Archived: The Elms Care Home with Nursing

At this inspection we identified shortfalls in both ‘Is the service Safe’ and ‘Is the service Well-led’ key questions and have rated the service ‘Requires Improvement’ overall.

Staff were committed to providing good quality care but the service was not consistently safe. We found people’s needs had not always been comprehensively assessed and staff did not always have the information they needed to understand how to support people to remain safe. We found people who required moving and handling support and those who required support to manage their behaviour did not always receive care in accordance with current best practice guidelines.

The provider and registered manager continuously worked to improve the service. Following our inspection feedback the provider took immediate action to increase staffing in the afternoons so that people could have staff support when they needed it. Additional staff training had also been arranged.

The provider had reviewed their internal quality assurance systems to ensure a more comprehensive audit of the service was completed. The audits had effectively identified most of the shortfalls we found prior to our inspection. However, progress against the provider’s action plan had been slow and the provider’s area operation manager was working alongside the registered manager to make the required improvements.

More information can be found in the Detailed Findings below.

Rating at last inspection: Good (Report published on 4 April 2017)

About the service: The Elms Care Home with Nursing accommodates up to 22 older people in one adapted building. 13 people were using the service at the time of this inspection. Some people using the service were living with dementia, physical disability and/or sensory impairment.

Why we inspected: This inspection was prompted by concerns raised by a health professional regarding people's safe care and treatment. The information shared with CQC indicated potential concerns about the management of risk relating to safeguarding, response to deterioration in people’s physical health and safe moving and handling techniques. This inspection examined those risks.

This was the second concern raised to CQC about the service within the last 12 months. In December 2017, similar concerns had been raised by a health professional and relatives, relating to one person’s care and treatment. This concern was shared with the Local Authority who found action had been taken by the registered manager to address shortfalls in the care provided.

We inspected the service against two of the five questions we ask about services: Is the service safe? and Is the service well-led? No risks, concerns or significant improvement were identified in the remaining three Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure the provider improves the rating of the service to at least Good. We will revisit the service in the future to check if improvements have been made.

The Elms Care Home with Nursing provides nursing and residential care for up to 22 older adults. At the time of our inspection visit there were 12 people using the service.

We found improvements to the management of risks to people from fire and legionella.

We also found improvements to how people’s medicines were managed when prescribed to be taken on an ‘as required’ basis.

We identified some issues with doors in people’s rooms. The manager confirmed the doors had been reviewed and work had started to improve the safety of the doors.

At the time of our inspection visit The Elms Care Home with Nursing did not have a registered manager in post. The current manager was in the process of making an application for registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Records showed that where risks had been identified, staff had monitored people closely and had taken timely action when indicated. We saw that when staff had reviewed people’s care they had taken all relevant information into account and their interventions had been based on current research and guidance. This meant that risks to people were managed effectively.

There were effective recruitment and selection processes in place. This was evidenced by the low staff turnover at the home and by positive feedback from people who use the service and their relatives. One person said about staff, “I have no complaints at all… they listen to you and when you ring the bell or anything they don’t moan about it… it’s the little things they tell you about that are helpful”.

Effective quality monitoring systems were in place. People told us that they would recommend The Elms. Two people we spoke with had originally been admitted for respite care but had decided they did not want to leave. One said, “I came here for three weeks and have stayed three months. I’ve been looked after and I decided that I wanted to stay”.