Enter and view: Elmstead House

Healthwatch Barnet carried out an announced Enter and View visit to Elmstead House on 31 October 2017 to assess the quality of care provided. Elmstead House, part of the Care UK Group, accommodated up to 50 residents and was divided into separate dementia and mental health units. At the time of the visit, there were 36 residents living in the home. 

The inspection found that the home was clean, welcoming and generally well maintained. Healthwatch noted positive improvements since a previous CQC inspection, including the appointment of a permanent manager, improved record keeping, a greater emphasis on residents’ hydration and the availability of additional snacks. Inspectors praised the commitment of management and staff, who were seen as caring and focused on residents’ wellbeing. 

Care planning arrangements were comprehensive and included information about residents’ medication, nutrition, continence and personal preferences. Care plans were reviewed regularly, families were invited to attend reviews and staff used a “resident of the day” approach to ensure individual needs received focused attention. Most relatives reported being involved in care planning, although some felt communication could be improved. 

The home supported a large number of residents subject to Deprivation of Liberty Safeguards (DoLS), with 34 authorisations in place. Residents also had access to healthcare services including weekly GP visits, opticians, dentists, chiropody and podiatry services. Relatives generally praised the home’s response to health concerns and the new GP service. 

Staffing emerged as the main area of concern. Although staffing levels met required ratios, both staff and relatives reported that the dementia unit in particular was under pressure. Staff described high turnover, absenteeism and recruitment difficulties, while several relatives felt there were not enough permanent staff who knew residents well. Staff also reported limited time for meaningful interaction with residents because of workload pressures.

Training was largely delivered through e-learning, supplemented by specialist training in areas such as dementia care, moving and handling, safeguarding and clinical procedures. However, some staff stated that they often had to complete online training in their own time because workloads made it difficult to access training during working hours. 

Healthwatch expressed concerns about activities provision. Although an activity programme was displayed and events such as parties, cinema sessions and religious services were offered, little activity was observed during the visit. Relatives frequently commented that residents, particularly those living with dementia, would benefit from more personalised one-to-one stimulation, walks and therapeutic activities. Healthwatch was also concerned that the sensory room was not always being used in a way that maximised benefit for residents.

Food and hydration arrangements were generally viewed positively. Menus included photographs of meals, alternative options were available, snacks and fruit were accessible throughout the day and relatives praised staff vigilance in encouraging residents to drink. However, Healthwatch noted that residents were not routinely offered hand wipes before meals. 

Feedback from residents and relatives was largely positive. Many praised the caring attitude of staff, the cleanliness of the home and the pleasant environment. However, concerns were raised about staff shortages, communication, high staff turnover and the amount of time available for personalised care. Despite these concerns, most residents, relatives and staff said they would recommend the home.

Overall, Healthwatch concluded that Elmstead House was a clean and caring home with committed staff and improving leadership, but one that would benefit from additional staffing and enhanced dementia-focused activities. Recommendations included reviewing staffing levels, improving staff retention, providing management cover seven days a week, enabling staff to complete training during work hours, improving use of the sensory room, increasing dementia-specific activities, adding pictorial signs to bathroom doors and providing hand wipes before meals. 

Elmstead House accepted the recommendations and reported that recruitment efforts were underway, additional activity coordinators had been recruited and staff training arrangements were being further monitored and strengthened.