The Elms

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 good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 75 (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 a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Relatives told us they were confident their family members were kept safe. Those who had experienced a family member have an accident, for example a fall, confirmed they had been informed about this immediately and about the action staff had taken in response. The provider understood their responsibilities in relation to Duty of Candour; being open and honest when something happens.

Risks to people were not ignored, all staff had completed health and safety training. They were aware of what may constitute a safety concern and reported these. Records showed these ranged from environmental safety issues, such as a trip hazard, to personal safety issues.

Unplanned events and emergency situations were reflected on so learning could be taken from these and any necessary changes in practice or process implemented. Examples included additional guidance for staff when the fire alarms sounded at night and improved information for staff in relation to people’s resuscitation status.

Daily heads of department meetings were held, and any safety issues were communicated and decisions made on how to address these. The provider’s health and safety board met regularly to review relevant processes and practices to ensure these were in line with the provider’s policies and procedures and relevant legislation.

The registered manager showed an open and transparent approach when discussing with us, safety risks and the management of these. They had needed in the past to respond to bad weather conditions, including loss of utilities and means of communication. They had learnt from these situations and had contingency plans in place.

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

Relatives confirmed their family member had access to healthcare professionals who addressed their health needs. One relative said, “The doctor calls in regularly, she has the chiropodist, (the hairdresser) and we take her to the optician. We have a good relationship with the staff and receive phone calls and emails to regularly update us.” Another relative said, “Staff seem to have a good relationship with the doctor and other visiting healthcare people.”

Prior to and after admission to the service people’s care needs were discussed with them and with their representative and the funding authority (where appropriate). Involved healthcare professionals were included to ensure care and treatment remained continuous and effective during transition.

Care records showed people received visits from primary care health professionals such as GPs and community nurses. People also received visits from community health services such as opticians and chiropody services. Two visiting healthcare professionals confirmed they had a good working relationship with staff.

Healthcare professionals and the staff followed agreed pathways of care, for example, when supporting people who lived with dementia, when supporting and managing distressed behaviour and when supporting people at the end of their life. This approach meant decisions made by the professionals involved were evidence based, and people’s care was planned according to best practice guidelines.

The provider worked with people and their relatives to understand what being safe meant to them and the best way to achieve that. Staff worked with health and social care professionals to uphold people’s right, to live in safety, remain free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Records showed staff had received safeguarding training; what to recognise and how to report concerns of a safeguarding nature. Staff were aware of the provider’s safeguarding and whistleblowing policies and knew which agencies to contact if they felt the provider was not acting on their concerns.

Care records provided staff with information about people’s individual safeguarding concerns and guidance on the actions they should take to protect people from abuse and harm.

Safeguarding concerns were shared with the local authority (LA) and staff worked with the LA’s safeguarding teams to safeguard people. The registered manager told us information about safeguarding and how to recognise abuse was shared with relatives on admission.

One relative said, “I haven’t seen any aggression from the staff, they are very patient. They deal with people gently.” We observed staff helping people with their individual needs in a respectful, kind and patient way.

People were protected from non-authorised restrictions to their liberty. There was a clear understanding of the Deprivation of Liberty Safeguards (DoLS). A system was in place to ensure DoLS referrals were appropriately made. Records helped staff keep track of when referrals had been applied for, when authorisations were granted (by the LA) and when these expired.

The provider worked with people to understand and manage their risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s risks were assessed before and after their admission. Risk assessments and care plans outlined what people’s risks were and the actions staff needed to take to reduce these. People were receiving support to manage risks associated with old age, living with dementia as well as other medical conditions. Risks associated with choking, malnutrition, falls, frail skin and changes in behaviour were managed. One relative said, “I am confident that they understand her risks and manage them well.”

Care plans outlined how people’s risks were managed, balancing the need to reduce risk, maintain people’s independence and consider their wishes. One relative described how staff supported their relative (who lived with dementia) to mobilise safely whilst also recognising they sometimes wanted to mobilise without staff support.

We reviewed one care plan which outlined how a person’s behaviour, at times, posed a risk to themselves and others. It gave instruction to staff on how they should support the person when they exhibited these behaviours. One relative said, “Some residents get quite aggressive, and they (the staff) know what to do to calm people down.” We observed staff providing reassurance to people when they became distressed.

Care staff attended handover meetings each time they came on duty, which updated them on people’s health and risks including any changes in the management of these. Heads of departments attended a daily risk meeting, so all departments were aware of any general risks arising across the service.

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

Relatives had no concerns about the safety of the environment. One relative said, “I have no concerns regarding the environment or about how staff treat people.”

There were arrangements in place for the upkeep of the building, including the internal and external environments. Records showed servicing of utilities, care equipment, fire alarm and call bell systems took place. Safety checks, including planned and unplanned maintenance tasks, were completed.

Some areas of the building were not accessible to people who used the service for their safety, such as the kitchen, laundry and cleaning cupboards. Staircases were keypad protected, and people did not have access to these unless they were assessed as safe to use them.

We observed one person making their own cups of tea, in the kitchenette, which was part of the lounge/dining area; they had been assessed as safe to do this. Throughout the assessment a member of staff remained present in this area although a relative told us this was not always the case.

The care office, containing confidential information, was kept secured. Some people had wanted the ability to lock their bedroom door, so some bedroom doors were fitted with keypads. These doors could be unlocked from the inside and staff could gain access from outside when needed.

Visitors could only gain entrance to the building by ringing the front doorbell and by being let in by staff. Staff could monitor who was at the front by a visual monitor.

Technology was used to help manage risks. For example, alarmed sensor mats were used to monitor some people’s movements, for example, if they were at risk of falling. Staff could then attend and support them.

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

Most relatives told us there were enough staff available to meet people’s needs. Some relatives told us there were fewer staff on duty at times, but this did not impact on their relative’s care. Most relatives were aware of longstanding staff, but they had also noticed a higher turnover of other staff in recent months. Some staff told us there were times they worked with less staff than had been planned, for example, due to last minute sickness, which could not be covered, and this was difficult. One member of staff told us the efficiency of the staff team was not always dependent on the number but the mix of the staff on duty.

During the assessment the registered manager told us changes made in 2024 had led to increased staff recruitment and reduced usage of agency staff. However, subsequent changes to staff rotas had resulted in changes to some staffs’ working patterns and staff had not been able to cover the required shifts. The service experienced staff retention difficulties and subsequently, maintaining a consistent number of staff on duty had become difficult. The registered manager had taken action to address this. We reviewed a selection of weekly staff rotas and saw a consistent number of staff planned for each day. Where there were gaps in shift cover, bank and permanent staff were picking up additional shifts to make up the required numbers. The registered manager confirmed the service was staffed in accordance with their dependency tool.

There were arrangements in place to ensure staff completed induction training, kept up to date with mandatory training and staff supervision sessions were organised.

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. The provider had cleaning arrangements in place.

Most relatives were positive about the cleanliness of the environment. One relative said, “It doesn’t smell, smells of lovely food like your own home, it’s clean, the carpets are professionally cleaned more than monthly; they seem to be doing it regularly.” Another relative said, “The carpets are horrible” and said, “They need cleaning more often.” The provider had replaced some of the floor coverings with easy to clean covering prior to our last inspection in March 2024 and had an ongoing refurbishment plan in place. On this assessment we were not aware of any offensive odours.

Some relatives referred to the visiting restrictions which had been in place during the pandemic and told us these no longer applied, and they could now visit as they wished. One relative told us, “When covid was around we had to book in (to visit), but now we don’t so I just turn up randomly and [name] is always clean. The place is clean.”

A member of the housekeeping staff explained what their responsibilities were regarding cleaning and preventing the spread of infection. They confirmed they followed a cleaning schedule and had received guidance on which cleaning products to use. Soiled laundry was segregated by the care staff and not handled again until after it had been machine sluiced and washed at an appropriate temperature.

We observed plenty of personal protective equipment (PPE) which was appropriately stored and accessible for staff. We observed staff putting appropriate PPE on before delivering people’s personal care and disposing of it correctly after use. We observed staff washing their hands before preparing food. Use of the kitchen was limited to those preparing food and a ‘5’ hygiene rating (good standard) had been awarded by the Food Standards Agency.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff infirmed people or their representatives of any changes made to these.

Relatives told us they had no concerns regarding the management of medicines. Most were aware their relative’s medicines were regularly reviewed by a GP. A relative said, “We had a medication review 3 weeks ago, they took [name] off one medication, we are kept informed of changes.” Another relative said, “The doctor reviewed her medication when she went in, took her off some tablets she didn’t need, and she is only on 2 or 3 tablets now.”

Some medicines were prescribed by a GP and stored securely at the care home for use by the community nurses. There were clear process in place for the collection, storage and use of these medicines. Decisions on how and when these medicines were administered were made by a GP and the community nursing team.

Records provided staff with guidance on how people preferred to take their medicines, including guidance on any associated risks, such a choking. Refusals to take medicines were reviewed with the GP to ensure people’s health needs remained supported. At the time of the assessment no-one required their medicines to be administered covertly (hidden in food or drink) to ensure they took their medicines as prescribed.

Medicines were administered by staff who had been trained in medicines administration and whose competencies in this task were reviewed. The staff rota was organised so there was always a medicine trained member of staff on duty, during the day and nighttime. We reviewed a selection of records pertaining to the management of people’s medicines and found these were well maintained. There were established and effective processes in place to ensure medicines were ordered and delivered in time and stored safely. Stock balances were monitored to avoid over or under stocking of medicines.