This was an unannounced inspection, carried out over two days on 4 and 6 March 2015. The Elms Care Centre provides accommodation for up to 37 older people who require support in their later life, with nursing care needs. The care home also supports people who are living with a dementia. There were 31 people living at the home when we visited.
Accommodation was arranged over two floors and there was a passenger lift to assist people to get to the upper floor. The home had 33 single bedrooms and two double bedrooms. Some bedrooms had en-suite facilities. There were also three shared lounges, a conservatory/dining room, a small secure outside patio, toilets, bathrooms and shower facilities.
There was a registered manager in place. 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.
We last inspected The Elms Care Centre in May 2013. At that inspection we found the service was meeting all the essential standards that we assessed.
People told us they felt safe living at The Elms, and we found people were protected from avoidable harm and abuse that may breach their human rights. However, people’s care plans showed that their consent had not always been obtained and mental capacity had not always been fully assessed and documented. Staff did not have a full understanding of the legal requirements relating to people giving consent to their care or where people’s freedoms were restricted. The registered manager told us training was in place, but would review the reasons for staff’s lack of knowledge. People’s medicines were managed well which meant they received them safely.
People told us, at times, there were not enough staff; however the registered manager was aware of people’s concerns and was taking action to make immediate improvements. Staff had the knowledge, skills and experience to carry out their role. The registered manager provided support, training and development opportunities for staff. Staff were aware of people’s individual nutritional needs and drinks were available at all times. However, documentation was not always completed accurately and risk assessments and care plans were not always in place as required.
Positive working relationships were adopted by the registered manager with agencies and other professionals such as GPs, the local authority and external health professionals. This helped to ensure the approach to meeting a person’s care needs was linked. There were systems in place to ensure staff shared information about people’s health care. This encouraged effective communication, and meant staff were pro-active in meeting people’s needs. However, staff had recently highlighted to the registered manager that improvements could be made.
People were supported by staff who were kind and caring. Staff were considerate and respectful which helped to ensure people’s privacy and dignity were promoted. People, relatives and staff were encouraged to be actively involved in the running of the service by providing feedback to the registered manager. Their views were valued and used to facilitate change and improvement.
People received care which was personalised to their needs. Care plans did not always give clear direction to staff about how to meet a person’s needs. But, from our observations and conversations with staff, it was clear they were knowledgeable about people. Care records did not always demonstrate people were involved in creating their own care plans and people told us they were not aware of their care plan.
People were encouraged to take part in social activities and continue to be part of the local community. Staff recognised and understood people’s individuality and social engagements were tailored to suit. However, care plans were not descriptive about people’s social interests.
The registered manager and registered provider promoted a positive culture that was open, inclusive to people, staff and visitors. There was a clear management structure in place. There were quality monitoring systems in place to help ensure continuous improvement.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of this report.