Elmcroft Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked at all quality statements for Responsive at this assessment. The service was not responsive. This showed a decline since the last inspection. People’s care, treatment and support did not promote equality, remove barriers or delays and protect their rights, including those people living with dementia or other protected characteristics. People did not feel empowered. This was reflected in people’s care, treatment, and support, which was delivered intuitively by staff rather than following robust training and plans. Information was not always up to date, accessible or available for review. There was an inconsistent approach to seeking people’s views on the quality of care, which excluded those unable to complete a written survey. A complaints policy was in place, and the service had received some compliments. End of life care planning required improvement. During our assessment of this key question, we found concerns about person-centred care, which resulted in a breach of the legal regulations. You can find more details of our concerns in the evidence category findings below.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not have access to consistently personalised care, and we received feedback from people they were bored and had limited ways to spend their time. A person told us, “Look, I loved gardening at home and am really fed up today, bored. They don't do gardening here and there is loads of space out there. I can’t be the only one who likes it. Yes, gardening would be nice, give me something to do. What we need is easy gardening like raised beds, but they’ve got none.”

Resources were not always available to meet people’s individual interests. The Nominated Individual told us of plans to improve the outside areas available to people, including new raised beds and a sensory garden. A new activities co-ordinator had also just started at the time of assessment.

Established staff knew some people’s preferences and needs, but care was intuitive and not informed by care plans. This included a failure to ensure people who use services and those close to them (including carers and dependants) were regularly involved in planning and making shared decisions about their care and treatment. We observed a married couple were placed on separate units. As both parties were unable to mobilise independently and key code barriers in place, staff presence was required to enable them to see one another in a supported way. This was only put in place once raised by inspectors.

We received mixed feedback from people about continuity of care provision, including communication within the home. A person’s relative told us, “What is lacking here I think is communication between the care workers and staff in general. I'm told they have an exchange board in the office but one of the care workers said, ‘We never use it’. So, they don't make the best of it. That would help transfer current information about the residents.” However, another person’s relative said, “If my [relative] needs a healthcare professional or a hospital referral, staff will make it.”

Staff told us they did not have good continuity of care and integration within the care home setting and did not know people living on units they did not usually work on. When asked whether any people had a specific health condition, a staff member told us, “I’m not sure, I will have check with the manager. I don’t think so. As I told you, I work on that side [the other unit]. I need to be here today. A lot of residents here are new.” Another staff member expressed anxiety at not being able to give relatives an accurate update if working on an unfamiliar unit.

System partners told us there was a lack of flexible, joined-up care for people. A professional who works with the service told us, “Most times when the care home sends us a referral, we are struggling to triage it over the phone, as the phone goes unanswered, or we are being told that there is no one to talk to. Whenever we are asking [staff] to call us back, they don’t. This makes triaging the referrals, especially urgent ones, extremely difficult.”

Systems and processes were not in place to ensure people’s care and treatment was delivered in a way that consistently met their assessed needs, in a co-ordinated and responsive way. This included a lack of oversight of the difficulties in consistent communication experienced by staff, families and professionals who work with the service.

Due to poor governance, oversight and care planning, people could not always get information and advice that was accurate, up-to-date and provided in a way that they could understand, in alignment with their communication needs. Some people’s relatives told us they had difficulty getting through to the service over the telephone. However, others felt information was communicated in a timely way.

People and their representatives did not always have access to information that was up-to-date, accessible, safe and secure. On day 1 of inspection, the provider was unable to supply any of the care plans requested for review by inspectors, and other documents were not available until late in the day. The Nominated Individual told us this was because of internet issues and manager sickness. However, there were no contingency measures in place.

Some people’s care plans set out their communication needs such as glasses or hearing aids. Pictorial menus were available for people, including those living with dementia. However, we found these to be incorrect and did not always relate to the menu for the day.

Methods for seeking and acting on people’s views were not always accessible. People were not always being supported to give a view on their care. We received mixed feedback from people’s relatives about whether they knew how to make a complaint if required, and who to direct complaints to. The service had received some compliments and positive online reviews.

Some staff told us their concerns about people’s care were not always acted on, or they did not have confidence in leaders to investigate issues robustly. This meant it would be difficult for them to advocate for people to improve their experience of care.

Satisfaction surveys had been carried out by the provider to gather people’s views and experiences, and the results returned from the survey were overall good. However, the results of the survey did not say how many people responded, or if anyone needed any support to complete it. There was no evidence to show how the service reached out to people without the capacity to respond to the survey. A complaints policy was in place, although we saw a copy of the complaints procedure on display with a previous manager as the point of contact.

People could not always access care, treatment and support when they needed to and in a way which promotes equality, removes barriers or delays and protects their rights. This included being physically able to access shared parts of the care home due to mobility needs. A person’s relative told us, “The main problem is if [staff] ask [my person] if they want to get up, [my person] will say no, but they (staff) need to find ways around that. We feel [person] needs to get up and out more.” And, “There must be ways to get residents up and out. In the year [my person] has been here [they’ve] been in the lounge 3 or 4 times.” However, we received some positive feedback from others to say staff encouraged people to join social areas.

Leaders were not alert to discrimination and inequality, even within their own staff teams. This did not demonstrate a service focused on meeting best practice quality standards, including awareness of equality and human rights. Multiple staff reported racial discrimination, with overseas staff not being listened to by management. A staff member told us of this concern, stating, “I don’t know if it’s safe saying this.” This had the potential to impact on people of different cultural backgrounds living at the service.

Partners told us people experienced delays in accessing support in relation to their health needs. A visiting professional told us, “‘I visited a patient last week in Elmcroft Care Home and staff were busy. They asked a care worker to assist with the patient I was seeing but after I had seen the patient, I needed to speak to the senior on shift to advise them that the patient looks like [they] have conjunctivitis in both eyes and [staff] need to raise this with the GP as soon as possible, as [person’s] eyes were discharging green and weeping. I was very surprised that the care home had not noticed this themselves and called the GP out.”

Processes were not in place to improve access for people likely to experience barriers or delays in accessing their care. People’s feedback was not used to ensure equity of access for all, including those people living at the service with physical disabilities, mental health needs or varying stages of dementia.

People and their advocates were not always able communicate their views about the service in a way which proactively considered equality characteristics. This impacted on tailored support provision, and outcomes for people. A person’s relative told us, “[Person] has been given range of exercises to help [their] movement as they have been in bed for 6 weeks, but I feel like I'm constantly banging on about it as they're not happening here. It's not difficult for [staff] but important for [person’s] mobility. Since [person] has been here, they have lost weight, and of course muscle wastage has taken place because [person] is not mobile.”

Leaders failed to demonstrate how they pro-actively sought out and listened to information about or from people most likely to experience inequality in experience or outcomes. This meant care, support and treatment could not be tailored in response to ensure equity and reduce the impact of barriers to care.

The provider was failing to meet its own CQC provider information return response (PIR) on how they met human rights principles in the service. This stated, ‘We support, encourage and monitor staff to ensure the delivery of high standards of care to ensure our residents feel safe, empowered and assured that they and their wishes are respected.’ This was not happening in practice, for example, there was limited information to guide staff on support for people living with dementia.

We received mixed feedback on people’s experiences around death and dying. Whilst the service had received some compliments from relatives for supporting people with end-of-life care, not everyone using the service had their spiritual and emotional needs met to reduce the risk of low mood. A person we spoke with told us, “I’m 87 now so hopefully not long left.” We asked the local authority safeguarding team to carry out a welfare check with the person as a result.

Staff received training in end-of-life care and expressed their dedication to compassionate care. However, they were not supported by leaders to deliver this due to lack of personalised care planning guidance on how people wished to be supported.

Some information relating to end-of-life care was contained in care plans, but this required further personalisation to ensure people’s spiritual and emotional needs were met in a holistic way. For example, 1 person’s care plan stated, ‘Meet the specific end of life wishes of the service user’ but gave no further details. This was a continued concern from our last inspection, and the provider had failed to make improvements in this area. Information was recorded such as whether DNACPRs were in place.