The Royal Elms Care Home

We looked at 7 quality statements in this domain. People and their relatives felt safe living at The Royal Elms and staff took action to manage risks. They said they had been involved in agreeing people’s care and support needs when they moved in and were kept informed of any changes in their needs or wellbeing. This involvement was not recorded. Staff knew people’s needs and how to support them, however, care plans did not always contain sufficient detail to guide staff in managing risks, for example if a person became agitated. The registered manager addressed these issues during the assessment. Relatives said there were enough staff on duty. Staff feedback was more mixed. We observed staff were stretched, and there were periods of time when there was no staff available in the communal areas of the home. People received their medicines as prescribed. Additional details on how people communicated they needed an as required medicines was needed. The site of where medicated patches were applied needed to be recorded to avoid using the same site too often. Equipment was serviced and maintained appropriately. The home was clean and personal protective equipment was available. People’s capacity to make decisions was assessed and best interest decisions recorded. Records did not show who had been involved in making the best interest decision. Staff recruitment procedures ensured checks were made prior to the staff member starting work. However, references weren’t always verified and gaps in employment history were not always explained. Staff received the training for their role, and all had completed or been enrolled on a relevant health and social care diploma. Some staff needed their training refreshed. We discussed if staff required further training for managing people’s behaviours and dysphagia. There were a small number of people living at the home where this specific training could support the staff team.

We looked at 3 quality statements in this domain. Relatives said they had been involved in agreeing the care and support people needed when they moved to The Royal Elms. They said they were kept up to date with any changes in the relative’s health and wellbeing. Staff knew people and their support needs and were kept up to date with any changes in people’s needs through handover meetings. However, care records did not always contain full details of the support strategies staff should use when supporting people. People were supported to maintain their health. The GP visited each week, and this was said to be working well. A visiting professional said appropriate referrals were made by the home and staff were knowledgeable about the people they came to see. They said they had worked with the home to improve the care for 1 person. The home had followed their advice. However, we saw a referral had been made to the speech and language team (SALT) which had not been followed up for 2 months when the home did not receive a response from the SALT. People and relatives said the food was good. People had a choice, and people’s preferences were catered for. A modified diet was provided where people were at risk of choking, although this wasn’t reflected in their care records, We were told 1 person refused to follow a diet recommended by health professionals. This wasn’t clearly recorded in their care file.

We looked at 2 quality statements in this domain. People and their relatives said the staff were kind, caring and knew their needs and how to support them. People were encouraged and prompted to complete things for themselves. A relative told us staff had supported their relative to use their walker so they could be more independently mobile around the home. Staff prompted people with everyday choices, for example around their meals. We observed positive interactions between people and staff throughout the assessment. People were comfortable with the staff support. However, we also observed 1 member of staff standing over a person when supporting them with a meal, which was not dignified. The registered manager said they would address this with the staff member. We did not observe any activities taking place. Staff said they arranged these when they could. Relatives said special occasions were celebrated, but they did not see many day-to-day activities taking place.

We looked at 3 quality statements in this domain. Relatives said communication with the home was good and they were able to raise any questions or concerns with the registered manager. They said these would be addressed straight away. People and relatives were also positive about the care and support they received. Staff knew people’s needs and how to support them. Relatives had been involved in agreeing people’s care and support when they moved to the home and were kept up to date with any changes. Systems were in place to make referrals to other professionals when required. However, 1 referral had not been followed up for 2 months when the home had not had a response. The home had used a translator to communicate with 1 person whose first language was not English.

We looked at 2 quality statements in this domain. Staff said they enjoyed working at the home, felt well supported in their role and had the training they needed. They felt able to raise any issues or concerns with the registered manager if they needed to and said they would be listened to. A recent staff survey was seen to be positive. Staff said communication within the team was good. Staff meetings were occasionally held. A governance system was in place. Audits were delegated to the deputy managers and senior care staff. The registered manager then reviewed these to make sure actions identified had been completed. However, the issues we found, for example some care plans not containing sufficient details to guide staff, had not been identified in the audits. The registered manager took immediate action to address the issues we found. Feedback we received from the local authority was positive about the home. The registered manager had acted upon any recommendations made by the local authority.