30 June 2022
During a routine inspection
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.