Elm Bank 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 as good.

At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People and their relatives told us they were actively involved in the assessment, planning and reviews of their care and this helped to ensure support remained person-centred. One person told us "I think I am well familiar with both my relatives care plans; we sort with one of seniors and I have updates if something changes."

People’s preferences and decisions made were recorded in their care plans. Staff demonstrated a good understanding of people’s individual needs and how to meet them effectively. There were processes in place such as handover meetings, to ensure staff were kept informed when people’s needs changed.

The service used clinical assessment tools including food charts and weight logs where people had unexplained weight loss and fluid charts where people were at risk of dehydration. However, we were not assured of the oversight and monitoring of these tools were effective. We had received concerns about a person had been admitted to hospital who was found to be dehydrated upon admittance. This was discussed with the management team, who acknowledged the concern and explained that their new electronic system, once fully embedded, would improve oversight and provide prompts when individuals were not meeting their nutritional or hydration targets.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Staff had access to information about people’s dietary needs and the support required. While there was a choice of meals and drinks, and staff were observed supporting people with kindness during mealtimes, concerns were raised about the wait times and quality of meals. The management team was already aware of these issues and had begun acting on this.

Feedback about food was mixed. One person said, “Food is reasonable…actually better than it was. There are twice-monthly meetings where food is often discussed." Another commented,“ I can’t say I enjoy food; the only meal I like is Friday’s fish and chips.”

On the first day of the visit, hydration stations were not present on any floor. Staff explained they are usually set up and all day and refreshed by morning staff, they were in place the following day. Some residents expressed frustration about inconsistencies between what was advertised and what was delivered. One person said, “The brochure says tea and coffee every day at 11am and 3pm — for the last 3 weeks we didn’t have any at 11am, but today someone came with a trolley.” ,However, this was not mentioned during resident’s meetings. It is also worth noting not all people were able/ chose to attend these meetings. Another added, “They advertise bowls of fruit, we asked for that about 3 weeks ago. The next day staff brought a bowl of fruits around so we can take one piece each. Today's fruit starter (plate consisted of thinly sliced apple ring, in the middle was half of grape and aside of apple was quarter of strawberry and same size on the other side), was a joke; I didn't know what to do with that, but it looked like bird food.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

People were supported by staff who worked effectively together and in partnership with healthcare professionals and services. This collaborative approach ensured a joined-up, consistent, and effective response to meeting people’s individual care needs.

One person told us, "I also don’t have many hospital appointments, but if I do, I’m sure somebody will be able to help me with anything I might need."

However, another person expressed dissatisfaction with GP services, "I expected GP services would be better. I have a sore and when it appeared, I asked for the GP to see it. On the day they were here, they asked the carer to take a photo of the sore. They couldn’t be bothered to see it themself. My sore is now looked after by nurses twice a week."

Staff were able to access care plans and deliver appropriate care and support. They reported that communication within the team was strong, with daily handovers used to share new information and instructions to meet people’s changing needs.

A visiting health professional told us, “A carer usually comes with me to see the patient. They've got really good insight into the patient, know why we've been called, and understand the concern." The home had recently implemented monthly meetings with the district nurses’ team.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People told us they were supported to access healthcare services and treatment when needed. Staff worked collaboratively with external professionals to ensure coordinated care and demonstrated a good understanding of individuals’ health needs and how to promote wellbeing. People’s choices were respected.

However, we found gaps in people’s monitoring records for instance, oral health support. There was no clear evidence of people being supported to access dental care, and oral care records were inconsistent, with some lacking explanations. In one case, a person was recorded as having “no teeth,” raising concerns about staff understanding of the broader importance of oral hygiene. Additionally, a person was diagnosed with oral thrush upon hospital admission, and we were not assured that all appropriate steps had been taken to identify this earlier.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

People told us their health and wellbeing were monitored, and we saw evidence that care plans were reviewed monthly or when changes occurred. One person told us "Person was on purified foods, but they could not see why they were on this, and they got somebody in to see them. Person is now on level six food which is minced rather than purified." Another told us, "(Staff) struggle with Person as they are reluctant to drink. They know during the hot weather that they are at risk of dehydration and urine infections, so they have been into their room there every hour. When Person was not eating well, they put them on fluids and on a diet chart. They also contacted the dietitian for advice. Person gets weighed every month, so they do monitor this."

Staff demonstrated confidence in identifying new risks and making timely referrals to healthcare professionals. They showed awareness of how to promote good health and respected people’s choices and wellbeing. However, the oversight of monitoring records required improvement. We found food and fluid intake logs and repositioning records were not consistently or fully completed. For example, one person with a wound had no wound care instructions in place, and no referral to district nurse team had been made. Where the person declined dressing, this was poorly documented. These concerns were raised with the provider representative during the assessment. In response, they confirmed that a referral to a dermatologist had since been made and assured us that increased monitoring and scrutiny would be implemented as the new electronic care planning system becomes fully embedded.

The service had designated champions in key areas such as safeguarding and dementia care. They also received support from the provider’s dementia nurse to further enhance care quality.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People’s care plans clearly reflected their capacity, and the support required to make decisions. We saw evidence of family involvement in best interest decisions, and mental capacity assessments were completed appropriately. Staff demonstrated an understanding of the Mental Capacity Act and applied its principles, including the presumption of capacity.

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms were readily accessible in both electronic and paper formats, ensuring swift access during emergencies. Staff gave good examples of how they gain consent before providing support and were observed respecting people’s privacy and autonomy, such as knocking before entering rooms and seeking permission to proceed.

Feedback from relatives confirmed that staff respected people’s choices. One relative shared,“The carers do listen to relatives concerns and certainly don't force them to do things they do not want to. For example, there have been occasions when they have wanted to remain in bed, and they have left them to do this. I think they genuinely know when they are not feeling great and therefore, do not push them to get up.”Another commented,“Yes, they always ask Person about things, and they are quite respectful of their wishes.”