Elmwood Residential Home Limited

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified 1 breach of the legal regulations. Where required, the provider had not ensured legislation was fully complied with when restrictive practices were put in place for people’s safety. This was a continued breach from the last inspection. People had their needs assessed and told us that staff supported them to live healthy lives and provided care in line with their needs and preferences. People were complimentary about the food within the service. Where required the service worked in partnership with other healthcare professionals to achieve good outcomes for people.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us they all received care that met their needs. They told us they felt the staff at the service understood their needs well. One person said to us, “They just get on with the job. I just want them to do that, they do what I want.” When we spoke to a relative about if they felt personal needs and preferences were met they told us, “I’ve seen them taking [person’s identity] to the garden or the lounge, they are very patient and kind.”

Staff understood the needs of people they supported. Staff said they used the care planning system to access and review people’s needs to understand the level of care they required. Staff also told us that people’s changing needs were continually discussed. Some staff explained that as part of their induction they undertook a period of shadowing to help understand the needs of the people they were caring for.

There were a range of assessment tools used to record people’s assessed needs. There were systems and process prior to and on admission to a senior a senior member of staff was allocated to do initial risk assessments which then form part of the person’s care plan. Staff were made aware of any concerns or known risk upon admission. Where initial assessments identified the need, escalation was made to district nurses or GPs if required.

People and families had been involved in care planning. When we spoke with people about the quality of the care they received and standard of care delivered, no significant concerns were raised. One person said, “Yes, I haven’t got many needs really, they do it very nicely.” One relative when we asked if they felt staff were competent said, “I do. Sometimes the language barrier can be a bit difficult. On the whole I can’t fault their training.” We saw staff using safe manual handling techniques and preparing people to mobilise before offering support.

Staff told us they felt they received sufficient and well-delivered training to provide the best possible care to people. They confirmed that training was delivered both in theory via an online platform but also practical training delivery. Staff told us they had received best practice training from healthcare professionals in subjects such as oral care and stoma care management. Staff told us the provider had arranged for a ‘Virtual Dementia’ experience where staff were in a simulator that gave them the experience of what living with dementia would be like for others.

There were processes to ensure staff received training in line with best practice. We saw staff using safe manual handling techniques and preparing people to mobilise before offering support. We saw the provider recorded people’s food and fluid intakes and people’s weights were recorded to identify any significant weight gain or loss. Improvements were needed in how these records were used and reviewed. At the time of our assessment there was no process in place to review weights or ensure any assessed food or fluid targets were met. Following the assessment the registered manager told us that nutrition and hydration audits were being introduced.

People told us they received care and support from a staff team that work well together. No concerns were identified when we spoke with people or relatives about getting information relating to care and treatment. Positive comments were received about the service working with others. One relative said, “I phone [person’s identity] every other night. She said she wasn’t feeling great, [staff member] picked up on it, called the nurse and she had a [medical diagnosis] and has to see the nurse again this week.”

Staff had access to the information they needed to deliver people’s care. Staff were aware of the importance of working in partnership with other professionals to achieve good outcomes for people. One commented when asked how people’s skin was monitored said, “We would report everything – so document so any blisters or skin tears or marks and we would have to reposition them maybe every 2 hours and that is all recorded on the app and then many people may have cream to be, a senior will inform the DNs, then they will check and tell us what to put in place, all those kind of things are explained in handovers.”

We spoke with a number of professionals who worked with the service. Most of the feedback we received was positive, with comments including, “I have found the management and staff at Elmwood to be extremely responsive and proactive in the care they provide to their residents.” However, some less positive feedback was received relating to the standard of some care delivery and the standard and accuracy of documentation kept by the service.

The provider had systems and process in place to ensure staff had the required information to meet people’s assessed needs. There were meetings held and handovers completed to discuss people’s health and welfare. Where required, this was escalated to healthcare professionals. Where people were required to attend hospital or other health related appointments, relevant documentation was produced to share with other professionals.

The service knew how to respond to peoples’ changing needs. People and their relatives said they had received the support they needed when required. Relatives told us people had seen GPs and other professionals where required. They also commented positively about the communication they received from the service management.

Staff spoke confidently and positively about the people they cared for and understood their needs. Staff supported people well with different aspects of their care, for example moving and handling and with their food and drinks. On the day of our assessment it was a very warm day and staff ensured people all had plenty of fluids available. Where people were observed not to be eating, staff offered alternative choices to support people to maintain a good diet.

People, or those acting on their behalf were involved in the review and planning of care provision. There were process to review care plans with people and their relatives. This was confirmed by people and relatives we spoke with. Other health and social care professionals were involved to encourage health promotion for people. In relation to hydration, the service had a ‘hydration station’ with a selection of drinks and snacks for people to use.

People and that we spoke with did not raise concerns around consent. When asked about daily living, one person told us, “Nothing to complain about at all. Asking questions and listening to the answers.” Relatives shared the same views, with one telling us, “They always knock on her door, say her name gently with a smile. They explain everything they are going to do.” Whilst people told us they experienced care in line with their wishes, we identified practice improvements were needed where people were unable to provide consent.

Staff told us they had received training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and records supported this. We saw staff knocking on doors and asking people if they were ready to receive support. Staff understood the need not only to ensure people had consented to care, but that they were enabled to be empowered to do things independently with a little restriction as possible.

The provider told us they provided training in these areas but it was not clear there was a full understanding of how to apply the Mental Capacity Act 2005 in the service. Where people did not have the capacity to consent to some restrictive practices, the correct best interest processes had not always been followed. For example, some people had their capacity to consent around care and treatment completed. The service had then imposed additional restrictive practices in one persons best interest to keep them safe, but had not undertaken decision specific capacity assessments with other relevant persons. We also identified within some care records that there were conflicting records around people’s capacity levels.