We carried out a review of the data available to us about Elm Lea Residential Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Elm Lea Residential Care Home, you can give feedback on this service.
Elm Lea Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Elm Lea is registered to provide accommodation and personal care to 15 older people. The service is a detached house in a residential area, it has 14 bedrooms all of which have ensuite toilet and wash hand basin facilities. None of the rooms are used for double occupancy therefore the maximum number of people accommodated at the service does not exceed 14. There were ten people living there at the time of our inspection; a further person had recently been admitted to hospital.
At the last inspection on 23 and 24 November 2016, the service was rated Requires Improvement. At this inspection the service was rated Good.
At our last inspection in November 2016, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the management of people’s ‘as and when required’ medicines, and, failure to ensure effective systems were in place to monitor the quality of the service. The registered manager sent us an action plan stating they would meet the regulations in November 2016. This inspection took place to check that the registered provider had made improvements to meet the regulations. We found that improvements had been made and the breaches had been met.
The service had a registered manager in post who had worked with the provider for a number of years. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was supported by a team leader.
People were not always offered the opportunity to participate in a range of activities to meet their needs and interests. We have made a recommendation about this.
People felt safe and were protected from the potential risk of harm and abuse. Staff understood their responsibilities for safeguarding people and followed the provider’s policy and procedure. Potential risks to people had been assessed and steps were taken to reduce any risks. The premises were well maintained and equipment had been regularly serviced to ensure it was in good working order.
There were enough staff deployed to meet people’s assessed needs. The provider operated safe and robust recruitment and selection procedures to make sure staff were suitable and safe to work with people. Staff were trained to meet people’s needs including any specialist needs. Staff were given feedback, support and guidance from their line manager, through regular supervision meetings.
People received their medicines safely as prescribed by their GP. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed regularly. People were protected by the prevention and control of infection where possible, with systems in place to ensure the risk of contamination were minimised. Accidents and incidents were monitored and managed effectively.
People’s needs and choices were assessed when they started using the service. People received care that was personalised to their needs. People were encouraged to maintain as much independence as they were able. People knew who to speak to if they were unhappy about the service. No complaints had been received.
People were encouraged to make their own choices about their lives. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.
People were treated with dignity and respect by staff that were kind and caring. Staff knew people’s likes, dislikes and personal histories; this information was readily available within the persons’ care plan. People were supported to maintain relationships with people that mattered to them.
People were given choice at mealtimes and were able to access drinks and snacks throughout the day. People’s nutrition and hydration needs had been assessed and recorded. Staff and the chef met people’s specific dietary needs and support. Staff ensured people remained as healthy as possible with support from health care professionals, if required.
Systems were in place to monitor the quality of the service being provided to people. There was a range of checks and audits carried out to ensure the safety and quality of the service that was provided to people. People and staff were asked for their feedback about the service, with action taken if any suggestions or concerns were raised.
The registered manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.
The registered manager spoke passionately about providing a high quality person-centred service. They had developed working relationships with other services to promote and encourage best practice.
Further information is in the detailed findings below.
This inspection took place on 23 and 24 November 2016 and was unannounced.
Elm Lea is registered to provide accommodation and personal care to 15 older people. The service is a detached house in a residential area, it has 14 bedrooms all of which have ensuite toilet and wash hand basin facilities. None of the rooms are used for double occupancy therefore the maximum number of people accommodated at the service does not exceed 14.
At the time of our inspection there were 13 people, with a range of health and support needs, living at the service; a further person had recently been admitted to hospital.
Bedrooms are spread over two floors, these can be accessed by the use of a passenger lift; the premises are suitable for people with physical mobility problems. People had access to assisted bathrooms and a dining room/lounge/conservatory. There is parking to the front of the property and further on street parking available nearby.
The service has an established registered manager, who also managed another service owned by the same provider. They split their time between the two services, spending mornings at one and afternoons at the other. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
The previous inspection was carried out in September 2015 and concerns relating to care planning and risk assessments, management of medicines, some staff recruitment processes and quality management were identified. At that time and we asked the provider to send us an action plan about the changes they would make to improve the service.
At this inspection we found actions had been taken to implement these improvements, however, some areas required further improvement. There were continued shortfalls where the regulations around some medication and quality checking processes were not met, albeit of a much reduced nature. We also identified an area where improvement was required and made a recommendation the service should adopt.
The administration of some medicines required closer monitoring to make sure it fulfilled the purpose for which it was given.
Some audits had not been used to maximum effect as tools to assess the quality and safety of the service and bring about improvement and promote best practice.
Our inspection found the service offered people a homely, supportive environment and their care needs were being met.
A survey of people living in the service found they felt safe. Staff knew how to recognise signs of abuse and how to report it. They told us how they protected people from financial abuse and supported people to be safe.
There were enough staff on duty to support people, proper pre-employment checks had taken place to ensure that staff were suitable for their roles.
Assessments had been made about physical and environmental risks to people and actions had been taken to minimise these. There were low levels of incidents and accidents and these were managed appropriately with action or intervention as needed to keep people safe.
Equipment including the electrical installation, gas safety certificate, portable electrical appliances, fire alarm and firefighting equipment were checked when needed to help keep people safe. The service was well maintained and comfortable.
The registered manager had a good understanding of the Mental Capacity Act 2005, and Deprivation of Liberty safeguards. They understood in what circumstances a person may need to be referred, and when there was a need for best interest meetings to take place. We found the service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and that people’s rights were protected and upheld.
New staff underwent an induction programme and shadowed experienced staff, until they were competent to work on their own. There was a continuous staff training programme, which included courses relevant to the needs of people supported by the service.
Care plans were reviewed regularly and included the views of the people and their relatives or advocates when needed. The service showed an awareness of people’s changing needs and sought professional guidance.
People were able to choose their food each meal time, snacks and drinks were always available. The food was home-cooked. People told us they enjoyed their meals, describing them as “lovely” and “home cooking”.
The service was led by a registered manager who worked closely with the care team and provider. Staff were informed about the ethos of the service and its vision and values. They recognised their individual roles as important and there was good team work throughout the inspection. Staff showed respect and valued one another as well as people living at the service.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
The inspection took place on 28 September 2015, and was an unannounced inspection. The previous inspection on 28 August 2014 was a follow up inspection to check on breaches found during an inspection on 8 April 2014. The inspection found no breaches in the legal requirements at the last inspection.
The service is registered to provide accommodation and personal care to 15 older people. The premises are a detached house in a residential area. The service has 14 bedrooms all of which have ensuite toilet and wash hand basin facilities. None of the rooms are used for double occupancy therefore the maximum number of people living at the service does not exceed 14. Bedrooms are spread over two floors, these can be accessed by the use of a passenger lift; the premises are suitable for people with physical mobility problems. People had access to assisted bathrooms and a dining room/lounge/conservatory. There is a parking area to the front of the property and further on street parking available nearby. There were no vacancies at the time of the inspection.
The service has an established registered manager, who also manages another service owned by the provider. They split their time between the two services, spending mornings at one and afternoons at the other. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People told us they received their medicines safely and when they should. However we found shortfalls in areas of the management of medicines, including sufficient stock, safe storage and guidance for staff about how to administer some medicines safely.
Risks associated with people’s care and support had been assessed, but the level of detail recorded in the risk assessments or on related records was not sufficient to ensure people always remained safe. Some first floor fanlight windows, although high, had not been restricted and posed a risk.
People and sometimes their families were involved in the initial assessment of their care and support needs. Care plans lacked detail about how people wished and preferred their care and support to be delivered or what independence skills they had in order for these to be encouraged and maintained.
People were not fully protected by safe recruitment procedures, as records required by legislation were not always present on staff files.
People told us they had adequate food and drink. However at certain times their choices of food were limited. People said they liked the food and enjoyed their meals. Staff understood people’s dietary needs and special diets were catered for.
People had a varied programme of suitable leisure activities in place, although some people felt they would like to get out and about more. People enjoyed the activities and outside entertainers who visited, such as singers and playing musical instruments, board games, exercises and bingo. Family and friends visited and were made welcome at the service.
New staff underwent an induction programme and shadowed experienced staff, until staff were competent to work on their own. Staff received training relevant to their role. Staff had opportunities for one to one meetings, staff meetings and appraisals, to enable them to carry out their duties effectively. Some staff had gained qualifications in health and social care. People had their needs met by sufficient numbers of staff as rotas were based on people’s needs. People felt staff had the right skills and experience to meet their needs and said staff were very caring and kind.
People were happy with the service they received and felt safe living at Elm Lea. The service had safeguarding procedures in place and staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.
People benefited from living in an environment and using equipment that was maintained. There were records to show that equipment and the premises received regular checks and servicing. A development plan was in place to address ongoing redecoration. People freely accessed the service and spent time where they chose.
People had signed consent documents and told us their consent was gained through discussions with staff. People were supported to make their own decisions and choices and these were respected by staff. Most staff had received training in the Mental Capacity Act (MC) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process.
People were supported to maintain good health and attend appointments or were visited by healthcare professionals. Appropriate referrals were made when required.
People felt staff were very caring. People were relaxed in staff’s company and there was often plenty of banter, staff listened and acted on what people said. People said they were treated with dignity and respect and their privacy was respected. Staff were kind in their approach and knew people and their support needs well.
People told us they received person centred care that was individual to them. They felt staff understood their specific needs. Staff had built up relationships with people and were familiar with their life stories and preferences. People’s individual religious needs were met.
People felt comfortable in complaining, but did not have any concerns. People, relatives and staff had opportunities to provide feedback about the service provided both informally and formally. Feedback had been positive.
People and staff felt the service was well-led. The registered manager adopted an open door policy and senior staff worked alongside staff. They took action to address any concerns or issues straightaway to help ensure the service ran smoothly. The provider visited regularly and spoke to people and staff. Staff felt the registered manager motivated them and the staff team.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.
During this inspection we found that improvements had been made and the provider was compliant.
We had also received anonymous information of concern, with regards to the time people were being supported to get up in the morning, and staff not being given appropriate training. We therefore inspected two additional outcomes as well as following up the previous outstanding compliance actions.
We arrived early in the morning to find there were two night staff on duty and two day staff. The registered manager arrived a few minutes later. We listened to the hand over session from one night member of staff to the day staff. We spoke with the manager and six staff. We also spoke with seven people using the service and one visiting health care professional. We found that people were satisfied with the service. They told us they were well cared for, and the staff were polite and respectful.
We considered our inspection findings to answer questions we always ask:
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well-led?
This is a summary of what we found:
Is the service safe?
People were treated with dignity and respect because staff understood how to apply these principles.
Risks to people's health and welfare had been identified, and there was guidance for staff to follow to reduce the risks, and to implement strategies to make sure people were as safe as possible.
Safeguarding procedures were in place and staff were able to demonstrate they understood how to safeguard the people they supported. People told us they felt safe living in the service.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. No DoLs applications had needed to be submitted, but policies and procedures were in place should the need arise. Relevant staff had been trained to understand when an application should be made, and how to submit one.
Is the service effective?
People told us that they were happy with the care they received and had signed to agree to the content of their care plans. Each care plan had been reviewed with detailed personalised information about each person so that staff had clear guidelines to fully meet the needs of the people using the service. One person said: 'It's good here, we are looked after very well, I may be old but I am still flourishing!'
People had access to health care professionals to help make sure their health care needs were met. People's nutritional needs had been assessed and we found that they had adequate food and drink.
People were receiving care from staff who had been supervised and appraised.
Is the service caring?
We saw that people were supported by attentive caring staff. People told us that staff were kind and respectful. They said they were treated with privacy and dignity at all times and trusted the staff.
Staff demonstrated a kind and caring approach during the inspection when discussing people who used the service..
People's preferences and interests were recorded and care and support was provided in accordance with their wishes. Throughout the inspection we saw staff asking people what they wanted to drink, what they wanted to do and supporting them to go where they wanted to be, for example, either in their rooms or the small quiet lounge.
Is the service responsive?
People told us that staff were responsive to their needs. We found that the care plans had been reviewed on a monthly basis or before if people's needs had changed. They told us that staff always came promptly when they pressed their call bells, even during the night.
We saw and heard during the inspection that most people were able to make their views known about what they wanted in relation to their day to day care and support. We saw that staff respected these wishes.
People were given the opportunity to voice their opinions about the service through surveys and meetings. They told us that the staff and managers listened to them and would make every effort to get them what they wanted. One person told us that they had a meeting with the owners who had asked them for their views and listened to what they had to say. They told us that they were kind and considerate and said: 'This is your home and we will do anything to make you happy'.
Care records showed what people's interests were and there was a programme of activities in place. People told us how they could choose to participate in the group activities or spend time quietly if they wished within the service.
Is the service well-led?
The service was well led. There were systems in place to assess and monitor the quality of the service being provided. For example, checks were being carried out to ensure care records were being completed appropriately and medicines were being administered safely.
People told us they would raise any concerns with the staff or speak with the manager. People said they did not have anything to complain about. They said: 'This is the best care home for miles around'. 'I know that if I told staff I was unhappy they would do something about it'. 'I am happy and contented here'.
Staff told us they were clear about their roles and responsibilities and that they felt supported by the management team. They felt the manager had an open and supportive approach that created a culture where staff felt comfortable in taking any concerns forward. There were systems in place to monitor that staff had the necessary training and skills to meet the needs of people who used the service.
There were contingency plans in place in the event of an emergency.
We considered our inspection findings to answer questions we always ask:
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well-led?
This is a summary of what we found:
Is the service safe?
People were treated with dignity and respect because staff understood how to apply these principles.
Each person had a care plan detailing their care needs; however records showed that although risks had been identified, there was a lack of guidance for staff to follow to reduce the risks and implement strategies to make sure people were as safe as possible. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.
Equipment at the home had been maintained and serviced regularly.
The registered manager could not demonstrate that they had carried out a needs analysis and risk assessment as the basis for deciding sufficient staffing levels. We have therefore asked the provider to note that a review of staffing levels would benefit the people using the service to make sure that there was, at all times, sufficient staff on duty to fully meet their health and social care needs.
Safeguarding procedures were in place; however staff did not demonstrate they fully understood how to safeguard the people they supported. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. No DoLs applications had needed to be submitted, but policies and procedures were in place should the need arise. Relevant staff had been trained to understand when an application should be made, and how to submit one.
Is the service effective?
People told us that they were happy with the care that had been delivered and their care needs were met, however they told us they would like to have more social activities. We saw that staff were attentive to people using the service and responded promptly when needed. People told us they were satisfied with the service they received. They said: 'We can do what we like here'. 'I have nothing but praise for this service'. 'I would recommend this home'.
Is the service caring?
People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People we spoke with said they felt staff respected their privacy and dignity and staff were polite and caring. People commented: 'The staff are marvellous'. 'The staff are helpful and overall are very nice'. 'We are looked after well here'.
Is the service responsive?
People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of the people's care and support needs. A visiting professional told as that the staff always responded to their advice to support people with their health care needs.
Is the service well-led?
Quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities and that they felt supported by the management team. Systems were in place to ask people who used the service, relatives and staff for their views about the service. Audits of the medication and care plans had been completed to assess the quality of the care being provided. However the service had not fully identified the shortfalls in the care plans noted at the inspection. Therefore we have asked the provider to note that the system in place to audit the care plans was not fully effective to make sure people were receiving the care they needed.