CQC report explained · a residential care home
What the CQC found at Elm House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, April 2023
Rated Requires Improvement; inspectors found risks with the building, staffing, food and management systems, although medicines and kindness were strengths.
This was an unannounced focused inspection on 2 and 15 February 2023. One inspector and an Expert by Experience spoke with people, a relative, staff, managers, family members and health and social care professionals. They also observed care and checked care, medicines, staffing and management records.
The home was not consistently safe or effective. Inspectors found damaged and unclean areas, overdue fire safety reviews, too little staff cover at times, limited food choice and food that was not easily accessible. People also had too few meaningful activities and were not always involved in decisions about food and care.
The home was rated Requires Improvement overall, with Safe, Effective and Well-led also rated Requires Improvement. Inspectors found breaches of five regulations. The provider took immediate action, including arranging repairs and a deep clean, seeking extra support and starting an urgent action plan.
Safe medicines
Medicines were given by trained staff, recorded correctly and checked through regular audits.
“People received medicines safely by suitably trained staff.” from the report
Kind and respectful care
People were treated kindly and their privacy was respected. Some relatives and people spoke positively about staff.
“People were treated with kindness and staff respected their privacy.” from the report
Personalised care planning
Care plans showed a good understanding of people's needs and communication support. People had health action plans and passports.
“Care plans reflected a good understanding of people's needs, including relevant assessments of people's communication support needs.” from the report
Staff training and recruitment
Recruitment checks were completed, and staff had relevant training, induction and time working alongside experienced colleagues.
“Training records confirmed that staff had completed training that was relevant to people's needs.” from the report
Immediate response
The provider acted during and after the inspection, including arranging repairs, a deep clean and a fire risk assessment.
“The provider responded immediately during and after the inspection.” from the report
Unclean and damaged environment
seriousSeveral areas were damaged or visibly unclean. This made effective cleaning difficult and increased the risk of infection.
“Areas of the service were visibly unclean, including flooring, banisters, and bathrooms.” from the report
Safety checks were incomplete
seriousFire risks had not been assessed by a qualified assessor, emergency evacuation plan reviews were overdue and other safety issues were missed.
“The environment and systems in relation to fire safety had not been risk assessed by a qualified risk assessor.” from the report
Not enough staff at times
seriousOnly one staff member was on duty on the inspection day while also expected to provide care, cleaning and activities. This limited individual support.
“there was only 1 staff on duty on the day of the inspection” from the report
Limited food and access
seriousMenus offered limited choice, and food stored outside the main house could not be accessed by people without staff help. Inspectors found a breach relating to nutrition and hydration.
“Both fridge and freezer contained adequate food, salad and fresh fruit. However, these were outside the main house and were not accessible to people.” from the report
Too few meaningful activities
needs fixingPeople did not always receive support to follow their interests. Activity records did not show enough about duration or engagement, and some people spent much of their time alone watching television.
“Staff did not ensure people using the service had a fulfilling and meaningful everyday life.” from the report
Weak management oversight
seriousAudits and quality systems failed to identify several safety, food, activity and involvement problems. Inspectors found a breach relating to good governance.
“Effective quality assurance systems were not in place to mitigate risk of harm to people.” from the report
- 01What repairs, replacements and cleaning have been completed since the inspection, and how are you checking that infection risks are controlled?
- 02What did the external fire risk assessment identify, and have all the required actions and emergency evacuation plan reviews been completed?
- 03How many staff are now on duty at different times, and how do you ensure people receive individual support and activities?
- 04How can residents choose meals and get food and drinks without unnecessary restrictions or having to ask staff?
- 05How are you recording and reviewing people's activities, interests and level of engagement?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and the report says ratings for questions not inspected carry over from the last inspection. This explanation was written from the published report of 27 April 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, March 2022
Inspected but not rated; inspectors found good infection control, safe visiting arrangements and measures to manage COVID-19 staffing pressures.
This was an announced, targeted inspection on 3 February 2022. Inspectors looked at infection prevention and control, visiting arrangements and whether COVID-19 staffing pressures affected the home.
Inspectors were assured that the home was managing infection risks. They found suitable checks for visitors, effective use of protective equipment, testing arrangements, up-to-date policies and regular infection control audits.
Family and friends could visit without undue restrictions, using safe arrangements. When people could not take part in outside activities, staff organised activities in the home and maintained staffing levels.
The home was inspected but not rated. This report does not give a current overall quality rating or ratings for the other key questions.
Family contact
People could keep in regular contact with family and friends. Visits were allowed without undue restrictions and were arranged safely.
“People were supported to stay in regular contact with their family and friends, who were able to visit with no undue restrictions.” from the report
Infection control
The home had up-to-date infection control policies, regular audits and arrangements for testing, vaccination and protective equipment.
“The service's IPC policy and plans for managing an outbreak were up to date and in line with current guidance.” from the report
Clean environment
Inspectors found the home clean and hygienic, with daily enhanced cleaning and good ventilation in shared areas.
“The environment was clean and hygienic. Enhanced cleaning took place on a daily basis.” from the report
Staffing arrangements
The provider said it had measures to manage COVID-19-related staffing pressures. Staffing levels were maintained during the restrictions described in the report.
“The provider had been able to maintain staffing levels to make sure people experienced the same level of service.” from the report
Inspectors raised no specific concerns in this report.
- 01How are you managing staffing pressures now, and what happens if COVID-19 affects staffing levels?
- 02What checks are currently made for visitors, staff and visiting professionals?
- 03How do you keep the infection prevention and control policy and outbreak plan up to date?
- 04How are visits arranged now, and are there any circumstances in which visits could be restricted?
- 05How do you support people to take part in activities if they cannot go out?
This was a targeted inspection of infection prevention and control, visiting arrangements and COVID-19 staffing pressures; it was not a full inspection and the service was not rated. This explanation was written from the published report of 2 March 2022 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 Elm House
4 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- April 2023Requires improvementcurrent ratingSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2022Inspected but not ratedSafe: Inspected but not rated
- May 2019Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- September 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- June 2015
Registered with the Care Quality Commission on 15 June 2015.
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.
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At least 100 live-in carers within about an hour of Enfield
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 £1,260 a week. 79 can care for a couple. 11 years' experience on average.
“Over the time he spent with them he got to know our parents very well and became like part of the family, even joining in family celebrations.”
“Charity would take Nan on holidays day trips and shopping adventures”
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.