Archived: The Elms Care Home

Updated 9 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.

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 carried out by two inspectors, a medicines specialist, 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 Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Elms Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

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 there was a registered manager in post.

Notice of inspection

This inspection was unannounced. Inspection activity started on 30 June 2022 and ended on 12 September 2022. We visited the home on 30 June 2022 and 4, 14, 20, and 26 July 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and commissioners of the service. We used information gathered as part of monitoring activity that was completed on 14 October 2021 to help plan the inspection and inform our judgements. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

During our visits we used observations to help us understand the experience of people who could not talk with us. We spoke with nine people who received the service, and two of their relatives. We received feedback from an external social care professional and local pharmacist who had contact with the service.

We spoke with 22 members of staff. These included care staff, senior care staff,, catering staff, administration staff, nursing staff, three of whom were employed by an external agency. We also spoke with the deputy manager, the registered manager, two interim home managers, five area directors, a practice development nurse, a senior clinical oversight manager, and a managing director. We also spoke by telephone with another managing director and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. These included sampling seven people's care records, multiple medication records, and two staff files in relation to recruitment checks. We also looked at a variety of records relating to the management of the service, including staff rotas and training records, meeting minutes, audits, quality assurance reports, and action plans.

Updated 9 December 2022

About the service

The Elms Care Home is a care home that provides personal and nursing care for up to 37 people living with dementia. The home is in one adapted building over two floors. At the time of our inspection there were 29 people receiving the service.

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

The service was not well-led. The registered manager and provider failed to carry out their regulatory responsibilities. Quality assurance processes were ineffective, this meant people were exposed to unnecessary risk of harm. The provider failed to deliver safe and effective care and had not always taken the action they said they would to improve the service people received.

People were not always protected from harm because staff did not always ensure they received care and treatment in a safe and effective way. People did not always receive their medicines as prescribed. Staff did not always seek prompt medical advice after medicines errors occurred.

People's needs were not effectively assessed or reviewed, and their care was not always planned in line with best practice guidance. People’s health conditions were not monitored in line with guidance and necessary referrals were not always made to external healthcare professionals. People were not effectively supported at the end of life. People were not always supported to make informed decisions about end of life care in a person-centred or timely way.

Staff did not always safeguard people from harm and had not referred all potential safeguarding events to the local authority in line with the local authority’s protocols.

People experienced delays in receiving care and staff felt rushed when providing care. The provider was highly reliant on the use of agency workers and resulted in people not receiving consistent care. There was no reliable record of the staff who had worked in the home. We therefore could not be confident of who provided care or was present in the home on any given date.

People's fluid and food intake was inconsistently managed. Despite the provider’s assurances, we continued to find these records were not satisfactorily completed and we therefore could not be confident people were receiving sufficient fluids.

Staff received an induction when they were first employed at the service. However, they did not always receive an induction when they were promoted into new roles within the senior team. This meant staff did not always know and understand the provider’s systems or their responsibilities. Not all staff had completed relevant training within the provider’s expected timeframe. The registered manager was addressing this and had written to staff with short timescales for completion. Staff did not feel well supported by management.

People were not consistently supported to have maximum choice and control of their lives and staff did not always 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 were not always treated with dignity and respect or their independence promoted.

People told us they liked the food and were given choice at mealtimes. Some people told us they could make decisions about their day to day lives, such as when they got up and went to bed and how they spent their day.

People who were able to access communal areas told us they had opportunities to pursue interests and join in communal activities. Some people told us they liked the staff. They described staff as good and kind.

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 last rating for this service was requires improvement (report published 20 September 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations. The rating has changed to inadequate.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and was prompted by a review of the information we held about this service.

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 COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified continued breaches in relation to safe care and treatment, and good governance at this inspection. We have identified new breaches at this inspection in relation to safeguarding people from abuse, staffing, person-centred care, nutrition and hydration, and dignity and respect.

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

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

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.