Elm House 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 the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

The provider was no longer in breach of the legal regulation regarding consent.

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

The registered manager conducted assessments of people’s needs, and these were reviewed monthly or following any changes to people’s health. Guidance was in place for staff to access via handheld devices. Most relatives said they were involved in reviews of care, but a couple of relatives said they were not. The registered manager had further plans to make sure relatives were involved as much as possible where it was appropriate to do so.

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

Use of nationally recognised clinical tools was ad hoc. We did not see recent MUST (a risk assessment for nutritional health) or Waterlow assessments (assessment to check risks around people’s skin health). However, improvements had been made following the last inspection around the development of a falls policy and post falls protocol. Staff recorded when someone had a fall; they completed safety checks and made referrals to the falls team. The registered manager conducted generic risk assessments regarding people’s health and wellbeing, including fluid and nutrition, moving and handling needs and risk of falls. Referrals were made to the speech and language team and the dietician if people were noted to be at potential risk or their needs changed.

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.

Staff made referrals to external agencies, for example, falls teams and community mental health teams, and information was shared well. Staff could access up to date information about people’s health and wellbeing easily and were involved in processes such as the pre-admission assessment. There were regular handover meetings for important information to be shared with different levels of staff. Relatives thought staff worked well together. A relative said, “There are 2 teams who do shifts during the day and at night. I think they get on well together and there is a good balance between the teams.” Another relative said, “There have been quite a few managerial changes over the years, but it is probably the staff who have held the place together.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control.

We saw various examples. Food was freshly prepared, and people had a choice of healthy options. There was a dedicated activities co-ordinator who was employed on a full-time basis. This meant people were supported to participate in a range of activities both inside and outside of the home. Staff arranged for different types of entertainment such as music groups and singing. Staff helped people with armchair activities and walks in the local area.

The provider did not always routinely monitor people’s care and treatment to continuously improve it.

The provider was using a mixture of paper based and electronic recording methods and so recording of outcomes was inconsistent or ad hoc. Staff monitored people’s weight, and this was recorded either weekly or monthly. Staff identified if people were at risk from weight loss and took necessary action when needed, such as referrals to the GP or dietician. However, on some occasions staff had not recorded how much fluid or food people had. Limitations with the electronic system made it difficult for staff to clearly record times they supported people with pressure relief. The registered manager took on board our feedback and arranged alternative measures for staff to record more accurately, and outcomes could be monitored effectively.

Improvements had been made following the last inspection, although some further actions were required. The provider had a system to make sure they made applications to the local authority if someone was at risk of being deprived of their liberty, and the registered manager monitored these for expiry dates. Staff considered people’s capacity throughout their caring interventions, and we saw consent forms in people’s records. Although we saw Mental Capacity Assessments in people’s records, including for covert medicines, they had not been completed on behalf of everyone who may have needed these. The registered manager advised this would be addressed immediately.