them at risk of deterioration and poor outcomes.
 

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.
There was a lack of oversight to ensure people’s needs, preferences and wellbeing were regularly reviewed, understood and acted upon. People’s quality of life was not consistently promoted. For example, we observed 1 person who expressed a clear wish to go out into the local community, which was also identified in their care plan as important to them. Staff did not respond or support the person to do this, resulting in a reduced quality of life and poor experience.
Systems to monitor behaviours and outcomes were not in place. Although the provider was aware that some people could experience distress or display behaviours that challenge, there were no systems to record, analyse or respond to these. For example, 1 person had a known risk of becoming distressed if unable to go outside; however, there was no evidence of monitoring incidents, identifying triggers, or implementing strategies to achieve positive outcomes.
The provider did not maintain effective oversight of people’s changing needs or clinical outcomes. We observed 1 person with significant skin tears to their leg. Staff were unable to explain how the injury had occurred, how long it had been present, or what action had been taken. There was no evidence of monitoring or referral to healthcare professionals. When the wound was reviewed, staff demonstrated a lack of knowledge in assessing and responding appropriately, and despite the person expressing pain, medical advice was not sought in a timely way. A further person had also sustained skin damage, with no evidence of ongoing monitoring or management in place. These concerns had not been recognised or escalated by the provider.
Care records did not reflect these changes, and the provider was not aware of the injuries despite being present within the service. This demonstrated a lack of effective oversight and review of people’s clinical needs.
The provider had failed to monitor, assess and improve outcomes for people, resulting in poor experiences and placing people at risk of harm.
 

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.
The provider did not ensure people, or their representatives, were appropriately involved in decisions about their care and support. Consent was not consistently sought or respected, and people’s rights were not protected in line with the Mental Capacity Act 2005.
We found examples where decisions had been made that significantly impacted people’s daily lives without evidence of consent. For example, 1 person receiving end of life care was moved from a single bedroom into a shared room. The provider was unable to demonstrate that consent had been obtained from the person’s advocate or representative, or from the person already occupying the room.
Consent was not consistently sought in day-to-day care interactions. We observed staff placing food in front of a person without asking if they wanted the meal or offering an alternative. On another occasion, a person who had not been eating was approached by a staff member who placed a spoonful of food to their mouth without introducing themselves, explaining their actions, or seeking consent. We also observed a staff member placing aprons on people without asking if they wished to wear them; this included 1 person who was asleep at the time. These examples did not demonstrate respectful or person-centred care.
Care records, although regularly reviewed, did not evidence meaningful involvement from people, their representatives or advocates. This was despite these individuals being identified as key contacts, meaning decisions about care and support were not made collaboratively or in line with people’s wishes.
The provider did not operate in accordance with the principles of the Mental Capacity Act 2005. Where people were subject to restrictions and Deprivation of Liberty Safeguards (DoLS) applications had been made, there were no associated mental capacity assessments or best interest decisions in place. For example, people were living in a locked environment and were unable to make decisions about their care or daily routines. There was no evidence decisions made on behalf of people who lacked capacity followed a structured best interest process, including consultation with relevant others or consideration of less restrictive options.