Queen Elizabeth Care Centre

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 provider met people’s needs.

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

This meant people’s needs were not always met.

This service scored 57 (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 person-centred because their needs were not clearly recorded.

Care plans did not consistently evidence people’s preferences, life histories or what was important to them. Although we found some information was recorded, there was limited guidance for staff to support people during periods of distress.

Observations also identified limited meaningful engagement during the day. We also observed occasions where care was task-focused rather than driven by individual preferences. This meant people were not always supported to take part in meaningful activities that reflected their interests and preferences. The registered manager acknowledged the importance of meaningful engagement and following the inspection commended a review of daily activity provision and staff interaction opportunities.

Despite these issues, we did observe some staff demonstrating kind and respectful interactions and supporting people in a personalised way. We observed staff asking for consent and adapting support to people’s wishes and supporting people at their own pace. People and relatives told us staff knew them well and provided individualised care. Pureed meals were observed to be well presented and appetising, supporting people to enjoy their meals.
Overall, people largely received personalised care from caring staff, but improvements were needed to ensure care plans consistently supported person-centred delivery.

The provider understood the importance of providing coordinated and responsive care. However, improvements were needed in the consistency of documentation.

We found that care records and incident management did not always demonstrate effective integration. There was limited evidence that incidents informed care planning or preventative action. We found inconsistencies in care plan documentation, which did not accurately reflect people’s current needs, preferences or risks. This meant that care was not always well-coordinated or responsive across the service and limited the provider’s ability to provide a fully coordinated approach.

Whilst partnership working took place, information was not always recorded within care plans to support a holistic understanding of people’s needs. This meant opportunities to tailor support to meet people’s diverse needs were sometimes missed. While systems were in place to support joined-up care, these were not always fully effective in practice.

The provider did not always ensure people and relatives received clear, accessible and consistent information, because their communication needs were not consistently assessed and clearly recorded.

Care records contained information on people’s communication needs and included information, such as if people had a visual impairment. However, these records also showed inconsistencies and contradictions, which could affect how clearly information was shared between staff and with people. For example, we found in one care record there was a comment that it was not known if the person could read or write, with no additional guidance for staff. We found another example where care records stated the person spoke English as a second language and used pictures to communicate. We did not see pictures used; however, staff told us the person understood basic English. This limited assurance that records identified people’s communication needs for staff to provide them with accessible information if needed.

People and relatives told us communication was good. However, some people were unaware of opportunities such as ‘resident meetings’, suggesting information was not always effectively shared.

The provider had clear signage around the home to help people orientate and find their way around the different areas. Overall, improvements were needed to ensure information was clear, consistent and accessible to all people.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

Systems were in place to gather feedback, including meetings for people, surveys and complaints processes. The registered manager described using complaints as opportunities to learn and improve. Records showed complaints were taken seriously, investigated and responded to in a timely manner. The provider had a complaints policy in place which detailed how concerns could be raised, timescales for a response and how information would be handled.

Many people and relatives felt able to share their views and were positive about their involvement. People and relatives told us, “I've got nothing to complain about, and I never have had. They look after you here, I'd have said something if they didn't” and “I was asked to leave a review, and I filled it in and left it for them, full of praise.”

The provider made sure that people could access the care, support and treatment they needed when they needed it.

People had access to a range of healthcare professionals and services, including GP visits and specialist support, which helped meet their needs. One person told us, “I have seen the dentist and the optician, this was all organised for me.” The provider also ensured people were offered a choice to register with a preferred GP surgery.

Professionals told us referrals were made appropriately and when advice was provided this was followed. One professional told us, “When urgent issues arise, such as the need for medication or changes in the person's health, they contact me without delay and provide regular updates until the matter is resolved. Their communication is timely, professional, and reassuring.”

The provider did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Feedback from people and relatives was mainly positive, describing kind and compassionate care. However, our evidence showed variation in people’s experiences. Some people were not meaningfully engaged, and activities did not always take place as planned. Some people told us they wanted more activities and outings. One person told us, “I’ve never been out on a trip. What frustrates me is not being able to have a conversation with anyone.” Managers told us they recognise the importance of meaningful engagement and have commenced a review of daily activity provision and staff interaction opportunities.
The service supported people to access community resources and maintain connections, including attending religious services and participating in activities linked to cultural or community events. While some people had positive experiences, these were not consistent for everyone.

People were not always 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.

The provider did not always ensure people’s future wishes, including end-of-life care, were fully explored and clearly documented. Care records often focused on Do Not Attempt Cardiopulmonary Resuscitation (DNAR) decisions, with limited evidence of wider discussions about people’s preferences and wishes. We also found one example where care records stated the person had a DNAR form in place but later that they were to be resuscitated in the event of an emergency. A DNAR is a medical order that instructs healthcare professionals not to perform cardiopulmonary resuscitation (CPR) if a person's heart or breathing stops. Following the inspection, the manager undertook an audit of care records to identify and rectify contradictory wording.

Where we found further inconsistencies in care records, including conflicting information about people’s decisions and capacity, this meant there was a risk to supporting people with planning for the future.

The registered manager described discussing end-of-life wishes with people and families but acknowledged some barriers to fully embedding these conversations and how they referred to appropriate external professionals when required. Despite these concerns, staff received training and we saw they supported people at end of life with compassion.