Elm House Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

The provider was no longer in breach of the legal regulation regarding safe care and treatment.

This service scored 66 (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 had improved their learning culture following the previous assessment, however some aspects still required embedding. Some staff continued to use a paper form to record incidents whilst others used the electronic record. Work was needed to ensure a consistent approach so that opportunities to learn lessons were not missed. The manager reviewed incidents to identify themes.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider established a robust pre-admissions process, and the manager conducted thorough pre-admission assessments. Key staff were included to make sure admissions were safe and appropriate.

Staff and management shared important information with other agencies on a regular basis to make sure pathways between care was well managed. Staff commented handovers were effective, and they had all the right information to care for people well.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Significant improvements had been made following the previous assessment. There was a system to manage safeguarding concerns and referrals, and the registered manager monitored outcomes of safeguarding investigations to make sure any recommendations were implemented. There were good working relationships with local authorities to make sure people were safeguarded. Staff knew how to raise concerns and completed relevant safeguarding training.

Improvements had been made following the previous inspection. The manager undertook risk assessments and regularly reviewed risks to people’s health and wellbeing and included relevant people. However, some risk assessments were missing, for example to assess the appropriateness of bed rails for some individuals, and bed rail safety checks. This was rectified by the manager following our feedback. Staff understood people’s needs well and could provide de-escalation techniques to help ease people’s distress.

The provider established a falls policy and protocol following the previous assessment, although more work was needed to make sure staff recorded post falls observations consistently.

Relatives said they were kept involved and up to date. A relative said, “I will occasionally get calls telling me if they have any concerns about [relative], which gives me some confidence in the home, and that [relative] is being looked after.” Several relatives told us they thought staff managed the risk of falls well.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider made sure health and safety checks were made and we saw these were all up to date. For example, electrical safety testing and water safety. Fire risk assessments were conducted and the provider managed regular fire drills.

The building and premises were in good working order and there was a robust maintenance system to make sure items were replaced or fixed.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The manager recruited staff using safe processes, and necessary safety checks were made such as references and Disclosure and Barring Service (DBS) checks.

Staff completed training relevant to their roles and participated in supervision sessions with the registered manager. We checked rotas and found there were enough staff to meet people’s needs. Some relatives thought the service would benefit from more staff, although many relatives said that staff seemed well trained and observed them using moving and handling equipment safely.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There were regular cleaning schedules and dedicated housekeeping staff. The home looked clean and tidy. Staff wore clothing to protect from the spread of infection and the manager spot checked staff hand hygiene. Many relatives said they were very happy with the cleanliness of the home.

Although improvements had been made with medicines practice since our last assessment, medicines management records required further improvements. For example, where people had been given their medicines, there were occasional missed signatures in the records. Staff did not always record people’s thickeners where required or the amount of thickener added to drinks. Some care plans did not include guidance for staff about people’s ‘as and when required’ medicines. There were occasional gaps in the recording of the fridge temperatures. Some creams and eye drops did not have the date of opening recorded. When we informed the registered manager about these issues, they addressed them straight away. Additionally, the provider planned to move to an electronic recording system which would help address some of the issues we identified.

The manager had put guidance in place regarding topical creams following the last assessment. Creams were stored unlocked in people’s bedrooms; the registered manager was completing risk assessments to underpin this. The registered manager agreed to make sure that where people lacked capacity, creams would be stored securely.

The registered manager had commenced thorough medicine audits and staff completed medicines training. There was a robust process for stock management, and the provider had changed pharmacies after the previous assessment, which led to improvements in practice. The registered manager checked staff competencies, although we did not see evidence of this for 2 members of staff.