CQC report explained · a residential care home
What the CQC found at St Elmos
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, July 2021
St Elmos was rated Requires Improvement, with significant concerns about risk management, staff training and provider oversight.
This was a focused inspection after concerns about how people were supported and whether enough suitable staff were available. Inspectors visited on 29 April and 20 May 2021. They reviewed records, medicines, infection control and recruitment, and spoke with staff, relatives and health professionals.
Inspectors found that risks to people were not always identified, recorded or acted on quickly enough. Changes in people's needs were missed, including risks linked to choking, behaviour and health. Some incidents and hospital admissions were not reported to the appropriate authorities.
Staff did not have consistently recorded or up-to-date training, supervision and development. The home also had recent management and staffing changes. Inspectors found some positive care, including support with independence, activities and healthcare, but the systems checking safety and quality were not reliable enough.
The overall rating fell from Good at the previous inspection in 2018 to Requires Improvement. The Safe, Effective and Well-led questions were rated Requires Improvement. Caring and Responsive were not inspected at this visit, so their previous ratings were carried forward.
Positive family feedback
Relatives gave positive feedback about the home, staff and communication. The report also recorded that some people appeared settled and happy.
“One describing the service as, "Outstanding." Another told us their relative, "Appeared settled and happy.” from the report
Support for independence
People had their own apartments and were supported with shopping, meals, budgeting and independent living skills. The provider reported progress for some people, including reduced staffing needs as independence increased.
“Good outcomes of care had been achieved for some people.” from the report
Support with activities
Although activities were reduced during the pandemic, staff continued to support people's social opportunities and individual objectives.
“Staff continued to try and support people and maximise their opportunities against agreed objectives.” from the report
Safe recruitment
The recruitment files inspected showed that safer recruitment processes were being used. People could also be involved in choosing staff.
“Recruitment files inspected demonstrated that safe recruitment practices were in place” from the report
Infection control arrangements
Inspectors were assured about several infection control arrangements, including PPE, testing, cleaning and plans for managing outbreaks.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Risks were not managed consistently
seriousSome risks were not identified or described in enough detail for staff to manage them safely. Changes in people's needs were not always recognised or escalated, and this contributed to hospital admissions.
“The failure to have an effective system to assess, monitor and manage risk was a breach of Regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Staff training records were incomplete
seriousThe home could not clearly show that all required training had been completed and refreshed. Staff skills audits and regular development support were also missing.
“There was no clear record of staff training, so we were not assured all mandatory training had been completed and refreshed at suitable intervals.” from the report
Eating and drinking risks
needs fixingChoking and coughing incidents had not been fully analysed, and not all staff initially knew that one person's drinks needed thickening. The provider was advised to improve dysphagia training and competency checks.
“We received a concern that not all staff were aware of the need to thicken drinks for one person.” from the report
Management and staffing changes
needs fixingThe registered manager had left and several senior staff had also left or changed roles. Recruitment was continuing, and staff said covering shifts could sometimes be difficult.
“Recent changes in the management team had unsettled the service.” from the report
Medicines records and creams
needs fixingMost medicines safeguards were in place, but creams were not always given as prescribed. Auditing and escalation after missed medicines needed improvement.
“The exception to this was creams which were not always administered in line with the prescriber's instruction” from the report
- 01What changes have you made to identify and escalate changes in a person's risks or needs?
- 02How do you check that every staff member has current training and the practical skills needed for people's complex needs?
- 03How do you now manage choking risks, including thickened drinks and staff competency checks?
- 04How are safeguarding concerns, accidents and hospital admissions recorded and reported to the right authorities?
- 05How are staffing levels and the effects of recent management changes being monitored?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 24 July 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.
What inspectors found, June 2018
Rated Good in all five areas; inspectors found safe, kind and personalised care with clear management arrangements.
This was an announced comprehensive inspection on 24 April 2018. It was the first inspection since the home registered with CQC in June 2017. Inspectors reviewed care records, risk and medicine records, staff recruitment and training, meetings and quality checks.
Inspectors spoke with two people, the manager, a director and three care staff. They also observed care because not everyone could communicate their views directly. The home supported three people with learning disabilities and could accommodate up to eight people.
The home was rated Good overall and Good in Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, suitable recruitment checks, trained staff, safe medicines support, kind care, personalised support plans and systems to monitor quality.
Enough trained staff
Staffing levels were based on people's needs and reviewed weekly. Inspectors saw staff working patiently and without rushing, with extra staff provided for community outings.
“People received support from a staff team who were knowledgeable and were able to deliver care safely.” from the report
Kind and respectful care
Staff knew people's needs and preferences. They involved people in everyday tasks, respected privacy and dignity, and encouraged independence.
“People were supported by caring, kind and respectful staff who knew each person and their individual needs well.” from the report
Personalised support
People and relevant others helped create and review care plans. Staff used communication aids, photographs and other approaches to support people's choices.
“Care plans were in place detailing how people wished to be supported and had been produced jointly by staff and people living in the service.” from the report
Quality monitoring
The manager and director carried out checks across several areas of the service. People, relatives and staff could suggest improvements and actions were taken.
“Quality assurance systems were in place to review the quality and safety of people's care.” from the report
Inspectors raised no specific concerns in this report.
- 01How are staffing levels matched to my relative's needs, and how often are they reviewed?
- 02How would you support my relative to communicate choices, concerns or consent if they cannot communicate verbally?
- 03How are medicines checked, including medicines given only when needed?
- 04What activities and community outings would be available for my relative, based on their interests?
- 05How would my relative and our family raise a complaint, and how would we be told what action was taken?
This was an announced comprehensive inspection covering all five CQC questions and the overall quality of the home. This explanation was written from the published report of 2 June 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 St Elmos
2 rated inspections over 3 years: the service has slipped, from Good to Requires improvement.
- July 2021Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2018GoodSafe: GoodEffective: GoodWell-led: Good
- June 2017
Registered with the Care Quality Commission on 5 June 2017.
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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13 live-in carers within about an hour of Norfolk
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 £990 to £1,120 a week. 9 can care for a couple. 14 years' experience on average.
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.