CQC report explained · a residential care home
What the CQC found at The Elms
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that risks were assessed, staff understood safeguarding, staffing levels were considered sufficient and medicines were administered safely. They noted that some bedroom call bells were not within easy reach, although staff carried out regular checks.
- Effective?
- Good
- People's needs were assessed and reviewed, and staff received training and supervision. People had access to health professionals and were supported with food, drink and specialist diets.
- Caring?
- Good
- People were treated with kindness, dignity and respect. Staff knew people's preferences, interests, cultural needs and religious needs, and involved people in decisions about their care.
- Responsive?
- Outstanding
- Care was highly personalised. Staff supported people with hobbies, trips, new experiences, emotional support and settling into the home, while complaints were recorded and acted on.
- Well-led?
- Good
- The home had an open management approach, regular audits and a clear staff structure. People, relatives and staff gave positive feedback about how the home was run.
What inspectors found, May 2019
Rated Good overall, with Outstanding personalised activities and care, but inspectors recommended reviewing medicine returns and the dining-room layout.
The inspection was unannounced and took place on 24 April 2019. One inspector and an expert by experience visited. They spoke with people living at the home, relatives, staff and a health professional. They also checked care, medicine and staff records.
The home was rated Good for Safe, Effective, Caring and Well-led. It was rated Outstanding for Responsive. Inspectors found that people were safe, treated kindly, involved in decisions and supported by staff who knew them well.
Inspectors found particularly strong personalised support. People were helped to follow their interests, try new activities, maintain relationships and settle into the home. The home was also clean and well managed.
The overall rating stayed Good, the same as at the previous inspection published in December 2016. Inspectors noted some areas for review, including medicine waste and congestion around the dining tables.
Personalised support
Staff adapted care to each person's history, interests and emotional needs. Inspectors described examples that improved people's wellbeing and confidence.
“It was evident that each person was seen as an individual and these examples had a great impact on people's physical and mental wellbeing.” from the report
Meaningful activities
People were supported with activities and trips based on their own interests. Staff also provided activities outside the activity coordinator's working days.
“People were supported to take part in various activities that were of interest to them.” from the report
Safe staffing and risk management
Risks were assessed and reviewed, and staffing had been increased in the evenings as people's needs changed. Staff were trained in safe moving and handling.
“Staffing levels were planned and organised in a flexible way to support people with their daily needs and for additional activities and appointments outside of the home.” from the report
Open leadership
Managers were visible and knew the people using the service. Regular audits and feedback were used to identify and address improvements.
“There was an open and transparent management approach.” from the report
Medicine waste
minorSome medicines were returned to the pharmacy because they had been sent when they were not requested. Inspectors recommended reviewing this practice so medicines were not wasted.
“We recommended this practice be reviewed to ensure this was not wasteful.” from the report
Dining-room space
minorThe dining area became congested when everyone was seated. Some people could not easily move away from the table with their mobility aids.
“We saw that the dining area was fairly congested when everyone was sat down.” from the report
Call bells
needs fixingSome people choosing to stay in their bedrooms did not have their call bell within easy reach. Staff were regularly checking on them and offering drinks and snacks.
“Some people who had chosen to sit in their bedroom we noted their call bell was not in easy reach.” from the report
- 01What changes have been made to prevent medicines being sent unnecessarily and then returned to the pharmacy?
- 02What changes have been made to the dining area so people using mobility aids can move safely and easily?
- 03How do you make sure every person in a bedroom can reach their call bell?
- 04How are meaningful activities maintained at weekends and in the evenings when the activity coordinator is not working?
- 05How would you develop and review an end-of-life care plan if my relative needed this support?
This was an unannounced planned inspection covering all five key questions; the previous overall rating was Good and the home remained Good overall. This explanation was written from the published report of 10 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, December 2016
Rated Good; inspectors found safe, kind and personalised care, with one recommendation about checking staff competency.
This was an unannounced inspection on 25 October 2016. Inspectors spoke with people living in the home, relatives, staff and a visiting health professional. They reviewed care plans, staffing, medicines, recruitment, training and management records, and observed care.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines arrangements, suitable care plans, kind relationships and activities that reflected people's interests.
The home had improved its quality monitoring since the previous inspection. Inspectors made one recommendation because some new staff who had trained with another employer did not have formal records showing that their competency had been checked before working unsupervised.
Personalised care
Care plans gave staff detailed information about people's routines, preferences, communication and support needs. People and relatives were involved in care planning.
“Care plans provided staff with the information needed to provide person centred care.” from the report
Safe staffing and medicines
Inspectors found staffing levels were sufficient and flexible. Medicines were stored, administered and recorded safely.
“There were sufficient staff to meet people's needs.” from the report
Improving management
The provider and manager had strengthened quality checks and used feedback and action plans to improve the home.
“The provider and manager had quality assurance systems in place to ensure continuous improvement to the service.” from the report
Formal staff competency checks
needs fixingSome new staff had not completed the provider's training programme before working unsupervised because they had trained with a previous employer. Their competency had been observed, but this was not formally recorded.
“There was not however any formal record of these competency checks to ensure the member of staff was suitably skilled.” from the report
- 01How do you now formally check and record the competency of staff who trained with a previous employer?
- 02How do you make sure staff complete the provider's training before working unsupervised?
- 03How are people's care plans reviewed with them and their relatives when their needs or preferences change?
- 04How do you use medicines, care plan and training audits to identify and complete improvements?
- 05What activities and community opportunities are currently available for people with different interests and abilities?
This was an unannounced inspection of the overall service and covered all five CQC questions, with a Good rating in each area. This explanation was written from the published report of 2 December 2016 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 The Elms
3 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- May 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Good
- December 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- November 2014
Registered with the Care Quality Commission on 21 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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
40 live-in carers within about an hour of Bristol, City of
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 £1,300 a week. 34 can care for a couple. 11 years' experience on average.
“She became a good friend to my mother in law, chatting with her, dancing with her, knitting with her and the list goes on”
“She was very caring, kind and patient to all his needs, she built up a wondetful rapport with him, she was dedicated and was there for him through good times as well as through the tough times”
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.