Queen Elizabeth Care Centre

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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always ensure people’s care and treatment was effective because their needs were not consistently assessed and clearly recorded. Care plans and pre-admission assessments were in place. However, these were often unclear, lacked detail and did not consistently reflect people’s current needs.

There were multiple examples of contradictory or inaccurate information. One person’s care plan stated they required a walking frame, but staff confirmed they were no longer able to walk independently. Another person’s care plan stated they could eat independently, but they were observed being supported with eating by staff without clear rationale. These inconsistencies meant staff could not always rely on care plans to accurately respond to people’s needs.

We found that some key areas of people’s needs were not fully assessed or clearly documented. One person’s care plan stated they had a diagnosis of Chronic Obstructive Pulmonary Disease (COPD), which is a chronic respiratory condition that can result in breathlessness and reduced lung function and a history of respiratory failure. The care plan included a choking risk assessment, however, did not provide guidance for staff on how to monitor for signs of a chest infection or shortness of breath. There was no clear escalation pathway to guide staff in responding to changes in the person’s condition.

Care records for people with mental health needs were not always comprehensive. Information about people’s emotional needs, potential triggers and factors that could influence changes in behaviour were not consistently recorded. This meant people’s needs were not fully assessed and there was no guidance for staff on how to provide reassurance and emotional support during periods of distress.

This was not always consistent with people’s experiences. While people appeared comfortable and well cared for, shortfalls in assessment processes increased the risk that changes in people’s needs would not be identified or responded to effectively.

The provider did not always ensure people received effective care and treatment based on best practice guidance.

Recording and monitoring of clinical care was inconsistent. For example, wound care and observations relating to one person’s foot was not always clearly documented, making it difficult to assess whether care was effective or reviewed appropriately in line with best practice.

We also found for another person, there were no pictures or body maps completed for a wound of their foot. However, staff had taken photos of other wounds. For another person, there was a clear assessment in place and dressings were applied on alternate days. The care plan documented input from professionals, and the care plan included photographic evidence.

Whilst no direct impact on people was identified, these issues meant there was a risk of delays in staff recognising signs of infection or other complications. Inconsistent documentation also meant changes in people’s conditions may not be identified promptly or responded to appropriately.

Care plans included assessments of risks, such as skin integrity, malnutrition and choking. There was evidence that staff acted in certain areas, such as repositioning and monitoring skin condition. A relative told us, "They come and turn [person] all the time, making them as comfortable as possible."

The provider made sure people’s care and treatment was effective by working well across teams and services to support people.

Staff were observed communicating effectively during day-to-day care delivery. We observed good communication between staff, with care delivered in a coordinated way and call bells responded to promptly. Staff worked together to meet people’s needs at mealtimes and throughout the day, ensuring people received care in a timely way. One person said, “The staff are good and there is excellent communication. I'm confident they will look after me well.”

There was also evidence of partnership working with external professionals such as GPs, pharmacists and specialist nurses to support people’s health needs. One professional told us, “Staff maintain an efficient schedule for my regular clinics, ensure people are ready and comfortable for their appointments, that allows me to deliver safe, effective care. The nursing staff are diligent in monitoring specific risks between my visits, showing a genuine commitment to allied health advice.”

The provider did not always ensure people were supported to live healthier lives due to inconsistencies in care planning and delivery.

Care plans did not always link health conditions to appropriate interventions. For example, one person’s care plan did not incorporate key aspects of diabetes management, including dietary guidance and foot care to reduce the risk of complications. Although we did not identify any immediate impact on people, there was a risk that dietary support was not managed consistently and increased the risk of complications.

There was also a lack of clear, person-centred guidance for staff on how to monitor and respond to changes in people’s conditions, including when to escalate concerns to healthcare professionals. For example, one person’s wound management care plan did not detail how swelling was managed, the presence of bruising or how to escalate concerns in relation to infection. This meant opportunities to proactively manage people’s health and prevent deterioration could be missed.

Despite these concerns, we observed that people’s nutrition and hydration needs were supported, and staff ensured meals were provided in a timely and organised way. Some people spoke positively about the food, with one person stating, “The food is very good. I really love the cooked breakfast.” Staff also encouraged nutritional intake, particularly for people receiving end-of-life care. A relative told us, “They keep offering [person] nutritious drinks and things they think will help [them].”

The provider did not always effectively monitor and improve outcomes for people due to weaknesses in governance and oversight systems.

While audit systems and monitoring processes were in place, these were not consistently effective in identifying and addressing risks. Care plan contradictions and gaps in documentation further demonstrated that monitoring systems were not identifying or resolving issues effectively.

We found that one person’s care plan stated staff were to monitor for signs of high blood pressure and record this when they appeared weak, drowsy or sleepy. However, the care plan did not specify what the person’s normal blood pressure was, how often readings should be taken or what an abnormal result would be. This also meant there were no clear escalation procedures for abnormal readings.

In addition, the roles and responsibilities of healthcare professionals involved in supporting people with mental health needs were not always clearly identified. This meant there was a lack of clarity about who was responsible for assessing, monitoring, and reviewing aspects of care.

The provider generally ensured people’s consent to care and treatment was sought, although improvements were needed in documentation and consistency.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the capacity to do so themselves. Staff demonstrated an understanding of the MCA and their responsibilities to support people to make decisions wherever possible.

Capacity assessments and best interests’ decisions were in place. However, we found documentation was sometimes inconsistent or unclear. For example, one person’s care record stated they could make decisions for non-complex matters, they could sometimes retain information and make some complex decisions and best interests’ decisions were required. This meant there was limited assurance people were appropriately supported to make decisions about their care and treatment. This created a risk that people’s rights were not being upheld, and that decisions may not always reflect their wishes, preferences or best interests.

Where people had mental health needs, care plans did not contain detail on how staff should assess and respond to people’s decision-making capabilities during periods of distress.

Despite these issues, most people experienced respectful interactions, and consent was routinely sought in practice. Staff were observed asking people for consent before supporting them, using clear and respectful language such as, “Can I help you do this?” and “Is it okay if we move you now?” This demonstrated a person-centred approach in day-to-day care.

The provider used CCTV outside of the building in a way that respected people’s rights and privacy. They had policies in place that were aligned with current best practice and relevant guidance. These provided a clear framework to support safe practice.