The Elms

Updated 6 December 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Elms is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection visit there was not a registered manger in post. However, a newly recruited manager started after our inspection visit with the intention of applying to be the registered manager of the service.

Notice of inspection

This inspection was unannounced. Inspection activity commenced on 25 October 2022 with a visit to the service. Inspection activity continued on 27 October with calls to people receiving care and their relatives.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used all of this information to plan our inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We spoke with the deputy care manager, the administrator and a senior care worker. After the inspection visit we made calls to 8 people and 5 relatives to get their feedback about the care they received. We also received written feedback from 3 relatives. We also made calls to 4 care workers to get their feedback on the management of the service.

We reviewed a range of documents which included five people’s care plans, cleaning schedules for the premises, medicines administration records and five staff recruitment files. We also reviewed records relating to the management of the service, including infection prevention and control policies and procedures.

Updated 6 December 2022

About the service

The Elms is a residential care home providing personal care and accommodation for up to 26 older people and people living with dementia. At the time of this inspection 20 people were residing at the service.

People’s experience of using this service and what we found

The home was not managed safely. Medicines, including topically applied creams were not managed in line with current best practice guidelines. The risks related to COVID-19 were not always safely managed and government guidelines were not always followed. Risks to people’s safety were identified and reviewed regularly, however, care plans lacked essential detail on how risks should be mitigated.

Care plans did not always contain sufficient detail to ensure people’s needs and preferences were upheld and some care plans were not reviewed regularly.

Despite the issues we found we received positive feedback from people and their relatives about the quality of care they received. Comments included, “We are more than satisfied that the staff look after [family member] well in very trying circumstances” and “The interactions are caring, it is more like a home from home with a homely feel.”

People were supported by staff who knew how to protect them from abuse and harm. Allegations of abuse were reported to the appropriate authorities.

The provider had made improvements to how they supported people to make decisions and consulted with people’s representatives. 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 supported best practice.

Despite many improvements the monitoring and auditing systems were not always effective and had not identified the ongoing issues we found with care plans, risk management, medicine management, infection control procedures and recruitment.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The rating for this service was requires improvement (published 7 March 2022) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do to improve and by when. Although we found some improvements at this inspection the provider remained in breach of several regulations. The service remains rated requires improvement for three consecutive inspections.

Why we inspected

We carried out an unannounced focused inspection of this service on 23 December 2021 and breaches of legal requirements were found. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This focused report covers the entirety of the key questions Safe and Well-Led and part of the key question Effective. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make further improvements. The overall rating for the service has remained requires improvement. The key question Well-led has improved to requires improvement based on the findings at this inspection. Please see the safe, effective 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 on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to the recruitment of staff, management of medicines, infection prevention and control practices, person-centred care and the monitoring and auditing of the quality of people's care and support. We have sent a Regulation 17(3) Letter to the provider in relation to their failure to effectively operate systems and processes to assess, monitor and improve the quality and safety of the services provided in carrying on the regulated activities. A Regulation 17(3) Letter stipulates the improvements needed to meet breaches of regulation, seeks an action plan and requires a provider to regularly report to CQC on their progress with meeting their action plan.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow-up

We will meet with the provider to discuss how they will implement their action plan and make the required changes to ensure they improve their rating to at least good. We will work alongside the provider and the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.