Elmcroft Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in continued breach of legal regulation in relation to safeguarding, as systems and processes were not established and operated effectively to prevent abuse or improper treatment.

This service scored 56 (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 always have a proactive and positive culture of safety based on openness and honesty. Whilst leaders listened to concerns about safety and investigated and reported safety events, lessons were not always learnt to continually identify and embed good practice. Systems were still in early development to create a culture of safety and learning. For example, areas for learning were discussed in team meetings and additional training offered where this was required. However, whilst there had been improvement to the oversight and recording of incidents since the last inspection, further work was still required to ensure actions to mitigate future risks were robust. For example, many lessons related to individual care and support needs which should be included within a care plan for all staff to refer to and follow, or staff practice issues which would be better addressed through further learning and development. This included reducing the risk of skin tears and unexplained bruising, which was a continued concern from previous inspections.

At our last inspection the service did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services. For example, people had been inappropriately admitted to the service with support needs staff were unable to meet, including people with funding for intensive 24 hour 1:1 care. Since our last inspection the service had worked to support these people to move to more suitable placements. At this inspection they had made improvements to their admissions policy to ensure processes were safe going forwards. However, following the last inspection, commissioners had placed an embargo on new people joining the service. This meant this new policy remained untested as there had been no new admissions to Elmcroft Care Home since our last assessment.

The service did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. Whilst some improvements had been made to improving people’s lives and protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect, these had were not always embedded into staff practice. For example, although care and nursing staff received training in safeguarding, they were not always able to tell us what this meant or how to recognise potential abuse, neglect or restrictive practice. One staff member in a supervisory role told us, “I would not know what to do if I had a safeguarding concern. But I would report to my manager.” Leaders were continuing to work with staff to embed learning in this area. Whilst there had been improvements to management oversight and reporting of safeguarding matters, systems and processes were not yet in place to reduce the risk of reoccurrence. For example, 1 person’s care plan had not been updated to remove reference to the use of restrictive practice (the use of restraint) despite an earlier investigated safeguarding concern which found this could have been the cause of unexplained bruising.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Although people told us they felt safe, risk assessments were generic and lacking in detail. For those people who were communicating a need, expressing feelings or an emotional reaction, more detailed guidance was still needed for staff on how to support them in a positive way and minimise risk of harm. The new manager had started a full review of all Antecedent, Behaviour, Consequence (ABC) records to check staff practice when people became distressed which represented a significant improvement since the last inspection. However, work was still required to embed this. A person told us, “I do feel safe here because people are kind to me and look after me well.”

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. We looked around all areas of the premises and found significant work had been carried out to support safety measures, as well as some re-decoration. This included the sluice facilities and cleaning storerooms. The provider told us there was a planned schedule of work to address known maintenance issues. However, improvement was still needed to adapt the service for people living with dementia in relation to specialised design and decoration, such as colour, lighting, points of interest, sensory and quiet areas and assistive technology. A person’s relative said, “Decorating has gone on in the lounge and new chairs bought.”

The service did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide care that met people’s individual needs. The dependency and staffing hours calculator tool did not fully reflect person-centred aspects of care and support. Although there were sufficient care staff on shift, we observed people were still left unoccupied for long periods of time without meaningful staff engagement. Staff received an induction, training and supervisions, an improvement from the last inspection. However, whilst leaders had invested heavily in training, this was not yet fully embedded. Leaders told us staff now received Care Certificate training and were allocating Staff Champions in specific areas such as dignity. However, the impact of these new measures was not yet evident. Staff recruitment was safe.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Observations showed the care home was clean and hygienic in most areas. Some further maintenance works were required to ensure areas such as the laundry could be kept clean. Leaders told us this work was planned. A staff member told us, “I wear an apron and gloves, we use them when assisting residents (people) with food and personal care. I’m aware of what donning and doffing is and how to wash my hands. [Elmcroft Care Home] is cleaner now we have new managers, it is a daily routine. The night staff also clean the rooms and the kitchen.”

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. The service had systems for appropriate and safe handling of medicines. Medicines were managed using electronic medication administration records (e-Mars), which were completed accurately and monitored appropriately to ensure people did not miss any of their medicines. Staff were caring and treated people with dignity and respect during medicine administration and ensured medicines were given considering people’s individual needs and preferences.