Archived: The Elms Nursing Home

Updated 27 April 2019

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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

The inspection was carried out by three inspectors.

Service and service type:

The Elms Nursing Home 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 Elms accommodates up to 19 people in one building.

The service had a manager registered with the Care Quality Commission. 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.

Notice of inspection:

We carried out this unannounced inspection on 18 March 2019.

What we did:

Before this inspection we reviewed all the information we held about the service, including data about safeguarding and statutory notifications. Statutory notifications are information about important events which the provider is required to send us by law. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. This enabled us to ensure we were addressing potential areas of concern at our inspection.

As part of our inspection we spoke with three people, two relatives and three staff. We also spoke with the registered manager and deputy manager and a visiting healthcare professional. In addition, we received written feedback from another professional and reviewed the report from the most recent local authority’s quality assurance visit.

We reviewed a range of documents about people’s care and how the service was managed. We looked at five care plans, medicine administration records, risk assessments, complaints records, policies and procedures and internal audits that had been completed. We asked the registered manager to send us some further information following our inspection for analysis.

Updated 27 April 2019

About the service: The Elms Nursing home is a service where people can receive accommodation, nursing and personal care. The service accommodates up to 19 people who are living with dementia, elderly and frail or who have other health conditions. At the time of our inspection, 16 people were living at the service.

People’s experience of using this service:

Although people received the medicines they needed, we found a lack of good records in relation to people’s medicines. People continued to live in an environment that was not necessarily fit for purpose and was not kept free from infection. Risks to people had been identified, however staff were not always following guidance in people’s care plans to help ensure people were kept free from risk of harm. People were not always cared for by a sufficient number of staff. This meant people did not always get the support they needed. We observed times when people were not always shown respect by staff.

People were cared for by staff who had been recruited through robust processes and received the training and support they required. Where people had accidents and incidents, staff learnt from these and took appropriate action.

Where people lacked capacity, staff were not always following the legal requirements in relation to making decisions on their behalf. We also found that people were not supported to make informed choices about the food they ate. Activities on offer to people had improved.

People’s care plans contained some good information about their needs, however documentation was unwieldy and repetitive making care plans difficult to follow. We found in general people received responsive care, but there was some lack of consistency in relation to this.

The registered manager had started to make some improvements to the service, but progress was slow and audits carried out did not always identify shortfalls. Despite the registered provider telling us after our last inspection what action they planned to take to improve the service we found some of this had not happened.

People received input from healthcare professional involvement and people’s needs were assessed before moving into the service.

During our inspection we found two continued breaches and one new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made four recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: We last inspected The Elms Nursing Home on 18 January 2018 where we rated the service as Requires Improvement. We published the report on 24 March 2018.

Why we inspected: This was a scheduled fully comprehensive inspection carried out in line with our inspection methodology which is based on last inspection rating. We used this inspection to see if the registered provider had actioned the shortfalls we identified during our last visit.

Enforcement: The overall rating for this service is ‘Inadequate’ and the service has therefore been placed in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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

Follow up: If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.