CQC report explained · a residential care home
What the CQC found at Elmglade Residential Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, May 2019
Rated Good; inspectors found safe, kind and personalised care, with clear improvements since the previous inspection.
The inspection was unannounced and took place on 24 April 2019. One inspector and an expert by experience spoke with 13 people, a relative, a healthcare professional and staff. They also checked care records, medicines records, staff files and management records.
Inspectors found that people were safe, treated kindly and involved in decisions about their care. Staff supported people's privacy, dignity, independence, health, nutrition and medicines. The home was clean and comfortable, and there were enough staff.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. The rating improved from Requires Improvement at the previous inspection on 26 April 2018. Inspectors found that earlier concerns about safety, staffing reviews, activities, records, monitoring and the environment had been acted on.
Kind and respectful staff
Inspectors saw staff supporting people with patience, warmth and respect. People were given time to make choices and were not pressured to join activities.
“We observed staff were kind, patient and respectful when supporting people.” from the report
Safer environment
The provider made several safety improvements after the previous inspection. These included window restrictors, safer water temperatures, new flooring, grab rails and grip mats.
“Since that inspection the provider had acted to make the premises safer for people.” from the report
Personalised care
Care records included people's preferences, routines, communication needs and choices. Staff used this information to tailor support.
“People's records contained information for staff about their preferences and choices for how their care and support should be provided.” from the report
Improved activities
A full-time activity coordinator had created a broader programme, including creative activities, exercise, entertainment, games and outings. Staff were also trained to provide activities when the coordinator was away.
“Since that inspection the provider had acted to improve the range and quality of activities on offer to meet people's social and physical needs.” from the report
Stronger management oversight
The provider improved audits, incident reporting and responses to feedback. Inspectors found that shortfalls identified through checks were dealt with promptly.
“The provider had improved their quality monitoring systems so that audits and checks of the service were more thorough and detailed.” from the report
Inspectors raised no specific concerns in this report.
- 01How do you review staffing levels when a resident's needs change?
- 02What activities are available for residents when the activity coordinator is not working?
- 03How would you support my relative's particular communication, dietary or healthcare needs?
- 04How often will my relative's care plan and preferences be reviewed with them and their representative?
- 05How are complaints, accidents and incidents recorded, investigated and shared with families?
This was an unannounced inspection of the overall service, including both the premises and care, and all five CQC questions were rated. This explanation was written from the published report of 25 May 2019 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, April 2018
Rated Requires Improvement; inspectors found kind care, but safety risks and weak oversight needed fixing.
This was an unannounced inspection on 7 March 2018. Inspectors spoke with people living there, relatives, managers and staff. They observed care and lunch, and checked care records, medicines records, staff files and management records.
People generally received kind, respectful care. Staff supported people's health, food and drink, medicines, independence and privacy. Staff training, care planning and contact with health professionals were also judged good.
However, some parts of the building were unsafe. Hot water was too hot in some areas, window restrictors were missing and torn carpet created a trip risk. There were also too few activities, slow improvements and quality checks that did not find important problems.
The overall rating Requires Improvement means the home was not consistently meeting the expected standard. The report says the provider breached three regulations covering safe care and treatment, notifications, and good governance.
Kind and respectful care
People described staff as kind and caring. Inspectors saw people being given time, privacy and support at their own pace.
“People and relatives spoke positively about staff.” from the report
Medicines and health support
Medicines records had no gaps or omissions. Staff monitored people's health and sought medical help when needed.
“People were supported to take the medicines prescribed to them.” from the report
Staff training and support
Staff received relevant training, supervision and appraisals. They said managers supported them in their roles.
“Staff continued to receive regular and relevant training to help them to meet people's needs.” from the report
Too few activities
needs fixingPeople still had limited opportunities for social and physical activities, despite this being identified at the previous inspection. Inspectors saw no planned activities or one-to-one activities during the visit.
“No planned activities took place and we did not see staff undertaking any 1-2-1 activities with people.” from the report
Weak quality checks
seriousThe provider's checks did not identify problems that inspectors found. The report says this was a breach of Regulation 17.
“The provider's quality assurance systems were ineffective and did not identify the issues we found at the service.” from the report
Missing notifications
seriousThe manager had not notified CQC about some liberty restriction outcomes and an allegation of abuse. This was a breach of Regulation 18.
“Failure to notify CQC of all events and incidents meant we could not fully check that the provider had taken appropriate action to ensure people's safety and welfare in these instances.” from the report
- 01Have all missing window restrictors been fitted, and have the hot water temperatures and torn carpet been made safe?
- 02How do you now review staffing levels when people's care or monitoring needs change?
- 03What regular activities are available, including one-to-one activities, outings and activities based on each person's interests?
- 04How do your quality checks now identify building risks and other shortfalls before they affect people?
- 05How do you make sure all incidents and liberty restriction outcomes are notified to CQC without delay?
This was an unannounced inspection covering all five key questions, including both the premises and the care provided; 20 people were using the home at the time. This explanation was written from the published report of 26 April 2018 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 Elmglade Residential Home
3 rated inspections over 3 years: the service has held its Good rating throughout.
- May 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2018Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- January 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- June 2014
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 30 December 2010.
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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