Elmcroft Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the service met people’s needs. At our last assessment we rated this key question inadequate. At this assessment the rating has remained inadequate. This meant services were not planned or delivered in ways that met people’s needs. The service was in continued breach of legal regulation in relation to person-centred care, as care was not designed, planned and delivered to meet individual needs and preferences.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs. Language was not always person-centred, for example staff and records describing people as having ‘challenging behaviour’, rather than considering the need or feeling the person was expressing. Some daily care notes used infantilising language such as stating a person was, ‘Happy, cheeky, interested and peaceful.’ Care notes were not personalised, with staff recording all possible leisure activities offered to everyone on each unit in individual daily care notes, whether the person had participated or not. Staff had not assessed individual levels of physical and cognitive ability to enable people to participate, or whether the activities offered met individual personal preferences and interests.

There were some shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity. Whilst familiar staff provided continuity of care, staff were not always able to demonstrate a good understanding of people’s needs, such as best practice in dementia care. This impacted on care provision. A keyworker system had been recently introduced to provide a direct line of communication for people and their relatives with a consistent named member of staff. However, this had not yet been embedded as some staff could not tell us who they were keyworker for.

The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. A service user guide and statement of purpose was available, and the provider told us information could be provided in a variety of formats. However, whilst communication needs were recorded in care plans, this did not consistently translate to information being communicated to people in an accessible way. This included a lack of involvement for people who were unable to communicate verbally with words.

The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not always involve people in decisions about their care or tell them what had changed as a result, in particular those people with additional communication needs. Whilst observations were being completed by leaders to try to understand the experience of people less able to communicate with words, the approach used unclear metrics, and the results were not properly evaluated. Residents meeting had commenced to discuss the day to day running of the service, for those people able to participate. A complaints management process was in place. We received feedback relatives felt able to raise any issues or concerns and this would be listened to and acted on. One person’s relative told us, “There has been such a vast improvement here with everything since the new management took over. One of my biggest moans was communications but now I get straight answers.” Another person’s relative said, “I would certainly know how to make a complaint.”

The service did not make sure that people could access the care, support and treatment they needed when they needed it. Reasonable adjustments were not made to ensure access for people with sight loss or other communication barriers. A person with a visual impairment told us, “I have all my meals in my room because the table you sit at [in the dining room] is small and if you have people either side, I can knock into them when I am trying to eat and see my plate. I don’t eat daintily and it’s difficult at a small table.” The potential impact on the person’s feelings of social isolation had not been identified by the service and mitigated. Records relating to another person showed they frequently became distressed and tried to speak with staff in a language other than English. However, there was no translation services in place to support communication and reduce the person’s upset and frustration.

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this. For example, where people were living with low mood as a result of their dementia or mental health conditions, they were less likely to have the same opportunities to meet their social needs and reduce the risk of loneliness or isolation as others. One person told us, “I want my dinner in here [my room], I feel safer in here. There are people coming down at night, shouting. It’s a nightmare and I can’t take much more of it to be honest.” Another person told us, “The staff are busy so do not have time to chat” and, “It is nice you come in and talk to me because very few other people do, will you be coming back?”.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. Whilst some people had end of life care planning in place, not all care plans set out personalised comfort measures to support people with holistic care when they were seriously unwell. For example, a person with advanced dementia had an end-of-life care plan which stated, ‘[Person] is not currently nearing end of life and [their] wishes have not been discussed yet.’ Bereavement measures were not always managed sensitively.