The Elms Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

There were enough staff to keep people safe. Staff understood their role in the management of risks and their responsibility to report any concerns that could place people at risk of harm or injury. The provider had processes to improve staff practice and share learning. Care and support plans contained sufficient information to support staff in mitigating people's individual risks. However, there was a lack of consistency in the completion of tools to identify and evidence the management of risks. People received their prescribed medicines but records around the use of ‘as required’ and topical medicines needed to be more robust. The provider had effective processes to maintain the safety of the environment and to support good infection control practices. There were systems to ensure important information was gathered about people and shared with other healthcare professionals as they moved between services.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives were informed if their family member was unwell or had an accident and involved in discussions to mitigate future risks. Relatives said they would be confident to raise any concerns knowing they would be listened to. One relative said, “[Registered manager] is brilliant. You can’t fault her. I ring her if I have a concern about [Name] and I will always have an answer.”

Staff understood the process for recording and reporting accidents and incidents which impacted on people’s safety. They told us learning was taken from adverse events to improve staff practice and enhance outcomes for people. One staff member told us, “If something has gone wrong, we have a lesson learned and a reflective practice form which we go through. That form takes us through the procedure and then based on that, we go forward in changing our ways if something was wrong.” Another staff member told us that after a person had fallen in the home, staff had undertaken further training to help them mitigate future risks.

The registered manager reviewed accident and incident forms to ensure action had been taken to mitigate people's individual risks and referrals had been made to other healthcare professionals if required. However, whilst the registered manager looked at any trends or patterns in the occurrence of incidents, it was not always clear what action had been taken. Reflective practice was used to improve staff practice and share learning.

Some relatives told us their family members were sent from hospital to The Elms under a ‘discharge to assess scheme’. These relative told us they were fully involved during the assessment period. One relative told us, “I was very involved because we were having regular meetings, and they always let me know if any health professionals were visiting and invited me to be there.” Another relative said, “They did a pretty good job of finding out what [Name] wanted and what they were capable of.” People told us staff supported them if they needed to attend hospital. One person told us, “When I went into hospital it went smoothly. It was well managed really.” Another person said, “I have been to hospital while living here. Staff couldn’t have done anything better.”

The registered manager explained the process for ensuring people were admitted to the home safely. They told us they carried out baseline observations on admission so they could identify any deterioration in people’s health needs. The registered manager confirmed if people were discharged from hospital with incomplete paperwork, they would contact the hospital to ensure all relevant information was handed over. One staff member spoke positively about the relationships they had built with other healthcare professionals. They told us, “We have always had the nurses coming here and the GP comes in. For me, it has always been a positive interaction with them. Any concerns I have, I have always felt I can be honest with them, and they are part of the team.”

Partner agencies and healthcare professionals did not share any concerns in relation to this quality statement. One healthcare professional told us referrals were timely and appropriate and that staff obtained samples and completed any monitoring requested of them. This healthcare professional spoke of better communication because of improved consistency within the staff team. They also spoke positively about the registered manager’s detailed knowledge of people's healthcare needs.

The provider had safe systems to ensure important information was gathered about people and shared with other healthcare professionals as they moved between services. This included an emergency pack which contained key information about people's risks and care needs should they need to be admitted to hospital.

People told us they felt safe and confident with the staff who cared for them. One person told us, “The staff care about me. I have never experienced any intimidation or anything like that. The kindness from the staff is the best thing. They really take their time with you.” Other comments included: “I haven't got any problems with the staff. They are all ever so nice to me” and, “I feel very safe here. You don’t have to worry about anything untoward because the staff are nice.” Relatives were similarly confident their family members were kept safe and used terms like ‘friendly’, ‘wonderful’ and ‘patient’ to describe the staff team. One relative told us, “We can go away on holiday with no concerns because I have confidence to leave [Name] there.”

Staff told us they had received training in safeguarding and understood their responsibility to report any concerns about people’s safety and wellbeing. One staff member told us, “I would report it to the manager, so she is aware, and she makes sure it does not happen again.” Staff told us they would not hesitate to report poor practice by other staff which could place people at risk of harm or injury.

Staff were seen to be kind and comforting, providing physical and verbal reassurance to people when they became anxious or distressed. Staff approached people in a kind and caring way and people responded positively.

Processes were in place to identify safeguarding issues to ensure they were referred to the local authority and CQC as required. Staff training needs in relation to safeguarding incidents were identified and actioned. Where restrictions had been identified in people's care plans, applications under the Deprivation of Liberty Safeguards (DoLS) were made to the authorising body as required. The registered manager maintained a DoLS tracker to ensure renewal applications were submitted in a timely way and any conditions on authorised DoLS were met.

People and relatives were confident risks to health and wellbeing were assessed and managed well. One person with a health need that required them to drink well told us, “The staff keep me hydrated.” Another person told us, “I walk with a frame for safety and staff make sure it is close by me. I also have a bell in my room which I press. The staff come as soon as I press it as they know something is wrong.” One relative whose family member was at risk of falls told us, “They have put a (crash) mat by the side of the bed and a sensor mat on their bed, so it triggers as soon as they try to get out.” Another relative told us they had been involved in discussions with the registered manager and GP about risks to their family member’s health. This relative commented, “We spoke together as to what was the best option.”

Staff understood their role in the management of risks. For example, a member of housekeeping staff was clear about their role in minimising risks around infections spreading. Care staff knew people’s individual risks and described how changes in people’s needs were shared with them at a handover meeting between shifts.

Staff ensured people who required aids to walk had them within easy reach. We observed staff supporting one person to mobilise. They carried out the action confidently and supportively. When people became anxious, staff responded with reassurance and distraction. However, we observed there were periods during lunch when staff did not maintain a presence in the dining room. This meant people’s risks around eating and drinking were not always being monitored.

Care and support plans contained sufficient information to support staff in mitigating people's individual risks in areas such as eating and drinking, mobility, mental health and diabetes. However, we found tools to identify the level of risk had not always been regularly reviewed. This meant any changes in people's level of risk may not always be identified in a timely way. We also found records to evidence the implementation of risk management plans needed to be more robust. For example, there were gaps in one person's repositioning records because some staff were recording interventions in the daily records and others were completing a repositioning chart. Food records did not evidence the amount of food people were offered or when they had any snacks between meals. This made it difficult to accurately assess people's nutritional intake. Despite gaps in records, appropriate referrals were being made to other healthcare professionals which indicated emerging risks were being acted upon.

People and their relatives did not raise any concerns about the environment. One relative told us there were no ongoing maintenance issues and that their family member had all the equipment they needed to transfer safely. Another relative told us they were confident in the security of the home.

Staff told us there were processes to report and record any maintenance issues with equipment or in the environment. One staff member explained, “We have a maintenance record. The key thing is not to leave things as they are if they could potentially harm someone.” Staff told us they had regular fire drills, so they understood what to do in the event of an emergency.

Overall, the environment was well maintained and kept free from obstacles that could present a falls risk to people. However, we did identify two windows in a person’s bedroom that did not close properly which was a potential fire risk if not addressed. The registered manager confirmed these would be reported to maintenance for immediate action. We also saw one person had worn ferrules on their walking frame which increased their risk of falls.

The provider had systems and processes to ensure the environment was safe. This included regular fire safety checks such as fire alarm tests, drills and emergency lighting. Environmental safety certificates were seen for gas safety, electrical installation and equipment used within the home. The provider instructed external contractors to carry out risk assessments in relation to fire safety and Legionnella risks within the service.

We received mixed feedback about staffing levels. While people felt safe, they told us they sometimes had to wait for support. One person said, “It is hard to say if there is enough. You have to be patient is what I will say. They need another member of staff in the morning and in the evening. It isn’t so much waiting to get up in the morning, but if you need the toilet or need some assistance, then it is those times.” Another person said, “There isn’t enough staff in my opinion. They could do with a few more. The food we have to wait for. We could be sitting in there (the dining room) ages before they bring it in.” Relatives told us there were generally enough staff around. Comments included, “Not ever been in a situation where there has never been enough. You can always find someone when you need them” and, “[Name] is still being cared for, but it seems a bit less at the weekend.”

Staff told us there were enough of them to meet people’s needs but it could be busy when staff were unable to work at short notice. One staff member told us, “It is busy, but it is manageable because I don’t think there is a time when we couldn’t finish a task. When somebody is sick or can’t come to work, then it may be a bit short.” The registered manager told us they used a dependency tool to identify safe staffing levels but also carried out observations to ensure staff were able to provide responsive and effective care. They explained, “We look at the dependency tool but sometimes it might not be accurate so I assess it myself and if I need more staff then I will go to [the operations manager]. We have just increased from 2 to 3 on nights because of the fire risk and the layout of the home.”

Staff did not appear rushed and had time to sit with people in the lounge. Call bells were responded to and not left ringing for excessive periods of time.

The provider had safe and robust recruitment processes to ensure staff were suitable to provide care and support. Staff received ongoing training and supervision to ensure they had the skills and confidence to provide safe and effective care. Systems were in place to ensure agency staff profiles and photographic identification were received before they worked at the home. This meant the provider could be assured agency staff had received basic training or had Disclosure and Barring Service checks to ensure they were safe to work with vulnerable people.

People told us the home was clean and tidy. Comments included, “I am happy with the cleanliness. The cleaners come around and clean my room and keep it nice for me. No problems really. Staff wear gloves all the time”, “They do a good job with the cleaning” and, “The room is ever so clean. They come every day and dust and all that and empty my bins. No issues with that.” Relatives consistently used the word “spotless” to describe the cleanliness of the home.

Staff told us they had completed training in food hygiene and infection prevention and understood the importance of minimising the risk of infections spreading. Staff reported they had enough personal protective equipment and knew when to use it. One member of staff told us, “Infection control is important because when you have a lot of people living together there is a lot of touching and spreading. If there is an illness it could spread like wildfire. We have to do what we can to keep people safe.”

Throughout our visit we observed the home to be clean and there were no obvious odours. Staff were seen to follow good infection prevention and control processes and use personal protective equipment appropriately. The laundry was well organised with clear separation of clean and dirty items and clinical waste was observed to be managed well.

The provider’s systems ensured infection control processes were managed well. For example, cleaning schedules ensured all areas of the home had been cleaned and staff received regular training in infection control. The service had been awarded the bronze accreditation to ‘Say No to Infection’ in May 2024.

People told us they received their medicines when they needed them. Comments included, “The staff make sure I have them at the right time” and, “I am not aware of any issues with my medicines. Staff bring them to me, and I take them. I think they bring them when they should. It seems about right to me.” Relatives told us they were involved in discussions about their family members’ medicines and had no concerns about how they were managed. One relative told us when their family member sometimes declined their medicines, “Staff are really good at talking them into it and reassuring them.”

Staff confirmed only staff members who had completed medicines management training and had their competency assessed, were able to give people their medicines. The registered manager told us medicines management had been a focus for improvement and continued to be a work in progress.

Records demonstrated people received their prescribed medicines. However, the processes to support safe medicine practices needed to be improved to minimise the risk of harm. For example, when people were given ‘as required’ medicines to support their emotional well-being, the medicine administration record (MAR) and daily records did not evidence a clear rationale for why this had been administered. Improvements were also needed in the level of detail in the application instructions for topical creams and the recording of when they were applied. Medicines with short expiry dates when opened, had their date of opening recorded. This ensured they were not used beyond their expiry date.