The Elms

The Elms is a residential care home providing personal and nursing care to up to 29 people. The service also provides support to people who live with dementia. At the time of our inspection there were 28 people using the service. People are accommodated in one adapted building across three floors. There is access to an elevated garden space accessible from the first-floor communal room.

People’s experience of using this service and what we found

Processes for identifying and managing risks had not been maintained sufficiently to ensure risks were always effectively assessed, managed, and mitigated.

The provider’s quality monitoring system was not always effective in identifying where improvement to the service’s processes and systems was required, for example, processes for the assessment and management of risks.

People told us they felt safe knowing the staff were around to help. People said although sometimes they have to wait for help, they were never left unsafe.

People told us they were always treated with kindness and had never been treated badly. People told us they had never seen or heard anyone be abused in any way. People’s relatives also confirmed staff treated their relatives and others in a kind and respectful way.

People told us they received support to take their medicines and relatives confirmed their relative’s medicines had been reviewed when required.

People told us their bedrooms were cleaned regularly. There were arrangements in place to keep the environment clean and processes in place for effective prevention and control of infection.

We observed staff taking action to reduce risks to people, for example, when supporting them to walk, at mealtimes and when people who lived with dementia became confused or distressed. People’s relatives had been informed of any accidents or incidents and told about the action taken to keep their relative safe.

The management team promoted and supported a person-centred approach to care, meaning people’s individual preferences and wishes were listened to when delivering support to them.

Staff were provided with the support and leadership they needed to carry out their tasks safely and to work as one team when supporting people’s needs.

People and their relatives felt able to raise concerns and had the confidence that these would be addressed. The views of people, their relatives and the staff were sought and used to improve the service. People, their relatives and the staff told us the registered manager was approachable and helpful.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 9 May 2022).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about staffing numbers, the moving and handling of people, medicines administration and visiting arrangements. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the processes in place for assessing and managing risks and medicines administration. There were also concerns with the provider's quality monitoring and management of those processes, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

The provider took immediate action during the inspection to reduce risks to people.

You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded, at the last inspection they were inspected, to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Elms on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to assessing and managing risks, medicines and the provider’s quality monitoring arrangements at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Elms is a residential care home providing accommodation to persons who require nursing or personal care, to up to 28 people. The service provides support to older people; some whom live with dementia. At the time of our inspection there were 28 people using the service. People are accommodated in one adapted building.

People’s experience of using this service and what we found

People told us they felt safe and well looked after. They told us the staff were tolerant, patient and friendly. Although there had been challenges in recruiting staff, there were enough staff to ensure people’s care needs were met. People’s individual care and health related risks were known to staff, assessed and managed in order to keep people safe.

Appropriate action had been taken to reduce risks associated with the environment, infections and unplanned events. People’s medicines were managed safely. Managers and staff had learnt from situations which had not gone to plan during the pandemic, and they had adjusted their care and risk management strategies accordingly.

People, their relatives and staff told us the service was well managed. People and their relatives felt able to approach managers and the staff as needed. They told us communication, with them, had been well maintained during the pandemic. This had provided reassurances to relatives when they had not been able to visit past a designated area within the building.

Staff told us there was good team working in place and an open and transparent culture. They felt able to raise concerns where needed and able to constructively question directives or decisions shared with them, so they had a clear understanding on procedures and what was expected of them. Managers had sought feedback from relatives and people and used this to improve the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 12 December 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. This included information about the care of people with pressure ulcers, falls management and how the service worked with external healthcare professionals.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Elms on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Elms can accommodate up to 28 older people and people living with dementia. At the time of our inspection 23 people were living or receiving respite care at the home. There was a range of communal areas people could use on the unit, including a large living room. The third floor of the home had only recently reopened in full and was being used to support people new to the service and who required to self-isolate in line with best practice guidance on Covid-19.

We found the following examples of good practice at The Elms.

¿ The registered manager ensured staff had access to appropriate personal protective equipment (PPE). Arrangements had been made to ensure there was appropriate PPE to care for people who may have symptoms and require support to self-isolate. The third floor of the home had been allocated to support people newly admitted to the home and who in accordance with best practice guidance were supported to self-isolate.

¿ The registered manager has implemented processes for staff when starting their shift and when leaving. A handsfree thermometer had been installed and staff had a designated changing and washing area. Staff understood the reason for these processes and spoke positively about following them. The registered manager had reviewed staffing of the service due to the government lock down, they had increased staff presence, including domestic staff to ensure people's needs were met. All staff working at The Elms solely worked at this home.

¿ The registered manager worked proactively with healthcare professionals. They had implemented weekly calls with people's GP and were setting up monthly multi-disciplinary team meetings. Protocols had been set up to ensure people could be supported by healthcare professionals. Staff understood the importance of ensuring these protocols were followed.

¿ The home had appropriate access for healthcare professionals, with the aim of reducing the risk of Covid-19 going into the home. This had ensured people had continued to have access to healthcare support they needed, whilst managing identified risks.

¿ People were supported with a tailored activities programme, which included support to interact with their loved ones remotely. Staff spoke positively about the time they had to spend with people and talked positively about promoting people's wellbeing.

¿ The registered manager worked with people's relatives to ensure social distanced visits could work whilst protecting people who were vulnerable. There were plans in place to change areas of the home to provide a safe visiting place. The registered manager was aware of local area guidance and recommendations.

¿ The registered manager had robust systems to ensure there was clear oversight in relation to infection prevention and control. The registered manager and deputy manager ensured staff adhered to national guidance on PPE. There were comprehensive infection control audits and cleaning schedules in place to ensure the home remained clean and free from infection.

¿ The registered manager had ensured that all information and guidance, in relation to Covid-19 was taken onboard. They spoke positively about summarising this information and providing staff with the key information they required.

The Elms is a residential home which provides personal care for up to 22 older people and people living with dementia. The home has a range of communal areas, including lounges, dining room and reception area. At the time of our inspection 17 people were living or staying at The Elms for short term respite.

People’s experience of using this service and what we found

The provider had taken over the service in May 2019. Since taking ownership of the service they had implemented a clear service improvement plan which prioritised the health and safety of people and staff. They had also carried out a range of refurbishments to the home with more changes planned. The provider had a clear vision for The Elms which had been shared with people, their relatives and staff.

People and their relatives told us all staff were kind, caring and compassionate. Staff were attentive to people’s needs and knew how to promote their wellbeing. When people were anxious, care staff took time to reassure them. People were treated with dignity and respect.

Staff were appropriately trained and had the skills to meet people’s needs. The provider was ensuring staff had access to training, support and continued professional development they needed and requested. People received effective care and treatment. The service worked alongside a range of healthcare professionals to ensure people’s health and wellbeing were maintained.

People’s risks were known by the provider and care staff. Care staff were fully aware of their responsibilities to raise concerns and the provider ensured lessons were learnt from any complaints, incidents or accidents. There were enough staff deployed to ensure people received the support they required. People received their medicines as prescribed.

People received care which was personalised to their needs. Where people’s needs changed, care staff took appropriate and effective action to ensure their health and wellbeing. People enjoyed talking with staff, other people and taking part in activities, including games they had played throughout their life.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This is the first inspection of the service under the current provider. The service was last rated under the previous provider and was rated Requires Improvement (published 6 November 2018). At this inspection, we found the service had improved to be “Good”.

Why we inspected

This was a planned inspection based on the previous rating and following changes to the provider of the home. At this inspection we found that the service had improved under the new provider and was now rated “Good”.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.