The Elms

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

The service had made improvements and are no longer in breach of the regulations found at our last inspection. At this assessment, we found improvements had been made to the management and monitoring of people’s risks and medicines. People’s care records and assessments had been updated. People received safe care from supportive staff who understood their individual needs and risks. Staff worked in partnership with key health care professionals and made referrals to services in a timely manner. People received their medicines as prescribed. The provider had ensured systems were in place to keep people safe from abuse and harm. There were enough trained staff to support people. Health and safety systems were in place to check the home's environment, equipment and utilities. Plans were in place to enhance the fire safety systems. The home was clean and tidy.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives told us staff worked collaboratively with external agencies and health care partners to manage people’s risks and ensure continuity of care. People's relatives told us they were generally made aware of changes in people's health or any incidents.

Staff were knowledgeable about monitoring people's new or emerging risks and the actions they should take. For example, staff were able to describe the actions they would take if someone experienced a fall or had a head injury. This included using early warning monitoring tools and seeking medical assistance. The registered manager and staff worked in partnership with the designated GP service and made referrals to health care professionals in a timely manner. People's care records reflected recommendations made by the GP and health professionals which were followed by staff at the service.

Health care professionals spoke positively about their working relationship with staff and the registered manager. They said staff were always at hand to support their visits and acted in a caring and responsive manner. Professional feedback included, "We have enjoyed working with The Elms and found them open and responsive to recommendations" and "The staff are very knowledgeable about every patient I look after and show great care towards them."

People's care and support needs when transferring between services were considered and were reflected in the providers policies and protocols to help ensure people received safe and continuous care. People’s needs were assessed and continually reviewed when they moved into The Elms. Information sharing systems such as daily stand-up meetings and shift hand overs provided staff with current information about the home and the well-being of people and any new or ongoing concerns. Any health concerns were raised with the GP who visited the home weekly. Medicine reviews and referrals to specialist healthcare professionals and emergency services were carried out as required. People had been supported to have vaccinations such as the COVID booster.

People told us they felt safe living at The Elms and understood how to report concerns. One person said, "The carers are very good, I feel safe, I'm quite happy here. If I had any concerns, I would go to the boss." Another person said, "They [staff] are lovely and helpful. They treat you like a person and not a patient." One relative also said " Yes, I think she [relative] is safe. The quality of care is good, and staff are very friendly." People were comfortable in raising any concerns.

Staff demonstrated a commitment to keeping people safe. They were clear about their responsibilities to report and record any concerns to the registered manager and were aware of safeguarding organisations. Staff told us there was an open approach and atmosphere in the home. Staff and the registered manager were aware of the importance of supporting people in the least restrictive manner and to ensure people's deprivation of liberty authorisations were adhered to and reviewed.

We observed the atmosphere in the home to be relaxed and calm. Staff worked well with people, providing reassurance. We observed lots of positive interaction between staff and people. Staff spoke to people with endearment and kindness. They listened to people and gave them time to speak.

Resident meetings and questionnaires enabled people and their relatives to report any issues and safe guarding concerns. Any allegations of abuse or concerns had been investigated by the registered manager. The outcome of their findings and any actions needed to help prevent further concerns were shared with staff. The registered manager had ensured all staff were trained in safeguarding.

People told us they were well cared for. Staff were attentive to their needs and responded quickly when they rang their call bell or requested assistance. People and their relatives shared that appropriate equipment had been made available to keep them safe such as pressure relieving equipment. They told us they were confident staff had the skills to support them safely using this equipment. Relatives reported that they were kept informed of any changes in people's health conditions and were made aware of referrals to healthcare professionals.

Staff knew people well and had a good understanding of people’s individual needs and risks. They told us people's care plans were detailed and provided them with the information they needed to support people safely. For example, they described the actions they needed to take to reduce people’s risks such as how to prevent people’s skin breaking down. When people's health declined, or when there was an incident, staff took appropriate action to support the person, record the incident and sought medical advice. Staff were aware of people’s dietary needs and those people who required textured diets. Effective communication systems were used to keep staff updated about people’s current needs and risks. Staff said there was a whole home approach to monitor people's needs and to ensure they received good quality care.

We observed people being supported by staff who understood their needs and assisted people to manage their risks and encourage independence. Staff safely and confidently supported people using specialised equipment. Staff were skilled in distracting and supporting people when they became upset or agitated.

Since our last inspection, the provider had implemented several actions to help improve their systems to monitor and manage people's risks. For example, peoples care plans and risk assessments had been reviewed and updated. We found care plans were mainly detailed and reflected people's care needs and the measures required to mitigate people's risks. However, some care plans for people with emotional needs would benefit from more information such as specific triggers which may cause people to become upset and how to support them. Staff were reminded to encourage people to have high calorific food and fortified diets when people had lost weight; however, this was not always explicitly clear in their care plans. Additional training in record keeping and enhanced handover sheets helped staff to improve their awareness of people's needs. Systems were in place to ensure key members of staff such as kitchen staff were fully informed of people's needs and any changes in their support requirements.

People were cared for in an environment which was safe and well maintained. People and their relatives raised no concerns about the home's environment. They reported the home was kept clean and well maintained.

The registered manager shared with us the improvements that had been made to improve people's experiences such as a spa bathroom and reflooring the lounge and dining area. Staff spoke positively about the improvements which had been made to the home's environment. Staff told us they had been trained in fire awareness and were aware of their role and responsibilities in the event of a fire. They were aware of people's personal emergency evacuation plans and the available fire equipment.

The home was well maintained and free from any clutter. Fire doors were not blocked, and the home was clean. Staff were deployed so there was a member of staff always present in the lounge to ensure people remaining were safe.

Processes were in place to ensure the home's environment and equipment were checked and maintained regularly. Equipment used to deliver care and treatment was used for the intended purpose and stored securely. Health and safety systems were in place to check the home's environment and utilities. We saw external servicing report such as gas and electrical certificates and evidence of water testing. Fire safety checks were completed including weekly checks of fire doors and alarms. Staff had been trained in fire safety, but some staff were due their refresher training. The registered manager was aware of this and was taking action to ensure staff were trained and had the skills and confidence to manage the home's fire processes and evacuation equipment by completing frequent fire drills with all staff members.

People told us staff were polite, respectful and were attentive to their needs and wishes. People said they were supported by a familiar and consistent staff team who quickly responded to their requests for support. They raised no concerns about the skills and training of staff.

Staff told us they felt trained and supported. They understood their responsibilities within the role and department. Staff stated that generally there were sufficient numbers of staff to support people and provide additional support as required such as supporting people to access the community and personal interests. Managers said they consistently reviewed people's needs and adjusted the staffing levels according to people's support requirements.

We observed good engagement and interactions between staff and people in the dining room during the lunchtime. However, we found staff sometimes missed clues in people's body language which indicated they had finished their meal or required support.

The provider had effective systems in place to plan a monitor staff training and the required staffing levels in the home. Policies relating to the support and recruitment of staff were in place. We found safe recruitment practices were mainly carried out; however, the provider should ensure checks of staff employment in health and social care jobs are always fully explored and documented. Disciplinary action was taken with staff when poor practices were found.

People and relatives complimented the cleanliness of the home and raised no concerns about the provider's infection control practices. Some relatives said they were required to book to visit their family member. This issue was raised with the registered manager as people should not be deprived from receiving visitors. The registered manager said there were no restrictions to visiting times; however, they preferred people to have protected mealtimes to enable staff to monitor and support people with their food and drinks. The registered manager agreed to communicate this with relatives to ensure they understood there were no visiting restrictions other than around mealtimes.

Staff had a good understanding about infection control practises and the day to day actions they should take to prevent the spread of infection. Staff were able to describe the actions they would take in the event of an outbreak or finding bodily fluids or spillage. Stuff told us they had access too personal prevention equipment (PPE) and were aware of good hand hygiene and the correct use of PPE.

Throughout our site visit we observed good infection control practises. The home looked clean and well maintained. People were well groomed and supported to maintain their personal hygiene throughout their day such as staff helping people to wipe their hands prior to lunch.

The provider had implemented good infection control systems to ensure practises were being maintained throughout the home and reinforced the homes infection control processes during staff meetings, supervisions and training. The registered manager was the infection control lead and carried out visual and auditing infection control checks to ensure the required infection control standards were achieved. Housekeepers had a schedule of cleaning to adhere to. This ensured regular and deep cleaning of the home was carried out. Improvements to the homes environment such as new flooring had improved the effectiveness of the cleaning. The provider had engaged and acted on the recommendations made by the local authority infection control team. They had acted on their guidance to ensure infection control good practices were being used during a recent infection outbreak.

People's relatives told us they were informed of any changes with people's medicines. People raised no concerns about the management of their medicines. We observed staff administrating medicines to people in a person centred manner and checking if they had taken their medicines.

Staff who were involved in the administration of people's medicines, all reported improvement in the process of managing medicines. Medicine records and protocols were clear and provided staff with the guidance they needed to support people with their medicines. Staff had been trained and assessed as being competent in managing people's medicines, they were confident people's medicines were being managed safely.

The service had made improvements and are no longer in breach of the regulations. People's medicines were now being managed safely and in line with national guidance. The provider had engaged with a pharmacist and implemented their recommendations to improve their medicines management systems. The home’s allocated GP carried out regular medicine reviews.