The Elms

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 good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (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.

We reviewed a selection of health and care assessments, including associated care plans. In one person’s case these assessments had not been fully completed on admission, which had been several weeks prior to this assessment. Care plans for giving staff guidance on how to support this person, also not formulated. It was therefore difficult to be assured that the support we saw provided to this person, was fully meeting their needs. The registered manager told us the lack of assessments and care plans would be immediately addressed.

An electronic care records system was in place which provided staff with recognised assessment tools to assess people’s needs. Electronic care plans were subsequently formulated and recorded how people’s assessed care and communications needs were to be met. The care plans we reviewed reflected the recorded assessment information and had been personalised to include people’s wishes and preferences. One person said, “They (the staff) are responsive, and person centered here.”

The registered manager or deputy manager completed pre-admission assessments to ensure people’s needs could be met at The Elms. This process considered information provided by the person, their relative, the funding authority and healthcare professionals.

Relatives told us they had experienced different levels of involvement in the assessment and planning of their relative’s care due to previous pandemic restrictions. Several relatives however, told us they were involved in ongoing discussions and reviews of their relative’s care. One relative had appreciated being given access to their relative’s electronic care records. The ability to read the care plans and the daily care records had helped them to better understand the care being provided to their relative. They told us they hoped this access would continue.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Relatives spoke positively about the care provided to their relative and people told us the staff looked after them well. People’s care preferences and wishes were taken into consideration when planning their care. If decisions needed to be made about care or treatment, and the person was unable to independently make these decisions, people’s relatives or their legal representatives were consulted.

People were supported by staff who had received relevant training to a recognised standard. There were arrangements in place to ensure staff remained updated with current practice standards. Staff responsible for training other staff and monitoring standards of practice, received appropriate levels of training to complete this role. For example, staff received moving and handling training and had to complete an annual update. They were also supported to maintain continued safe practice by a member of staff who had received accredited training to be able to do this.

Staff often worked with specialist healthcare practitioners, so people’s care was planned and delivered in accordance with evidence based good practice and standards. People who were at risk of choking were assessed by speech and language therapists and their needs met in accordance with The International Dysphagia Diet Standardisation Initiative (IDDSI). People who required support with cognitive and behavioural changes, received care which was often planned with support from dementia and positive behaviour specialists. People’s medicines were administered by staff who had been trained to administer medicines in accordance with best practice guidance provided by the National Institute for Health and Care Excellence (NICE).

The provider worked well across teams and services to support people. They shared appropriate information about people’s needs when people needed to move between different services.

The provider’s electronic care records system, including other arrangements in place for sharing and communicating relevant information, ensured staff and external professionals had the information they needed to assess, plan and deliver people’s care. Care records showed staff were engaged with a variety of health and social care professionals when supporting people’s needs.

Arrangements were in place to ensure relevant information about a person’s care and treatment was shared appropriately and in a timely manner. During this assessment we observed staff engaging with healthcare professionals when people’s health declined. This included paramedics, GPs and community nurses. Staff shared pertinent information with them to help these professionals make their assessments and treatment decisions.

We observed staff using the recognised Red Bag Transfer Pathway to ensure important information was transferred with the person, from the care home to the ambulance staff and from ambulance staff to hospital staff.

Staff regularly referred people to NHS community nurses for assessment and treatment. People who were at risk of pressure ulcer development and who had other wounds, were assessed and treated by the community nurses. Staff also worked alongside primary healthcare professionals to support people at the end of their life.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People predominantly received long term care at The Elms, and they required staff support to remain as independent as they could, for as long as they could. Some people were admitted for short stays and were supported to retain individual skills so they could return home.

People were supported to lead healthier lives. People had access to eye tests and glasses, if needed, to support a better quality of life and independence. A chiropodist visited regularly to keep people’s feet in good condition to support better mobility. The service did not have access to a dentist for regular dental checks. Staff worked with professionals to help people access NHS emergency treatment and relatives supported their family member to access private dental care.

People were supported to exercise. One relative said, “They encourage people to maintain their fitness they do exercises, for example.” People were supported to socialise to help retain social skills and maintain mental wellbeing. Relatives spoke positively about how well the activities co-ordinator supported people in this respect. One relative said, “We have updates from [name of activity coordinator] regarding activities. They do chair exercises, quizzes, skittles, that sort of thing. [Name] has [health condition] and is deaf so could be isolated but isn’t." We received mixed feedback from relatives about how often people went outside. One relative said, “There is only one minibus, so outings are on a rota basis, [name] probably gets out every 6 weeks on average”.

People were involved in reviewing their health and wellbeing. One relative said, “[Name] is involved in the care plan, is independent and they ask her everything, she feels treated with dignity and respect and we are kept informed of issues.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People’s care and treatment was monitored to ensure it continued to meet their needs, improve their quality of life and meet with best practice guidance and standards. Most relatives told us they were aware their family member’s health and wellbeing was monitored, and they were informed of any changes in this. A few relatives told us this had not always been their experience.

The electronic care records system enabled staff to track health and care assessment outcomes and identify improvements or deterioration in these. Staff worked in collaboration with healthcare professionals to review and manage changes in people’s physical and mental health.

During this assessment we observed staff responding to significant changes in two people’s health. In each case staff followed the provider’s protocols and agreed NHS processes to secure the additional medical and nursing support these people required.

The service’s processes, including staff practices, were monitored, to ensure these continued to support good outcomes for people. An example had been monitoring food waste. There had been high food wastage following the main meal of the day at lunch time. Further investigation showed people were not eating all their food at this time of the day, potentially not benefiting from its nutritional value. In consultation with people, it was decided to serve a lighter lunch and move the main meal to the end of the day. This had resulted in less food wastage and people enjoying the meal more at this time of the day. Information received from the service in 2024 told us this had resulted in people settling better at night.

The provider supported people to understand their rights around consent and respected these when delivering person-centred care and treatment.

Relatives told us they were consulted about their family member’s care and treatment if this was their family member’s wish and if they held Lasting Power of Attorney for health and welfare. Several relatives confirmed they had been either consulted or their permission had been sought, prior to people having their Flu and Covid vaccines. One relative said, “They keep us informed of everything, let us know the jabs were all done, they asked her permission as she has full capacity, but we have Lasting Power of Attorney.” Another relative told us they did not have Lasting Power of Attorney but had been consulted on their relative’s treatment.

Staff worked with people to deliver their care in a way which met their needs but also respected their wishes. A person said, “If I don't want to do something they will not force me.” One relative told us their family member did not want to be checked at night despite them being a falls risk. Staff had made an agreement with the person which meant staff could still check the person’s safety but in a way the person agreed to. The relative said, “We have been involved in the care planning and decisions as has [relative].”

Staff understood the importance of obtaining people’s consent before delivering care. We observed staff asking people for their permission before supporting them. We also observed people being reminded what their medicines were for to help them understand their treatment.

People’s care records showed that the requirements of the Mental Capacity Act 2005 were considered and adhered to when planning and delivering people’s care and treatment. The care and treatment to be delivered in the event of a sudden decline in health, had been discussed with people or their representative/s by a GP and guidance on this recorded.