We carried out a review of the data available to us about The Elms Care Centre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Elms Care Centre, you can give feedback on this service.
We found the following examples of good practice.
• Staff completed some practise sessions putting on and taking off their PPE, (personal protective equipment, such as gloves, aprons and masks), in front of people. People were given laminated cards of how this should be done and were able to recognise if staff had done it correctly.
• One person used lip reading to understand what staff were saying. Staff understood there was a risk to the person if they removed their mask, so they made sure they were socially distanced from the person before removing their mask to communicate.
• Musical entertainment had been put on outside, in warmer weather, so people could enjoy it without the risk of cross infection. The registered manager told us people from the local community who were passing, stopped to enjoy the music and join in too.
• People and visitors confirmed visiting had continued according to current guidance, and that other social contact, such as phone and video calls had also been encouraged.
The Elms is registered to provide accommodation for nursing and personal care for up to 37 older people. During the inspection 34 people were living at the service. Nursing care is provided to people.
At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
We had some information of concern that we looked at during this inspection. This included how the service looked after people’s skin to ensure they did not develop pressure sores. Also, how the service checked staff were kind and considerate. We found there no concerns about these two matters during this inspection.
At this inspection we found the service remained Good.
Why the service is rated Good
People and their relatives all described the service as caring. We observed staff being patient, responsive and kind. There was a calm atmosphere in the service. People's privacy was important to staff and was respected. People, where possible, or their representatives, were fully involved in decisions about the care and support they received. People were supported emotionally and were involved in deciding how they wanted their treatment needs to be met. Every effort was made to make people feel special to the staff and maintain links with their community, work life and those important to them.
People’s medicines were administered and managed safely. We have however, recommended the registered manager reviews people’s records to ensure they consistently record people’s current medicines and topical creams.
People continued to receive care from staff who were knowledgeable and had the skills required to support them. Staff were competent and trained well. People had the support needed to help them have maximum choice and control of their lives in the least restrictive way possible. Policies and systems in the service supported good practice. People's wellbeing and healthcare needs were monitored by the staff and people accessed healthcare professionals when required.
The care people received was personalised and was responsive to people's individual needs. Each person could make choices about their day to day lives. People’s end of life needs were met in a careful, supportive and personalised way. Any concerns or complaints were quickly acted on and investigated. People were supported to take part in a range of activities according to their individual interests. People’s faith and cultural needs were respected and met.
The service was well led. People and staff told us the registered manager was approachable. The registered manager sought people's views to make sure people were at the heart of any changes within the home. The registered manager and provider had monitoring systems in place which enabled them to identify good practices and areas of improvement.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Further information is in the detailed findings below.
We undertook this focused inspection on 18 May 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Elms Care Centre on our website at www.cqc.org.uk.
The service had a manager in place who was registered with the Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service.
Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People’s human rights were protected. People who did not have the mental capacity to make decisions were protected by legislative frameworks. People had care plans in place which provided staff with information about how to appropriately support people in their decision making. Staff had received training in relation to the Mental Capacity Act 2005 and had a good understanding of how it had an impact on the people they supported.
We last inspected The Elms Care Centre on 4 and 6 March 2015. We asked the provider to take action to make improvements, as we found people’s rights to consent to and be involved in planning their care were not always respected; and records did not always reflect people’s current needs. The provider sent us an action plan detailing the improvements they would make. At this inspection we found improvements had been made, but we found concerns regarding the implementation of the Mental Capacity Act 2005 (MCA).
The Elms Care Centre is registered to provide accommodation for nursing and personal care for up to 37 older people. When we inspected 32 people lived at the service.
A registered manager was employed to manage the service locally. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People who were considered to lack capacity to make decisions did not have an assessment in place to explain how each decision had been made. People’s care plans did not give staff guidance about which daily decisions they may need to make in a person’s best interest and how to do this. The registered manager had applied to the local authority for authorisations to restrict the liberty of some people as being in their best interests. More important decisions about people’s lives had been made through a best interest meeting. However, as neither the authorisations or the meetings were supported by a mental capacity assessment they were not following the principles of the Mental Capacity Act 2005 (MCA). This meant that people’s rights may not always be protected.
People and staff were relaxed throughout our inspection. There was a very calm, friendly and homely atmosphere. People told us they enjoyed living in the home. Comments included, “It’s a lovely home. This is the best I can hope for. Every single staff member is helpful.” People spoke highly about the care and support they received; one person said “You are an individual here. They consider ‘you’. They look after you.” Staff responded quickly to people’s change in needs. People or where appropriate those who mattered to them, were involved in regularly reviewing their needs and how they would like to be supported. People’s preferences were identified and respected.
Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and practice was person focused and not task led. Relatives and friends were made to feel welcome and people were supported to maintain relationships with those who mattered to them. People and those who mattered to them knew how to raise concerns and make complaints.
People had their health and dietary needs met. Staff monitored people’s health and well-being and supported people to access health services when required. People had their medicines managed safely, and received their medicines in a way they chose and preferred.
People told us they felt safe. Comments included, “I have never felt at risk or unsafe.” All staff had
undertaken training on safeguarding vulnerable adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.
People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment. Staff received a comprehensive induction programme. There were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively.
People’s risks were managed well and monitored. People were promoted to live full and active lives and were supported to be as independent as possible. Activities were meaningful and reflected people’s interests and individual hobbies. A staff member commented, “We listen and observe people’s reactions to things and we chat to them and ask them what they like.”
Staff described the management to be supportive and approachable. Staff talked positively about their jobs. Comments included, “[….] is a very good manager and if there’s a problem, they’ll deal with it. I know I can talk to them and things will get sorted out.”
We found a breach of the regulations. You can see what action we told the provider to take at the back of the full version of the report.
This was an unannounced inspection, carried out over two days on 4 and 6 March 2015. The Elms Care Centre provides accommodation for up to 37 older people who require support in their later life, with nursing care needs. The care home also supports people who are living with a dementia. There were 31 people living at the home when we visited.
Accommodation was arranged over two floors and there was a passenger lift to assist people to get to the upper floor. The home had 33 single bedrooms and two double bedrooms. Some bedrooms had en-suite facilities. There were also three shared lounges, a conservatory/dining room, a small secure outside patio, toilets, bathrooms and shower facilities.
There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.
We last inspected The Elms Care Centre in May 2013. At that inspection we found the service was meeting all the essential standards that we assessed.
People told us they felt safe living at The Elms, and we found people were protected from avoidable harm and abuse that may breach their human rights. However, people’s care plans showed that their consent had not always been obtained and mental capacity had not always been fully assessed and documented. Staff did not have a full understanding of the legal requirements relating to people giving consent to their care or where people’s freedoms were restricted. The registered manager told us training was in place, but would review the reasons for staff’s lack of knowledge. People’s medicines were managed well which meant they received them safely.
People told us, at times, there were not enough staff; however the registered manager was aware of people’s concerns and was taking action to make immediate improvements. Staff had the knowledge, skills and experience to carry out their role. The registered manager provided support, training and development opportunities for staff. Staff were aware of people’s individual nutritional needs and drinks were available at all times. However, documentation was not always completed accurately and risk assessments and care plans were not always in place as required.
Positive working relationships were adopted by the registered manager with agencies and other professionals such as GPs, the local authority and external health professionals. This helped to ensure the approach to meeting a person’s care needs was linked. There were systems in place to ensure staff shared information about people’s health care. This encouraged effective communication, and meant staff were pro-active in meeting people’s needs. However, staff had recently highlighted to the registered manager that improvements could be made.
People were supported by staff who were kind and caring. Staff were considerate and respectful which helped to ensure people’s privacy and dignity were promoted. People, relatives and staff were encouraged to be actively involved in the running of the service by providing feedback to the registered manager. Their views were valued and used to facilitate change and improvement.
People received care which was personalised to their needs. Care plans did not always give clear direction to staff about how to meet a person’s needs. But, from our observations and conversations with staff, it was clear they were knowledgeable about people. Care records did not always demonstrate people were involved in creating their own care plans and people told us they were not aware of their care plan.
People were encouraged to take part in social activities and continue to be part of the local community. Staff recognised and understood people’s individuality and social engagements were tailored to suit. However, care plans were not descriptive about people’s social interests.
The registered manager and registered provider promoted a positive culture that was open, inclusive to people, staff and visitors. There was a clear management structure in place. There were quality monitoring systems in place to help ensure continuous improvement.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of this report.
We talked with eight people who lived at the home. They told us that they were happy with the way they were cared for at The Elms. Their comments included 'I am very happy here and I don't plan on leaving' and 'The staff are all so lovely'. Two people told us that they knew they had a care plan document in place and had signed to say they agreed with the content.
People told us that at all times staff treated them kindly and respectfully. They said that they had choices about their care and felt involved in decisions about them. People told us that they could talk to the registered manager if they had any problems and felt they would be resolved quickly and appropriately.
People were cared for by staff who had received training in the safeguarding of vulnerable adults. All of the staff we spoke with were able to describe what action they would take if they had any concerns about people in the home.
The management of the home continued to make improvements to the fabric of the home and the home appeared clean and in good repair.
Staff were available in sufficient numbers with sufficient skills to meet people's needs. People told us that sometimes when staff were busy they had to wait for their call bell to be answered, but that staff always came and explained the delay.
We talked with three people who lived at the home. People using the service told us, 'They are still looking after me well' and 'they are looking after me well, too well sometimes'.
We spoke with five staff who told us that they had received updated training and felt they had enough training to meet people's needs.
We looked in detail at the care three people who had specific dementia or mental health needs received. We spoke to staff about the care given, looked at records related to them, met with them and observed staff working with them. Records relating to people's care were detailed and personal and supported staff by providing sufficient information to meet people's needs.
We looked at the systems in place to monitor the quality of the service. We found that auditing systems were in place to monitor the service and included the areas of infection control, medication and management of the environment. The registered manager was seen to address any problems found and work towards continual service improvement.
We talked with five people who uset the service and one relative and we talked with four members of staff.
People who spoke with us were all happy with the care being provided. We saw that people were spoken with in an attentive, respectful, and caring way. People told us,
'You can't fault it' and 'I am happy here, no complaints '.
Another person told us 'You can have a bath or a shower' and 'The food is good but more variety would be good'.
People said that they would feel able to complain if they needed to and were confident that any issues raised would be suitably dealt with by the registered manager.
We pathway tracked three people who use the service. Pathway tracking means we looked in detail at the care three people received. We spoke to staff about the care given, looked at records relating to them, met with them and observed staff working with them.
We saw that two people with specific dementia care needs did not have care records that would instruct staff on how to meet their specific needs. This may mean that some dementia care needs were not identified and may not have been met.
Three people told us that they felt there were enough staff but sometimes you had to wait for assistance. They said,
' When you use the call bell, you don't wait that long ' trouble is they may be with somebody else, that's the way it is ' and ' you don't have to wait too long when you call, depends what's happening, I find them all alright'. A further person said ' they come to me when I ring the bell'
Four people told us about activities at the home. They said that some group activity took place in the lounge and that they had access to books and newspapers. On the day of our inspection three people went on a trip out to the waterside. No other activity took place that day. People told us that usually not much activity took place. They told us that,
'I don't get out much; I don't worry about getting out'
'We have bingo and I have been on a trip to the waterside and had a lovely time.'
'Matron can organise trips out and the staff go shopping for you if you want'.
Records of activities provided demonstrated a limited range and accessibility to activities at the home and the activities provided were not tailored to people's choices and preferences.
We looked at staff training records and saw that staff had received training in safeguarding vulnerable adults and safe moving and handling. However, most staff had not received training in infection control and dementia care. This means that people using the service may be placed at risk due to staff not having up to date training to support good practice.
We looked at the auditing systems of the service. We found that some auditing systems have been put in place and efforts made by the registered manager to monitor and address issues identified. However auditing care needs and care plans, staff training and some aspects of the environment and infection control practice had not been auidted and shortfalls identified.