CQC report explained · a residential care home
What the CQC found at The Elms Residential Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Some safety systems were not reliable enough. Inspectors found problems with infection control, incident monitoring and the storage of thickener, although medicines were generally administered safely and staff understood safeguarding.
- Effective?
- Good
- People's needs were assessed and staff worked well with health professionals. Staff supported eating, drinking, consent and independence, but some staff training was not up to date.
- Caring?
- Good
- People and relatives described staff as kind, patient and respectful. Inspectors saw people being treated with warmth and supported to make choices and remain independent.
- Responsive?
- Good
- Care was personalised and activities reflected people's interests. Staff supported contact with relatives and worked to prevent social isolation.
- Well-led?
- Requires improvement
- The manager promoted a friendly and caring culture, but quality systems were not comprehensive or effective enough. Audits did not identify some problems, and lessons from incidents were not always used to improve care.
What inspectors found, February 2020
Rated Requires Improvement; inspectors found kind, personalised care, but safety checks and management systems were not consistently effective.
This was an unannounced inspection over two days in December 2019. Inspectors spoke with people, relatives and staff, and reviewed care plans, medicines records, staff files and management records.
People were described as receiving warm, respectful and personalised care. Staff supported people's health, food and drink, medicines, activities and relationships well. Effective, caring and responsive care were all rated Good.
Some safety problems remained. These included weak monitoring of incidents, an unclean communal toilet, a damaged toilet door and unsecured thickener powder. Records and quality checks did not always identify or correct problems.
The overall rating was Requires Improvement. Safe and well-led were also Requires Improvement. Effective and caring stayed Good, while responsive improved from Requires Improvement to Good since the previous inspection.
Kind and respectful care
People and relatives spoke positively about staff. Inspectors saw warmth, reassurance, patience and respect in daily care.
“People were treated with warmth and affection, they were listened to, valued as individuals and respected.” from the report
Personalised support
Staff knew people's backgrounds, preferences and care needs. Care plans and activities were adapted to individuals.
“People were supported by staff who had a good understanding of, and were very attentive to their care needs and preferences.” from the report
Activities and relationships
People were offered daily activities linked to their interests. Staff encouraged social contact while respecting people's choices about how to spend their time.
“Staff knew people's backgrounds and interests and sought to promote activities that were relevant to them.” from the report
Safety checks did not always work
seriousSystems did not reliably identify patterns in incidents or prevent problems from happening again. Inspectors also found an unflushed communal toilet and a damaged toilet door that could not be cleaned effectively.
“This was a health and safety risk and more regular checks, and increased oversight of the checks, were needed to effectively manage the issue.” from the report
Unsecured thickener
seriousThickener powder had been left unsecured in a communal area, creating a possible choking risk. The issue was dealt with during the inspection by moving it and installing a lockable cabinet.
“This posed a potential choking risk to people and any children visiting the service.” from the report
Weak quality monitoring
needs fixingAudits did not identify some problems with the premises, medicines storage and care records. The systems also did not fully monitor incidents, care records or staff training.
“The quality management systems in place were not yet sufficiently comprehensive.” from the report
Staff training was not fully up to date
needs fixingSome staff had not completed required training across several topics. The provider was asked to prioritise training and had scheduled further sessions.
“Staff training records showed that some members of staff were not up to date on their training across various topics.” from the report
Care records contained gaps
needs fixingMost records were good, but some contained errors or omissions. Records did not always show people's current cognition or all information about legal powers of attorney.
“Care records did not always reflect people's current levels of cognition or detail in full any information regarding legal powers of attorney.” from the report
- 01What has been done to make sure communal toilets are checked and recorded regularly, and has the damaged toilet door been repaired?
- 02How are incidents, accidents and near misses now reviewed so that repeated risks are identified and acted on?
- 03Are all staff now up to date with the training required by the home's policy?
- 04How are care records checked for missing or incorrect information, including current cognition and powers of attorney?
- 05How is thickener stored now, and how do you prevent similar medicine or treatment items being left unsecured?
This was an unannounced inspection of all five key questions, including the premises and care provided; the previous overall rating was Requires Improvement. This explanation was written from the published report of 8 February 2020 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, November 2018
Rated Requires Improvement; inspectors found kind care and progress since the last inspection, but safety, activities and management systems still needed work.
Inspectors visited unannounced on 21 August 2018. They spoke with people living in the home, relatives, staff and a health professional. They reviewed care records, medicines records, recruitment files, maintenance information and quality checks.
The home had improved since June 2017. The five previous breaches had been addressed, and the home was no longer in breach of regulations. Staffing, cleanliness, the building and dining arrangements had improved.
However, the home was not consistently safe, responsive or well-led. Medicines records and audits needed improvement. Some risks had not transferred correctly to the new electronic care system. People could feel bored or lonely, end of life plans were basic, and dignity and management oversight were not always consistent.
The overall rating of Requires Improvement means inspectors found some good care, but important improvements were still needed. The home was not placed in special measures according to this report.
Progress since the last inspection
The provider had acted on the previous inspection findings. The home was no longer in breach of the regulations identified in June 2017.
“At this inspection in August 2018, we found improvements had been made and the service was no longer in breach of regulations.” from the report
Staffing arrangements
Staffing levels and deployment had been reviewed. A senior shift role gave staff clearer responsibilities and helped organise support.
“A key development has been the creation of a 'senior shift role', which involves a senior carer providing direction to other staff” from the report
Kind interactions
Inspectors saw positive relationships between staff and people living in the home. People could ask staff for help and were reassured.
“We observed that positive and caring relationships had been developed between staff and people.” from the report
Training and healthcare
Staff received training in areas relevant to people's needs and had supervision. People had access to healthcare support when needed.
“Staff received training that helped them develop the knowledge and skills needed to support people.” from the report
Improved premises and cleanliness
The home had addressed several previous environmental concerns. Flooring, doors, window restrictors and cleaning systems had been improved.
“Improvements had been made and planned, including the recent implementation of new and improved audit tools.” from the report
Medicines records and checks
seriousInspectors found problems with recording creams and checking a medicine patch was rotated as prescribed. Existing audits had not picked up all these issues.
“The areas of improvement we found, did not feature in the current medicine audit.” from the report
Care risks during record transfer
seriousSome important risk information had not transferred correctly to the new electronic system. This included choking risks, although the manager acted when inspectors raised it.
“We found that two people were at risk of choking, but the information from their paper notes had been filed and had not been transferred to the new electronic system” from the report
Activities and loneliness
needs fixingSome people said they were bored or lonely. Inspectors were not assured that activities met everyone's individual and specialist needs.
“We recommend that the service reviews the provision of activity, to ensure it is meeting people's individual and specialist needs on a day to day basis.” from the report
Dignity and consistency
needs fixingPeople gave mixed feedback about staff attitudes. Inspectors also saw an approach to checking oral health that was not dignified.
“We advised them that this was not a dignified approach to use and to consider how this kind of approach might be mirrored by other staff.” from the report
End of life plans
needs fixingCare records contained limited information about people's wishes for the end of life. Advance care plans were being developed.
“People's care plans held limited information on their end of life wishes and planning.” from the report
Management oversight
needs fixingNew governance systems had been introduced, but quality checks were not yet fully established. It was too early to know their full effect on people's experience.
“However some quality checks needed further improvement to ensure all areas for improvement were identified.” from the report
- 01How do you now check that all choking, falls and pressure ulcer risks are correctly recorded in the electronic care system?
- 02What checks are in place to make sure creams and patches are given and recorded correctly?
- 03How do you provide activities and regular company for people who feel bored or lonely, including people who stay in their rooms?
- 04How are each person's end of life wishes recorded and kept up to date?
- 05What has changed to make sure staff consistently protect people's dignity and that quality checks identify problems quickly?
This was an unannounced comprehensive inspection covering all five key questions, with the previous June 2017 breaches and improvements also reviewed. This explanation was written from the published report of 22 November 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 The Elms Residential Care Home
4 rated inspections over 5 years: the service has slipped, from Good to Requires improvement.
- February 2020Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at The Elms Residential Care Home →
- November 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at The Elms Residential Care Home →
- July 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- April 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2014
Report published without a new overall rating.
- June 2014
Report published without a new overall rating.
- April 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 17 January 2011.
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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