Elmcroft Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked at all quality statements for Well-led at this assessment. The service was not Well-led. This showed a decline since the last inspection. The service failed to operate safe and effective governance systems, and processes in place such as audits were incomplete or of poor quality. The provider did not independently identify risk which impacted on people’s safety and welfare. As there was limited oversight of accidents and incidents, this meant the service could not be open and transparent when things went wrong. Feedback from system partners showed the management team failed to seek and act on relevant feedback to ensure the quality and safety of care. Legal requirements were not consistently met, such as the failure to submit statutory notifications to the CQC. Staff reported a poor and closed culture, with staff factions and allegations of bullying, harassment and racial discrimination. There had been a high management turnover at the service which impacted on shared vision and direction to make improvements. During, or shortly after, our inspection all of the management team left the organisation. During our assessment of this key question, we found concerns about governance systems, 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.

A new management team had just been recruited including a home manager, a deputy manager and a clinical lead. Whilst new managers told us they were being inducted there was no formalised management induction plan. The new manager said they had looked up the service’s last inspection report and confirmed the provider had not shared a development plan to inform them of the provider’s direction and expectation. The manager said, “This is my 5th week and there are things I want to look at and potentially change.” A staff member told us, “This place used to be so nice, it was immaculate. But not now. The main problem is they can't seem to keep the managers, they keep changing. I think we've had 5 or 6 in the same number of years or less.” A new Nominated Individual and home manager were appointed following this assessment.

There had been multiple different managers in short succession, leading to an inconsistent approach to management of the location without a clear vision for improvement. The provider failed to actively involve staff for the purposes of continually evaluating and improving the service, which meant staff were not aware of any changes or improvement in the way they were working. During the inspection or shortly after, the home manager, deputy manager, clinical lead and provider’s Nominated Individual all left the organisation.

Leaders did not have the knowledge and capability to ensure the service was well-run and risks well managed. For example, the new manager was not aware of the CQC’s Right Support, Right Care, Right Culture guidance for supporting autistic people and or people with a learning disability, despite a recommendation made at the last inspection to increase awareness in this area. The provider applied to have this specialist service user band removed from its registration during the inspection.

Despite having the support of consultants, the provider had failed to make, sustain and embed any improvements since the last inspection. There was no cohesive or credible service improvement plan, and multiple versions were supplied piecemeal throughout the inspection process. Management visibility was poor, and we received feedback people’s relatives did not always know who the manager was.

Staff told us they did not have the freedom to speak up. A staff member told us, “We are here to work as a team but there isn’t really teamwork. Some of my colleagues lack confidence to speak out, if you are the one to always talk you can be seen as not good… It’s not easy to make suggestions.” Another staff member said, “I try talking but it’s a waste of my time. I say and nothing happens. And then it’s always [my] fault.” Only superficial action was taken in response to staff concerns when we shared these themes with leaders. Whilst a HR clinic was set up and a staff helpline shared, the Nominated Individual told us all concerns were resolved within 1 day, which was not a realistic timeframe to address embedded issues relating to staff culture.

The management team did not model an open and honest approach. We identified the provider either could not immediately supply, or had updated, many care plans and other documents after we had requested to see them, which was obstructive and did not demonstrate a transparent approach to the inspection process. Processes were not in place to reduce the risk of a closed culture forming.

Staff described an extremely poor and bullying culture, which was not inclusive or fair. A staff member told us, “The staff feel bad, [the management] approach is too harsh so mentally we become traumatised. When I come to work, I feel nervous and then you feel like you won’t get that respect or support. You are being more careful so that [managers] don’t shout at you.” Another staff member said, “I find the new manager has a heavy approach using tactics like shouting at staff and I think she would get more productive staff if she wasn’t like that. She is very dismissive and unapproachable and that’s what brought the morale down.”

Although there were processes in place such as the provision of equality and diversity training for staff, this did not translate into practice. There was a failure by the provider to implement effective systems to assess, monitor and record the impact of training to ensure it was embedded and to ensure a fair culture. Staffing skill mix, working hours and support was not proactively considered. This meant staff were not empowered to provide the care meeting the expected quality standards.

Feedback from staff and leaders across the organisation at all levels did not provide assurance or evidence of robust, effective or well-embedded governance and oversight measures. The integrity of information and data was not consistently assured. This had an impact on people using the service. There was no effective leadership to oversee and direct staff on each shift, and roles and responsibilities were not clearly defined. Multiple staff expressed serious concerns about poor management structures. A staff member told us, “It is just diabolical.”

Quality assurance processes were poor and systems were not well established and monitored to ensure safe and good quality care. There was no evidence of effective provider oversight in areas such as safeguarding, staffing, culture, or accidents and incidents. Audits were insufficiently detailed to address issues of concern, and the provider failed to act promptly in response to any issues identified. The provider failed to meet basic legal and regulatory requirements such as submitting statutory notifications to the CQC in cases of serious injuries and allegations of abuse.

People and those important to them, were not always able to work in partnership with the service and be fully involved in their own care. People told us there were relatives’ meetings, but not everybody had attended to share their views and they did not get minutes or updates on agreed actions. A person’s relative told us, “Communication could be better”. Another person’s relative said, “It's hard for me to say how good or bad it is here because we've had no experience of places like this.” People’s feedback had been gathered but not analysed to create an action plan.

Leaders were not always open and transparent in collaborating with all relevant external stakeholders and agencies. There were systemic failings in the leadership, governance and safety of the service. The Nominated Individual showed a lack of awareness as to the impact on people of this or validity of stakeholder concerns, stating, “This home has a lot of historical issues. People always jump to the worst-case scenarios.” Staff told us there were no regular team meetings to share their views.

The service did not consistently work in partnership with key organisations to support care provision, service development and joined-up care. A professional who works with the service told us, “During my visits, the staff appeared to be in need of training in managing and caring for not only [person living with dementia] but the other service users at the care home.” Following our inspection, the provider sought advice and support with the local authority quality improvement and safeguarding teams, as well as stakeholders from health.

As the provider had failed to identify serious incidents, this meant investigations were not always carried out to determine any wrongdoing and any subsequent improvements required. The provider was therefore unable to be open, honest and transparent with service users and their relatives, providing an apology as necessary under its Duty of Candour responsibilities. This also meant they were unable to engage with people and their advocates to drive improvements.

Feedback from staff and leaders did not demonstrate a focus on continuous learning, innovation and improvement across the organisation and the local system. The provider did not have an effective system in place for reviewing and investigating safety and safeguarding incidents and events that go wrong. Safeguarding concerns were not always recognised and appropriately reported, which impeded learning from serious safety events. The provider failed to look at its own practices to see where improvement could be made to ensure service user safety was not compromised. The provider failed to seek advice or guidance from the local authority as to safeguarding thresholds for accidents and incidents.

Governance processes were not well developed, and the outcomes and impact of any action taken was not monitored, placing people at risk of harm and continued poor care. The provider failed to demonstrate how the service learns and improves, including from serious incidents and safeguarding matters. We raised an organisational safeguarding alert with the local authority, so additional support and training could be provided by system partners.