CQC report explained · a nursing home
What the CQC found at Elderholme Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- Risks had been assessed and measures were in place, but records did not always show that actions had been followed. Some care plans and medicines instructions needed more detail.
- Effective?
- Good
- Staff were trained and supported, people's dietary needs were met, and referrals to healthcare professionals were made when needed. Records about consent and best-interest decisions could still be improved.
- Caring?
- Good
- This key question was not assessed during this focused inspection. Its rating was carried over from the previous inspection.
- Responsive?
- Good
- This key question was not assessed during this focused inspection. Its rating was carried over from the previous inspection.
- Well-led?
- Good
- Audits and management systems had improved, and people and relatives described the home as well managed. The report said care-record monitoring still needed strengthening.
What inspectors found, November 2023
Elderholme Nursing Home was rated Good overall; inspectors found kind, effective care but records about risks and medicines still needed improvement.
This was an unannounced focused inspection on 27 September 2023. Inspectors spoke with people living in the home, relatives, staff and a health professional. They reviewed care records, medicine records, recruitment files, audits and infection control arrangements.
The home was rated Good overall. Effective and well-led were rated Good. Safe was rated Requires Improvement because records did not always show that risk-reduction actions had been completed, some care plans lacked detail, and some medicines guidance needed improvement.
There were enough staff, medicines were stored and given safely, the home was clean, and people received support with food, drink and healthcare. The home had improved since the previous inspection, when it was rated Requires Improvement and breached the medicines regulation. It was no longer in breach, although further improvements were still needed.
Enough staff
Staffing levels were consistently maintained, and people and relatives said they did not have to wait long for help.
“There were enough staff available to support people in a timely way.” from the report
Kind and trusted care
People and relatives gave very positive feedback about the care. They said staff were patient, approachable and knowledgeable.
“Feedback regarding care and support provided to people was overwhelmingly positive.” from the report
Clean and infection-safe
The home was clean and well maintained. Inspectors found supplies and procedures to help prevent and manage infections.
“The home was clean and well maintained and the provider was promoting safety through the layout and hygiene practices of the premises.” from the report
Good health and food support
People's dietary needs were assessed and met, and staff involved other healthcare professionals when necessary.
“Systems were in place to ensure people's dietary needs and preferences were assessed, monitored and met.” from the report
Risk records were incomplete
needs fixingRecords did not always show that agreed risk-reduction actions had been completed. Some care plans also lacked detail about monitoring needs.
“Risks to people were assessed and measures were in place to mitigate identified risks, however records did not always reflect these were adhered to.” from the report
Medicine instructions needed more detail
needs fixingSome instructions for as-required medicines did not give enough detail. One covert-medicine care plan also needed more person-centred guidance, although it was updated during the inspection.
“However, some required further detail to ensure people would always receive them consistently and when needed.” from the report
Recruitment records
needs fixingSome staff files did not include a reference from the previous employer or a complete employment history. The manager acted to address this during the inspection.
“However, some staff records showed gaps in their employment history and not all staff had references from their last employer as required.” from the report
Best-interest records
minorBest-interest decisions were made, but records did not always show who had been involved in the decision.
“However, records regarding best interest decisions did not always reflect who had been involved in the decision-making process.” from the report
- 01How do you now check that repositioning and other risk-related care has been completed and recorded?
- 02What written guidance is available for my relative's as-required medicines?
- 03If covert medicines are needed, how will you make sure every staff member follows the person's individual instructions?
- 04How do you record who was involved when a best-interest decision is made?
- 05What checks are now in place to make sure recruitment files contain references and complete employment histories?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their ratings carried over from the previous inspection. This explanation was written from the published report of 1 November 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2021
Elderholme Nursing Home was rated Requires Improvement; inspectors found unsafe medicines management and weaknesses in risk checks and oversight.
Inspectors visited on 8 and 11 January 2021. They spoke with people living in the home, relatives, staff and the manager. They reviewed care records, medicines records, staff files and management records.
The home was clean and had effective infection control arrangements during a COVID-19 outbreak. There were enough safely recruited staff, people said they felt safe, and safeguarding procedures were in place.
However, medicines were not always stored or given as prescribed. Risk assessments were sometimes unclear or conflicting. Quality checks did not identify all these problems. This led to a breach of Regulation 12.
The Effective rating improved from Requires Improvement to Good because consent arrangements had improved. The overall rating remained Requires Improvement, and the home had held this rating for five consecutive inspections.
Infection control
The home was clean and had arrangements to reduce the spread of COVID-19. PPE, testing, cleaning schedules and hand hygiene checks were in place.
“There was an outbreak of COVID-19 at the time of the inspection, but we found there were effective infection prevention and control procedures were in place” from the report
Staffing and safeguarding
There were enough safely recruited staff to meet people's needs. Safeguarding procedures and training were in place.
“Records showed there were sufficient numbers of safely recruited staff on duty to help ensure people's needs could be met in a timely way.” from the report
Consent improved
The home had corrected the previous problems with recording consent. Mental capacity assessments and best-interest decisions were used when needed.
“During this inspection, we found that improvements had been made and the provider was no longer in breach of regulation.” from the report
Food and healthcare
People's nutritional needs were recorded and professional advice was included in care plans. People and relatives said medical help was sought promptly when needed.
“People and their relatives told us GP's were contacted in a timely way when people were unwell and emergency medical advice was sought when necessary” from the report
Medicines not always safe
seriousSome medicines were not given as prescribed, and some creams and thickening agents were not stored securely. Guidance was also missing or not always available for some medicines.
“Medicines were not always managed safely as they were not always administered as prescribed or in line with best practice.” from the report
Risk information was unclear
needs fixingRisk assessments sometimes contained confusing or conflicting information. There was also no risk assessment for legionella at the time of inspection.
“Risks were not always assessed and recorded robustly to ensure they could be mitigated.” from the report
Checks did not find problems
needs fixingAudits were not always completed regularly and did not identify all the medicines and risk management issues found by inspectors. Repositioning records were also not always fully completed.
“The systems in place to monitor the quality and safety of the service were not always effective.” from the report
- 01What changes have been made to ensure every medicine is stored and given exactly as prescribed?
- 02How are staff now guided when giving medicines covertly or giving medicines prescribed as and when required?
- 03Have all risk assessments been reviewed so that instructions are clear and do not conflict?
- 04How often are the new daily, weekly and monthly audits completed, and who checks that they identify problems?
- 05What evidence can you show that the Regulation 12 breach has been fully corrected?
This planned inspection covered Safe, Effective and Well-led, including infection control; Caring and Responsive were not rated in this report. This explanation was written from the published report of 11 February 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Elderholme Nursing Home
6 rated inspections over 8 years: the service has improved, from Requires improvement to Good.
- November 2023Goodcurrent ratingup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2021Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodWell-led: Requires improvement
- August 2019Requires improvementstayed Requires improvementSafe: GoodEffective: Requires improvementWell-led: Requires improvement
- July 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2017Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- July 2015Inspected but not ratedSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- May 2015Requires improvementSafe: Requires improvementEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- July 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 24 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
40 live-in carers within about an hour of Wirral
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,230 a week. 37 can care for a couple. 8 years' experience on average.
“It was clear that she genuinely cared and her warm approach really helped put our minds at ease.”
“He developed a close affinity with Terence, spending time talking with him before he retired to bed and looking after his needs during the night.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.