CQC report explained · a residential care home
What the CQC found at The Royal Elms Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, July 2021
Rated Good; inspectors found a safer, better-run home, with some records and guidance still needing attention.
Inspectors visited unannounced on 21 and 24 June 2021. They spoke with people living in the home, a relative and staff. They observed care and reviewed care, medicine, recruitment and management records.
The home was clean, staffing levels were sufficient and medicines were given as prescribed. Staff had appropriate recruitment checks, people were protected from abuse, and improvements had been made to the building, infection control and management systems.
Some smaller issues remained. Records about using some as-required medicines needed more detail, guidance about food and fluid thickeners needed updating, and two safety certificates had been missing, although the provider arranged servicing.
The overall rating was Good. The Safe and Well-led ratings improved from Inadequate to Good. The home had previously been in special measures, but inspectors said it was no longer Inadequate or in special measures.
Clean and safer surroundings
Inspectors found the home clean and saw improvements to its décor, bathrooms, storage and safety arrangements.
“The home was clean and tidy. Equipment was stored safely and there were specific areas for staff to put on and take off PPE.” from the report
Enough staff
Staffing levels were sufficient and agency staff were no longer being used.
“Staffing levels were sufficient to meet the needs of people living at the home.” from the report
Medicines generally given correctly
People received their medicines as prescribed. The report identified only some recording and guidance that needed further work.
“People received their medicines as prescribed.” from the report
Improved management
The provider had strengthened audits and acted on areas needing improvement. Staff said they felt supported and clear about their roles.
“Audits had been improved and now captured all elements of the home such as care plans, cleanliness, recruitment and safeguarding.” from the report
People and families involved
People were involved in decisions about redecoration, and relatives were supported to visit under infection control guidance.
“People told us they had been able to choose how the home and their rooms were redecorated and this had made them feel involved.” from the report
Records for as-required medicines
needs fixingRecords needed to show more clearly that staff used de-escalation techniques before giving some as-required medicines for agitation.
“Further recording of information was required to ensure staff used de-escalating techniques before this type of medicine were used.” from the report
Outdated thickener guidance
minorGuidance for people using food and fluid thickeners needed review so that it used the latest terminology.
“Where people used food and fluid thickeners to aid swallowing, guidance was in place, but this needed reviewing to ensure the most up to date terminology was used.” from the report
Missing safety certificates
needs fixingCertificates for electrical safety and the passenger lift could not be found during the inspection. The provider arranged for the equipment to be serviced immediately.
“There were two certificates missing for electrical safety and for the passenger lift.” from the report
- 01How do you record the use of as-required medicines, including what de-escalation techniques were tried first?
- 02When will the guidance for food and fluid thickeners be reviewed and updated?
- 03Can you show me the current electrical safety and passenger lift certificates?
- 04How are you checking that the improvements made after the previous Inadequate inspection are being maintained?
- 05How do you continue to involve residents and relatives in care decisions and visits?
This was a planned inspection based on the previous rating and focused on Safe and Well-led, including infection prevention and control; Effective, Caring and Responsive were not rated in this report. This explanation was written from the published report of 7 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, December 2020
Rated Inadequate and placed in special measures; inspectors found serious safety and leadership failures.
Inspectors visited on 13, 15 and 16 October 2020. Because the home had a COVID-19 outbreak, they also spoke to relatives and staff by telephone. They reviewed care records, medicines records, staff files, audits and safety records.
They found unsafe infection control, including poorly stored protective equipment, masks worn incorrectly and cleaning problems. Fire safety and gas checks were overdue. Some risks were not recorded clearly in care plans, and one recruitment check was not suitable.
Leadership and oversight were also inadequate. Safeguarding concerns were not properly investigated, staff did not always receive the right training, and audits had not found important problems. People who had tested negative for COVID-19 were not always supported to use communal areas safely.
The overall rating was Inadequate. Safe and well-led were both rated Inadequate. The home was placed in special measures, which means CQC will monitor it closely and re-inspect it to check for significant improvement.
Medicines administration
Medicines were generally given and recorded as prescribed. Audits showed good compliance, although records for food and fluid thickeners were not always complete.
“Medicines were administered and recorded according to the prescriber's instructions.” from the report
Staffing levels
Staff said there was generally enough staff on duty at one time.
“Staff said there was generally enough staff on duty at any one time.” from the report
Health professional involvement
Staff worked with health professionals to review people's physical and mental health.
“The staff team worked with health professionals to ensure people's physical and mental health was regularly reviewed.” from the report
Support from temporary management
Staff said a manager from another home was supportive and had made some improvements.
“A manager from another of the provider's services was overseeing the management of the home.” from the report
Infection control and building safety
seriousProtective equipment was stored on frequently touched surfaces and a waste bin was accessible in a busy corridor. The home also had cleanliness problems, trip hazards and overdue fire and gas safety checks.
“Stocks of PPE was not always safely stored. Gloves and aprons were stored across the home on radiator covers and units.” from the report
Care plans did not always record risks
seriousImportant instructions were missing from some care plans, including repositioning needs and what to do after a fall for someone taking anticoagulant medicine.
“However, the risks didn't always feed into care plans.” from the report
Recruitment and agency checks
seriousOne staff member had an old DBS check without a suitability risk assessment. There was also limited evidence that agency workers had received an induction or had suitable skills.
“The provider did not ensure all agency workers received an appropriate induction and had not assured themselves the agency workers had the appropriate skills and experience to work at the home.” from the report
Safeguarding and management oversight
seriousA safeguarding allegation was not assessed, investigated and concluded properly. The provider's audits and leadership systems did not identify or address important problems.
“The provider did not robustly assess, investigate and conclude any investigations into the allegation despite requests to do so.” from the report
Isolation during the outbreak
needs fixingPeople who had tested negative were not always supported to use communal areas safely. Inspectors said the home had not considered other ways to reduce the risk of isolation.
“The provider did not identify strategies to allow people living in the home to continue to access communal areas of the home to reduce isolation.” from the report
- 01What has been done to improve infection control, including the storage and use of PPE?
- 02Have all fire safety, gas safety and other maintenance checks now been completed and kept up to date?
- 03How are safeguarding concerns now reported, investigated and recorded?
- 04How do you check that permanent and agency staff have the right recruitment checks, induction and skills?
- 05How are residents being supported to use communal areas safely and avoid isolation?
This was a focused inspection of Safe and Well-led only, prompted by concerns about safeguarding and management; Effective, Caring and Responsive were not reviewed during this visit. This explanation was written from the published report of 8 December 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.
Every inspection of The Royal Elms Care Home
5 rated inspections over 6 years: the service has improved, from Requires improvement to Good.
- July 2021Goodcurrent ratingup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2020Inadequatedown from GoodSafe: InadequateWell-led: Inadequate
- June 2018Goodup from Requires improvementSafe: GoodWell-led: Good
- April 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 20 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.
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
At least 100 live-in carers within about an hour of Manchester
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 £980 to £1,260 a week. 89 can care for a couple. 10 years' experience on average.
“Primrose is a very kind and compassionate healthcare professional”
“She is an exemplary carer, she is knowledgable empathetic and very respectful in the home.”
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.