Elizabeth House

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 inspection we rated this key question good. At this inspection 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.
 

This service scored 59 (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 a proactive and positive culture of safety based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events, however lessons were not always learnt to continually identify and embed good practice.

Improvements were required in how accidents and incidents were recorded, reviewed, and investigated. Additionally, the analysis of incidents needed strengthening, including identifying trends and implementing actions to prevent further occurrences. The provider also lacked evidence that lessons learned were shared or that risk assessments and care plans were updated accordingly. For example, one person experienced an unwitnessed fall that required monitoring for injury, yet there was no record of lessons learned or a post-fall analysis being completed.”

People told us staff responded effectively to any concerns they had. One person told us, “I would speak to one of the people [care staff], they would deal with it for me.”

Staff told us they enjoyed working at the service and felt supported to raise any concerns with the registered manager. They felt confident action would be taken. One staff member said, “We can speak to [name of registered manager] at any time, they listen to our concerns.” Staff said they received training suitable to their role, which enabled them to meet people’s needs safely.

The provider worked with people and healthcare partners to establish and maintain safe systems of care in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People told us they were happy with how their admission to the home was managed. Some people told us this was discussed with them and others mentioned family members were involved in arranging their transfer to the home.

The provider ensured continuity of care for people when they were discharged from hospital or moved into the home from their local community by completing detailed assessments. These assessments helped to maintain people’s continuity of care, the registered manager had systems in place to check people’s needs could be met at the home. Assessments included a review of any known risks related to the persons health and welfare, ensuring the person could transition to the home safely. One relative told us, “[Name of person] has come here for respite. They have been waiting for a social services assessment. I think it's excellent.”

When people needed to attend hospital appointments, a summary record of peoples care needs was available to be sent with people to the hospital to support their ongoing care.

Staff contacted external healthcare professionals when a need was identified. This included the GP and specialist nurses.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The provider shared concerns (where appropriate) with the relevant agencies to enable them to take any required actions to keep people safe.

People told us they felt safe living at the home and in particular with the staff. One person told us, “I'm safe for here. The family sorted my care; I've not fallen since coming here.

Appropriate legal authorisations had been sought in relation to any restrictions imposed on people. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

Staff understood their role in protecting people from poor care, abuse and discrimination. Staff told us they had received safeguarding training and understood their responsibilities to keep people safe. One staff member told us, “There are different types of abuse such as financial, emotional, and physical”. Another staff member told us, “If I witnessed abuse, I would intervene to make sure the person is safe. I would report the incident to our manager. If I was unhappy with how the incident was managed, I would contact the safeguarding local authority, the Police and CQC”

Care plans recorded if people had capacity to make day to day decisions for themselves. Best interest meetings were also recorded to confirm any agreements made to support people’s needs.

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.

Staff spoken with understood the risks associated with the people’s needs and the importance of involving people in risk management. However, this was not reflected in peoples care records.

Systems in place were not effective to ensure people’s care records always contained when referrals to other health and social care professionals had been made. We found people did not always have plans and records to protect them from harm due to their health conditions. For example, we found one person’s care plan stated they had a diagnosis multiple sclerosis (MS]) however there was no risk assessment or detailed instructions for staff to follow, only a sight mention MS may affect the person’s cognition. When raised with the registered manager they confirmed the person did not have a diagnosis of MS and this was a records error. Another person had arthritis and back pain however there was no risk assessment or pain management care plan.

The provider did not always detect and control potential risks at the service.

We found a quiet lounge being used as a storage room for cleaning equipment. Staff we spoke with told us they stored the equipment in the quiet lounge because the storage room was on another floor, and they wanted quicker access to the equipment. We raised the concern with the registered manager, in relation to people having access to the quiet lounge and equipment currently stored in the room was a safety hazard. The registered manager who confirmed staff had an alternative location for storing cleaning equipment on the same floor and they would communicate this to all staff members.

The provider made sure equipment, facilities and technology was available to support staff in the delivery of safe care.

People did not express any concerns in relation to the environment and equipment they needed to support their needs to keep them safe freely.

Staff told us they had completed fire safety training and understood the action needed to keep people safe in the event of a fire or other emergency.

Guidance was in place to instruct staff to check equipment prior to use to ensure it was in good working order. Records viewed detailed when people’s equipment was last checked by the manufacturer, serial numbers and the contact details in case of any faults.

The provider did make sure there were enough qualified, skilled and experienced staff, however it did not always ensure staff received effective supervision. Staff worked well together to provide safe care that met people’s individual needs.

We found gaps in staff supervisions and appraisals for both staff members and the registered manager. Staff were not always receiving supervisions and appraisals in line with the provider’s own policy, which stated that three supervisions and one appraisal should take place each year. As a result, staff did not always receive regular support, oversight, or opportunities to reflect on their practice.

People spoke positively of the staff. One relative told us, “I've been there at weekends when it's slightly quieter. I've actually had occasion to be there quite late in the evening when everybody's getting ready for bed so I've been there at all times of the day, really. There always seems to be enough staff.” Staff confirmed staffing levels were usually sufficient to provide safe and effective care. One staff member told us, “There are always enough staff on duty, at the moment we are not a full at the moment so we probably have more staff on than we need.”

The registered manager told us they completed a dependency scoring for the home on a monthly basis which showed staffing needs for each floor. They advised this would be reviewed with any changes and updated.

Staff received an induction to the service when they started which included training appropriate to their role. One staff member told us, “My induction included shadowing experienced staff members. After my induction, I felt comfortable to support people, and I was given the option of extending my induction if I needed to.”

The provider had a policy to ensure checks were carried out to ensure the suitability of staff during the recruitment process. Staff had access to ongoing training to develop their skills however it was not always clear from training records if all required training had been completed and there was no training policy.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People told us their rooms were kept clean.

Staff told us they had completed infection prevention and control training and demonstrated an understanding of how to reduce the risks of the spread of infection. We observed staff using personal protective equipment (PPE) in line with good practice.

Care plans included guidance/risk assessments for staff to follow regarding the use of PPE. There was guidance of how to support people in isolation if they had an infection.

The provider ensured regular checks of infection prevention and control were completed to confirm staff followed their procedures.

We saw the home appeared clean and tidy and was free from odour.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people when changes happened.

People told us they received their medicines as prescribed. One person told us, “I’m on medicine. It's done properly. I take medication at night and in the morning.”

Staff completed medicine management training and were subject to regular competency checks to ensure they continued to manage medicines safely. We saw staff followed safe procedures when administering medicines to people.

Medicine records showed each person had their own medication record. We saw there were no gaps on these medicine records demonstrating people had received their medicines as prescribed. Care plan records listed people’s prescribed medicines.

The provider had policies and procedures in place to provide guidance to staff on medicine management if needed. The registered manager had arrangements in place to complete regular audits of medicine management to ensure they were being managed in accordance with the providers policies and procedures. These audit checks included:- medication counts to ensure they were correct, ordering and receiving of medicines, correct recording, storage of medicines, temperature-controlled medicines storage, disposal of medicines, and oxygen management.

Risk assessments were in place in relation to high-risk medicines such as flammable topical creams to ensure these were managed safely. Records showed pain relief patches were managed in accordance with guidance.