Elm View Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Risk assessments and care plans contained conflicting information around what support people needed, as well as their likes and dislikes. People were not involved in the development or review of their care plans. Although staff knew people well, records around people’s capacity did not always contain all relevant information and were not always assessed or documented in line with guidance. During our assessment of this key question, we found concerns around staff securely maintaining an accurate, complete and contemporaneous record in respect of each service user, which resulted in a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Not everyone using the service knew if they had a care plan. Relatives were not always involved in the care planning process, although felt involved in day-to-day care discussions about their loved ones. People and relatives told us “I don’t know if I have a care plan,” “I am involved in discussions around care”, and, “I am not involved in [persons] care planning.”

Staff did not feel they always had enough time to read people’s care plans and felt care plans were clinical, not always personalised or always updated in a timely manner. We asked staff about people using the service. Staff knew people well and demonstrated compassion and understanding to people they supported however, were not always aware of people’s risks and how to best support people. A person using the service had seizures. Staff had not received training in managing seizures and when asked, told us they would not know what to do if someone had a seizure. The home manager told us a percentage of care plans were reviewed monthly however, families and people using the service had not been involved in the care planning review.

People had risk assessments in areas such as their mobility, nutrition and pressure care were identified and risk management plans were in place. However, they contained inconsistent information about people’s care, which did not provide an accurate picture of people’s risks and the support they required. Therefore it was not always clear if staff had appropriately assessed people’s needs as documentation lacked consistent information. Senior staff reviewed a 10 percent of care plans each month. Five care plans we reviewed as part of our assessment contained incorrect information about people’s risks and care needs. Records around people’s capacity did not always contain all relevant information and were not always completed in line with national guidance. We received limited assurances around the monitoring and mitigation of the risks relating to the health, safety and welfare of service users and an accurate, complete. This was a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People at the service gave mixed reviews about the food at the home however, people felt there were enough options and variety, as well as snacks being available throughout the day. People told us “I'm asked what I would like, and I tell them,” “The food is very pleasant. We do have two heavy meals together; I have said about this but not written it down. We have been asking for a menu on tables since I don't know when. We have a slip but can't see the choices.” People also told us “Food is dreadful. One [member of staff] in the kitchen is super but isn’t in every day. They [staff] call supper, it could be 5pm or 6.30pm, you never know.” Relatives told us they had received conflicting information about speech and language therapy guidance for their loved one around supporting them with suitable food. This put people at risk of being given the wrong level of food and drink, and of choking. People told us the home manager was informed and took action to ensure information was shared and updated. People’s families and staff felt the nursing team were fast to act on any concerns around pressure care. One relative we spoke with was positive about the pressure care their relative received and felt staff managed this exceptionally well.

Staff we spoke with felt it was difficult to find accurate information about people’s dietary and nutritional needs. Staff were not always aware of the best practice to support people and kitchen staff took the lead from care staff at times regarding the required level of modified diet. Care plan documents we saw contained contradictory information on the level of which a person’s diet should be modified. This was because guidance from a speech and language therapist was not available. Staff knew how to escalate concerns around people’s pressure care. Staff commented that they felt the nurses managed people’s clinical needs well and changes to people’s needs were communicated effectively through handover. The home manager told us and we observed during the on-site visit, there was a dedicated nurse for each floor and an older person specialist assistant who carried out weekly ward rounds.

Nutrition and hydration documents we saw indicated, records were not always updated consistently around people’s nutritional needs, and they contained conflicting information. However, we heard people’s nutritional needs were reviewed and printed weekly for kitchen staff to follow. We did not see evidence of speech and language therapy assessments in place or guidance for staff to follow and training records did not evidence all staff had received training for nutrition and hydration. This placed some people at increased risk of choking. However, clinical review meetings lead by the clinical lead were held weekly. We were shown records of these. The meetings reviewed peoples’ clinical needs such as pressure ulcers, changes in medication, nutrition and hydration as necessary. There was no information on when each person’s individual plan of care would be reviewed to identify improvements needed.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

People had access to activities which benefitted their physical health. People had a timetable of activities in their room and spoke highly of the activities coordinator.

Care plans reviewed contained evidence people received ongoing support from healthcare professionals, such as dietitians, hospital specialists, members of the community mental health team, GP’s and activities coordinators. However, there was limited guidance and documentation to evidence where people had last seen dentists. Information around people’s oral hygiene was often conflicting, not always known or followed. We reviewed 5 care plans, all contained conflicting information regarding if people had teeth or artificial teeth, and not all staff had received training around oral care. Daily notes did not always document what support was provided around oral care.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.