CQC report explained · a residential care home
What the CQC found at Elmside
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, July 2018
Elmside was rated Good; inspectors found that earlier problems had been addressed, although staffing and activities on one unit still needed attention.
This was an unannounced inspection on 19 June 2018. Inspectors spoke with people living in the home, relatives, staff, managers and health and social care professionals. They observed care and reviewed six people's care records, medicines and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found kind care, safe medicines systems, suitable training, good access to health professionals and care plans that had improved.
The previous inspection in July 2017 found problems with management systems, staffing skills, care plans and meeting people's needs. Inspectors said the required improvements had been made. However, some staff said they were sometimes short staffed, and activities for people living with dementia on Cedar unit needed further development.
Improvement since the last inspection
Inspectors found that the problems identified in 2017 had been addressed. The home was meeting the required standards at this inspection.
“At this inspection, we found that they had made the required improvements and were now meeting the standards.” from the report
Kind and respectful care
Staff were calm, friendly and attentive. They supported privacy, dignity, choice and independence.
“We found staff to be kind and attentive and communicated well with people.” from the report
Good management checks
Managers used audits, walk-rounds, incident reviews and feedback to identify and address problems.
“There were quality assurance systems in place. These were used consistently and appropriately.” from the report
Staffing could be tight
needs fixingSome staff said shifts were sometimes not covered and they had to work short staffed. A relative also felt staffing was thinner at weekends, although inspectors saw people's care needs being met during the visit.
“However, some staff told us that at times shifts were not covered and they had to work short staffed.” from the report
Activities on Cedar unit
needs fixingInspectors found that many people living with dementia on Cedar unit spent much of the morning sitting without meaningful interaction or activities. They said this needed further development.
“Activities for people were sitting in Cedar unit needed further development to ensure people regularly had a purpose and the opportunity to do something between events and care needs being met.” from the report
One medicines record did not match
needs fixingMost medicine stocks matched the records, but one of 15 boxes had the wrong quantity. The home had monitoring systems to deal with such issues.
“However out of the 15 boxes we counted, one box did contain the incorrect quantity according to records.” from the report
Some care instructions were not always followed
minorOne relative said evening instructions about removing dentures were not always followed. Inspectors also found one person was missing clothing stated in their care plan and felt cold until staff acted.
“Sometimes in the evening instructions are not always followed, for instance [person's] teeth need to come out to avoid infections, this is not always done.” from the report
- 01How do you make sure there are enough permanent staff at weekends and when shifts are not covered?
- 02What activities are available for people living with dementia on Cedar unit during ordinary mornings and afternoons?
- 03How do you check that medicine quantities match the records and that any discrepancies are quickly resolved?
- 04How do you make sure evening personal care instructions, such as denture care, are followed every day?
- 05How are each person's clothing, comfort and other daily preferences checked against their care plan?
This was an unannounced inspection of the whole care home, including care and the premises, and it assessed all five CQC questions. This explanation was written from the published report of 21 July 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.
What inspectors found, October 2017
Elmside was rated Requires Improvement; inspectors found kind care but unsafe staffing, outdated care plans and weak leadership.
This was an unannounced inspection on 13 July 2017. Inspectors spoke with people, relatives and staff, observed care, and checked care, staffing, training, complaints and quality records.
The home was caring in its approach. Staff were kind, people were supported to make choices, and people had enough food and drink. Medicines were managed safely, and activities supported people's interests and links with the community.
However, there were not always enough skilled staff on duty. Agency staff were used heavily, and some people waited too long for help. Some risk assessments and care plans were not kept up to date. There was also no registered manager, and staff and families did not feel there was clear leadership.
The overall Requires Improvement rating means the home was not consistently meeting the standards expected. The report found breaches of regulations about person-centred care, good governance and staffing. The provider was asked to say what it would do to improve, and CQC said it would check the action taken.
Kind and respectful care
People were treated as individuals. Staff respected privacy, dignity, choices and independence.
“Staff were kind and caring towards people and there was a warm atmosphere throughout the home.” from the report
Safe medicines
Inspectors found medicines were stored and given safely. Medicine records had no unexplained gaps.
“People's medicines were managed and administered safely. People told us they received competent, sensitive assistance to take their medicines as prescribed.” from the report
Food and healthcare
People had enough to eat and drink, with choices and suitable support. The home helped people access healthcare services when needed.
“People were supported to have enough to eat and drink and told us that they enjoyed the food provided.” from the report
Activities and community links
There was a wide range of activities based on people's interests. People were supported to keep links with local groups and services.
“The home provided a wide variety of events and pastimes to support people to pursue their hobbies, interests and socialise with others within the home.” from the report
Staffing levels
seriousThere were not always enough skilled staff on duty. People sometimes waited for help, and the home relied heavily on agency staff who did not always know people's needs.
“This lack of forward planning left people at risk of receiving unsafe care because there were not enough staff to meet their needs safely.” from the report
Outdated care plans
seriousSome care plans and risk assessments were not reviewed after people's needs changed or after incidents. This could mean staff, particularly temporary staff, did not have current guidance.
“The lack of up to date care planning meant there was a risk that people would not be appropriately supported by new or temporary staff who were less familiar with their needs.” from the report
Weak leadership and oversight
seriousThere was no registered manager and staff described low morale and limited management support. Quality checks did not find problems that inspectors identified.
“The acting manager had not ensured that staff were adequately supported on a day to day basis by a visible manager who provided clear leadership.” from the report
Irregular staff supervision
needs fixingMany staff had not had regular supervision in recent months. This was only starting to be addressed at the time of inspection.
“We saw from records that formal supervision was starting to be addressed at the service but that many staff had not had regular meetings in recent months.” from the report
- 01How many permanent and agency staff are currently on each shift, and how do you make sure there are enough skilled staff at weekends?
- 02Has a permanent registered manager now taken up post, and who is responsible for the home until then?
- 03How often are each person's care plan and risk assessments reviewed, particularly after a fall or other change in need?
- 04How do temporary and agency staff quickly learn each person's key needs and preferences?
- 05How are staff given regular supervision, and how can people and relatives raise concerns directly with management?
This was an unannounced comprehensive inspection covering all five questions and the overall rating. This explanation was written from the published report of 11 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 Elmside
3 rated inspections over 2 years: the service has held its Good rating throughout.
- July 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- February 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2014
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 22 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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