Archived: Elm Tree

Updated 20 April 2021

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 Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by an inspector and assistant inspector. Following the visit to the service, an Expert by Experience completed telephone calls to people’s relatives. 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

Elm Tree 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.

The service did not have a manager registered with the Care Quality Commission. At the time of the inspection, Elm Tree was being managed by the provider. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

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. We sought feedback from the Local Authority prior to the site visit and reviewed information held by the Care Quality Commission. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with four people who used the service about their experience of the care provided. We spoke with the manager and deputy manager of Winsford House, the manager of Gairloch House, care staff, staff employed by an external employment agency, the provider’s IT expert and the provider. We reviewed a range of records including people's care records and medication records. We looked at four staff files in relation to recruitment procedures.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

After the inspection

We continued to seek clarification from the provider to validate evidence found. This related to the service’s quality assurance arrangements. We contacted six members of staff and asked them to contact us so that we could speak to them about their experience of working at Elm Tree. Unfortunately, only one member of staff contacted us and responded. The Expert by Experience spoke with 10 people’s relatives on 17 December 2020.

Updated 20 April 2021

About the service

Elm Tree is a residential care home providing personal and nursing care for up to 46 older people aged 65 and over; and people living with dementia. At the time of the inspection, 38 people were living at the service.

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

The leadership, management and governance arrangements did not provide assurance the service was well-led. Quality assurance and governance arrangements were not reliable or effective in identifying shortfalls in the service. The management team and provider did not understand their responsibility to ensure notifications relating to specific incidents and safeguarding concerns had been made to the Care Quality Commission. Relatives stated the arrangements to communicate with them were not effective. Lessons were not consistently learned to improve the quality of care for people using the service.

Suitable arrangements were not in place to ensure the safe management of medicines and this placed people at risk of harm. Information relating to people's individual risks were not always recorded or mitigated and did not provide enough assurance that people were safe. Appropriate measures were not in place to prevent and control the spread of infection. Staffing levels were not always being maintained to meet people's care and support needs

Not all staff had received up to date training and not all staff felt supported or valued. People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People had access to healthcare services and support when needed however this was sometimes delayed and not all relatives were informed and updated about their family member's healthcare needs.

Care plans covered most people's individual care and support needs. However, further improvements were still required to ensure each person's care plan was updated and accurate. People were not routinely supported and encouraged to take part in social activities.

Staff were recruited safely. People's comments about the quality of the meals provided were positive. Arrangements were in place for gathering people’s views of the service they received, those of people acting on their behalf and staff employed at the service.

We have made recommendations about safeguarding, training, staff induction, communication with relatives and complaints management.

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 28 April 2020).

Why we inspected

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 received concerns in relation to staffing levels, the management of medicines and training. As a result, we undertook a focused inspection to review the key questions of Safe, Effective, Responsive and Well-Led only.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elm Tree on our website at www.cqc.org.uk.

Enforcement

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. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk, including infection, prevention and control, medicines management, staffing and quality assurance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the Local Authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.