Elizabeth House

Elizabeth House is a residential care home providing personal care for up to 30 people. At the time of our inspection there were 28 people living at the home. The home is an adapted building set in its own grounds, opposite Alexandra Park and about a mile from Oldham town centre.

People’s experience of using this service and what we found

People’s medicines were not always managed safely. Some people had not received their medicines as prescribed by their doctor. There had been recent concerns about infection prevention and control at the home, with an infestation of mice and poor standard of cleanliness in the kitchen. However, the provider had taken prompt action to rectify the problem and there was ongoing work to improve the standard of decoration within the home.

Staff had completed training in safeguarding and knew how to recognise and report abuse or neglect. The service had a safe recruitment process which ensured only suitable staff were employed. Staff were aware of risks to people's health and wellbeing and knew how to manage them.

Improvements had been made to staff training since our last inspection. Staff were appropriately trained and received supervision and support from the management team. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff respected people's choices and independence. People's health and wellbeing was monitored and staff sought advice from outside health care professionals when needed. People's dietary needs were met.

There had been a change of ownership and management of the service since our last inspection. People, relatives and staff all spoke positively about changes that were taking place at the service. Audits to monitor standards at the home had been carried out regularly. However, medicines audits had not always been completed correctly which meant missed medicines had not been identified or any remedial action taken.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 February 2021). There was a breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection the provider remained in breach of regulations, and their rating remained requires improvement.

At our last inspection we recommended the provider improve staff training. At this inspection we found this had been completed. However, we found concerns around the management of medicines.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and to respond to concerns we had received about infection prevention and control.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Recommendations and enforcement

We have identified a breach of regulations in relation to safe care and treatment.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Elizabeth House is a residential care home providing personal care for up to 30 people. At the time of our inspection there were 21 people living at the home. The home is an adapted building set in its own grounds.

People’s experience of using this service and what we found

Relatives told us they were happy with the care and support provided by staff.

There had been an improvement in the standard of maintenance and cleanliness in the home since our last inspection. The communal areas and corridors had been redecorated creating a brighter environment.

Staff training had fallen behind. The normal provision of face to face training had not taken place due to the COVID-19 pandemic. However, the provider had not found alternative training provision, such as on-line training. Staff supervision meetings had been held regularly, and staff told us they felt supported by the manager.

Recruitment procedures were robust and there were enough staff to care for people safely. Staff told us they knew the procedure for reporting safeguarding concerns, although some staff had not completed training in this subject.

Medicines were managed safely.

Quality assurance audits and health and safety checks had been completed regularly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 11 October 2019). There were breaches of three of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection improvement had been made and the provider was no longer in breach of those regulations. However, we have found the provider was in breach of a different regulation.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

At this inspection we identified a breach of the regulations in relation to staff training.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service and what we found

We found some areas of the home were not adequately maintained or decorated. This was an area of concern at our last inspection. Although some improvements had been made since then, further improvements to the fabric of the building are required. Correct infection control practices had not always been followed.

Medicines were managed and administered safely. However, the temperature of the medicines room was frequently higher than recommended for the safe storage of medicines.

Risks associated with people's needs had been assessed, were understood and managed by staff. People had access to appropriate equipment where needed. People’s needs were assessed, and person-centred, detailed care plans were in place. These helped to ensure people received the right care and support. There were enough staff deployed to meet people's needs. The appropriate recruitment checks had been carried out when new staff joined the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff had completed appropriate training and received regular supervision to help develop their skills and support them. Staff helped people to access healthcare services and receive ongoing healthcare support.

People told us staff were caring and during our inspection we saw that staff treated people with warmth, kindness and respect. There was a positive culture in the home.

The home did not have a registered manager, although a new registered manager was being recruited. At the time of our inspection the day-to-day management of the home was being carried out by the owner (provider). People were complimentary about the way the home was managed. Audits were in place to monitor the quality of the service. However, they had not identified the concerns we found around infection control. The home owner was aware that further improvements were needed to improve the maintenance of the building.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update.

The last rating for this service was requires improvement (report published on 19 September 2018) and there was one breach of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of the regulations. The service remains rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

Enforcement

We have identified breaches in relation to infection control, maintenance of the building and governance of the service.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home is situated approximately one mile from the centre of Oldham. It is a large detached building that provides accommodation over two floors. It has a garden at the front and an enclosed yard to the rear of the property.

This was an unannounced inspection which took place on 07 and 08 August 2018. We last inspected the service in November 2015. At that inspection we rated the service ‘Good’ overall. At this inspection we identified one breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was in relation to the maintenance of the premises. We have made a recommendation about staffing levels.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The home was clean and new lounge chairs had recently been purchased. However, the main corridor carpet was badly stained and malodourous and there were areas throughout the home where maintenance was required. Although the provider was aware of the poor condition of the carpet and had scheduled for it and other carpets to be replaced, there were other parts of the building where general maintenance was required. Action had not been taken to resolve these issues.

There were effective infection control and prevention measures within the service. Checks and servicing of equipment, such as for the gas, electricity, passenger lift and fire-fighting equipment were up-to-date.

People's needs were responded to promptly during our inspection. However, several people told us they felt more staff were needed, particularly during the night, when only two staff members worked the shift. The registered manager told us they were in the process of recruiting new staff to increase the number of care staff on duty and in particular, at night.

There were systems in place to help safeguard people from abuse. Recruitment checks had been carried out to ensure staff were suitable to work in a care setting with vulnerable people.

New staff were provided with an induction programme. All staff had undergone training to ensure they had the knowledge and skills to support people safely. Staff received regular supervision. This gave them the opportunity to raise any concerns, identify their training needs and receive feedback about the standard of their work.

People were supported to make choices, such as what they would like to eat and wear and what they would like to do. This showed the service was working within the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

Staff worked with health and social care professionals to ensure people were supported to maintain good health. People were provided with a choice of good quality, home-cooked meals.

The service had a process for handling complaints and concerns. There had not been any recent complaints.

People’s care records were detailed and person-centred. They provided staff with sufficient information to guide them on how people would like to be supported. Staff helped people to take part in activities of their choice.

The service had a registered manager who was new to this role. She showed enthusiasm and commitment to the service.

There were some systems in place to monitor the quality of the care provided. However, the audits had not identified all the maintenance problems we found during our inspection.

Is the service safe?

People we spoke with told us they felt happy and safe. Relatives told us that they felt confident with the care and support delivered by staff in the home. One person told us that they could go home feeling happy and confident that their relative was being very well cared for.

During our visit we saw good examples of care practice and noted that staff took time to follow guidance in care plans so that they provided care and treatment in a safe and effective manner.

From records we looked at we saw that people who lacked capacity were fully protected when decisions were necessary regarding their health and personal care needs.

Records seen provided evidence that staff had received appropriate training so that they had the skills and knowledge to provide care and support in a safe way.

Is the service effective?

All relatives we spoke with told us that they were very happy with the quality and standard of care provided by staff. They told us that the manager and staff team were very open and responsive and addressed any issues they raised in a friendly, professional and timely manner. Relatives told us that they felt very involved in the care planning process and that they were kept up to date and informed regarding any changes in care needs.

Is the service caring?

All the people we spoke with during this visit expressed satisfaction about the care and support provided to people. Comments included : "The staff here are very caring, nothing is too much trouble for them".

Care plans were in place and these provided staff with detailed information on how to provide care and support to people in a safe and appropriate way. When we observed staff, we saw that they followed the instructions in the care plans. During our discussions with staff it was evident that they had a good knowledge and understanding of individual care needs. During the day we saw staff engaging in meaningful conversations with people and supporting people to join in activities.

Is the service responsive?

We saw that people's needs were assessed before moving into the home to ensure that their needs could be met by the skill level of staff employed by the service. We saw that care plans were detailed and there was evidence that they were regularly reviewed. When any changes were identified the care plan was updated. We saw several examples where appropriate referrals had been made to healthcare professionals for additional assessments and guidance in respect of care and treatment.

Is the service well led?

The service had a registered manager in post and a number of senior staff. All the staff and relatives we spoke with spoke highly of the manager and her open and transparent approach in managing the home. People told us they felt confident in raising any issues of concern with the manager and that she was always visible and made herself available. There were robust auditing and monitoring systems in place and there was evidence that people using the service were regularly consulted on how the service was run.

We spoke with two people living at the home. One told us the food was "nice enough". Another told us it was "lovely" and they enjoyed it. People had a choice of suitable and nutritious food and hydration in sufficient quantities. Adequate support was provided to meet their needs.

One person living at the home told us they were happy with their bedroom. They described it as "comfortable" and "adequate". We found that the provider had taken steps to provide an environment that was suitably designed and adequately maintained.

We spoke with two people living at the home. One person said staff were "kind" and there were "enough of them". A healthcare professional who visited the home told us "staff seem rushed". We spoke with two members of staff who told us they felt there were sufficient staff on duty to meet the needs of those people living at the home.

The provider had a policy in place which set out the procedure to be followed if a complaint was received.