CQC report explained · a residential care home
What the CQC found at Elm Tree House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risks were not always properly assessed or managed. Inspectors found unsafe hot water temperatures, inadequate fire and Legionella risk arrangements, incomplete risk information and concerns about staffing and a delegated clinical task.
- Effective?
- Good
- No separate rating was given for Effective in this inspection report.
- Caring?
- Good
- No separate rating was given for Caring. Inspectors observed kind, compassionate and respectful interactions.
- Responsive?
- Good
- No separate rating was given for Responsive. People were consulted about their care and the running of the home.
- Well-led?
- Requires improvement
- Management checks were not effective enough to identify the problems found by inspectors. Staff views about support and night staffing were mixed, although the manager responded openly to the inspection findings.
What inspectors found, March 2023
Rated Requires Improvement; inspectors found kind care, but safety and management systems had serious gaps.
This was an unannounced inspection by one inspector on 17 and 24 January 2023. The inspector reviewed care, medicines, recruitment and management records, spoke with people, staff, a relative and professionals, and looked around the home.
The home was not always safe. Risk assessments were incomplete or out of date, hot water could cause scalds, and fire and Legionella risks had not been properly managed. Recruitment records were not always complete, and there were concerns about staffing levels and a delegated clinical task.
People said they felt safe. Inspectors saw kind and respectful care, and found that infection control and mental capacity arrangements were working. However, checks by the management team had not found the problems identified during the inspection. The overall rating was Requires Improvement, as were Safe and Well-led.
Kind and respectful care
Inspectors saw relaxed, compassionate interactions. People were treated with dignity and said staff were kind and supportive.
“Throughout the inspection we observed kind, relaxed, compassionate and caring interactions between people and staff.” from the report
People felt safe
People and relatives did not raise safety concerns. Staff knew how to recognise and report abuse.
“People spoken with said they would talk to staff if they had any concerns.” from the report
Choice and freedom
The home followed mental capacity principles and used best-interest decisions for restrictions. People were supported to have choice and control.
“People were supported to have maximum choice and control of their lives” from the report
Positive professional relationships
Health and social care professionals said the home communicated quickly about concerns and changes.
“Staff and management are quick to contact me if they have any concerns about the clients mental or physical health” from the report
Infection control
Inspectors were assured that infection prevention arrangements, protective equipment and visiting procedures were in place.
“We were assured that the provider was using PPE effectively and safely.” from the report
Environmental safety
seriousFire safety information was unsuitable, water temperatures were too high and Legionella risks were not adequately checked. These issues created risks to people's health and safety.
“This presented a risk of scalds for vulnerable people who lived at the home.” from the report
Incomplete risk assessments
seriousPeople's risk assessments were not always accurate or updated after incidents. Information about choking risks and specialist advice was missing from care records.
“This meant the risk had not been fully assessed and the service did not have sufficient guidance in place for staff to support the person safely.” from the report
Staffing and recruitment
needs fixingEmployment histories and gaps were not always fully recorded. Staff gave mixed views about staffing, including short cover at weekends and concerns about working alone overnight.
“Staffing is alright in the week, but weekends can be short.” from the report
Delegated clinical task
needs fixingA staff competency assessment was not specific to the person and task, and had not been reassessed by a health professional for almost three years.
“Staff's competency had also not been reassessed by a health professional for almost 3 years.” from the report
- 01What has been done to make hot water temperatures safe, and how are they now checked and recorded?
- 02Has an independent fire risk assessment and Legionella risk assessment been completed, and can we see the actions taken?
- 03How are risk assessments updated after accidents, incidents or changes in a person's needs?
- 04How many staff are on duty during weekdays, weekends and overnight, and how is one-to-one support protected?
- 05How is the delegated clinical task assessed, recorded and regularly rechecked by a health professional?
This was an unannounced inspection focused on Safe and Well-led, including infection prevention and control; the report gives no new ratings for Effective, Caring or Responsive. This explanation was written from the published report of 15 March 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, October 2017
Elm Tree House was rated Good; inspectors found safe, kind and personalised care, with past medicine errors addressed through extra checks.
This was an unannounced comprehensive inspection on 4 October 2017. Inspectors observed care, spoke with six people, three staff members and the registered manager, and received feedback from two health and social care professionals. They also reviewed care plans, staff files, quality checks, meeting records and medicine records.
The home supported nine people with long-term mental health needs. Inspectors found people felt safe, staff were trained and there were enough staff. People were treated kindly and with respect. They were supported to make choices, follow their own routines, stay independent and take part in community activities.
All five areas were rated Good: safe, effective, caring, responsive and well-led. This means the inspectors found the home was meeting the relevant requirements and providing a good standard of care. The home was also rated Good at the previous inspection in September 2015.
People felt safe
People said they felt safe with staff. The home used risk assessments and recruitment checks to reduce risks of harm.
“People felt safe at the home and with the staff who supported them.” from the report
Kind and respectful care
Inspectors saw warm, patient and respectful interactions. People could talk to staff when they were worried.
“Throughout the inspection we saw and heard kind and caring interactions between people and staff.” from the report
Choice and independence
People could follow their own routines, choose when to eat and take part in activities. Staff adapted support to individual needs.
“People said they were able to please themselves about their daily lives and were able to be as independent as possible.” from the report
Good understanding of health needs
Staff recognised changes in people's health and involved other professionals promptly. They supported people to attend appointments and manage their health.
“Staff demonstrated a good knowledge of each person and their needs.” from the report
Past medicine errors
minorMedicine audits had identified a number of errors. The home introduced extra checks and assigned one staff member each day to handle medicine administration, with no further errors found by the inspection.
“Medication audits had highlighted a number of errors.” from the report
- 01What extra medicine checks are now used, and how are any errors recorded and followed up?
- 02How would you support my relative to keep their independence while managing risks in the home and community?
- 03How do you recognise and respond if someone's mental health starts to deteriorate?
- 04How often would my relative's care plan and risk assessments be reviewed after a change in their needs?
- 05How would you support my relative's preferred routines, interests, healthcare appointments and contact with family or friends?
This was a comprehensive, unannounced inspection covering all five CQC questions and the overall quality of the home. This explanation was written from the published report of 17 October 2017 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 Tree House
3 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- March 2023Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2017Goodstayed GoodSafe: GoodWell-led: Good
- September 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2014
Registered with the Care Quality Commission on 3 November 2014.
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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76 live-in carers within about two hours of Somerset
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 £1,020 to £1,370 a week. 62 can care for a couple. 12 years' experience on average.
“She looked after my mum, who can be incredibly challenging, so well and so gently, and we always felt confident that my mum was getting the best care available.”
“She was not phased by anything, she was adaptable, kind & gave us complete confidence to go away & not worry about a thing!”
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.