11 January 2023
During an inspection looking at part of the service
The Elms Residential Home is a residential care home providing personal care and accommodation for up to 27 older people, some of whom have dementia. The service is made up of a four-storey house with en-suite bedrooms and communal facilities. At the time of our inspection visit there were 21 people receiving care.
People's experience of using this service and what we found
Risks to people's health had been assessed and identified, but staff were not always aware of people's risks to keep them safe. Records did not demonstrate safe practice and enable effective monitoring of risks to take place. Staff had not always recorded that people’s topical medicines had been applied to provide assurance they were given in accordance with the prescriber’s instructions.
Staffing was maintained at the level the provider had assessed was needed. However, due to the high numbers of new and agency staff, shifts were not always staffed with care workers who had extensive knowledge of people's individual needs. The provider did not have effective systems to confirm the identity of agency staff and ensure they had the appropriate training and employment checks in place.
Staff understood their role in reporting any safeguarding concerns. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
There had been recent and significant changes in managers and key senior staff at the service which had impacted on some quality standards. Systems and processes to monitor and improve the quality of care provided had not been effective in identifying the areas of improvement we found during our visit.
Despite the issues we identified, people and most relatives were happy with the care provided. Relatives told us they were kept informed about their family member’s health and that staff worked with other healthcare professionals to improve outcomes for people.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 6 December 2019).
Why we inspected
The inspection was prompted in part due to concerns received about staffing and the culture within the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Elms Residential Care Home on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches of regulations in relation to the management of risks and the governance of the service at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow-up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.