Archived: Elizabeth House Residential Care Home

Elizabeth House Residential Care Home is a care home which can provide personal care for up to 16 people. Accommodation is provided over two floors. The service supports people who have needs associated with ageing or are living with a dementia related illness. At the time of this inspection six people were using the service.

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

People were not safe. Risks to people were not always assessed, reduced and monitored. Medicines were not used safely. The service was not clean. Lessons were not learnt when things went wrong. The provider and registered manager did not follow safe recruitment practices.

There were enough staff to keep people safe.

People’s needs had not been adequately assessed and recorded. People’s care was not designed to include any of their desired outcomes or goals. The provider and registered manager did not ensure staff received the induction and training required to provide good quality care. People were not supported to have a balanced diet. The service required redecoration and refurbishment. The registered manager confirmed there was no overall plan to improve the building. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice.

People were not consistently treated with dignity and respect. People were not supported to express their views or make decisions about their own care. People were not offered choices in ways which were meaningful to them. People were not supported to maintain their independence.

People were not involved in planning or reviewing their own care. Care plans were not always up to date and did not always reflect people’s current needs. People were not supported to take part in activities that were meaningful and enjoyable for them. People were not fully supported to make a complaint or raise concerns. People’s care plans regarding end of life care were basic and not personalised.

The service was not well-led. People were put at risk because the provider and registered manager failed to ensure suitable quality assurance checks identified issues with care and support. The provider and registered manager did not develop any clear plan of action to address issues found from internal or external audits. The provider and registered manager did not have systems in place to identify when things went wrong. The provider and registered manager had failed to act on the issues identified at this inspection and from our previous inspection.

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 Inadequate (published 19 August 2019) and there were multiple breaches of regulations. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified ten breaches in relation to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following representations and appeals, CQC have acted to cancel the provider and registered manager's registration.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Elizabeth House Residential Care Home is a care home which can provide personal care for up to 16 people. Accommodation is provided over two floors. The service supports people who have needs associated with ageing or are living with a dementia related illness. At the time of this inspection five people were using the service.

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

The service was not safe. The provider and registered manager failed to ensure risks to people were assessed and managed. Risks to people were not always assessed, reduced and monitored. The provider had not ensured they followed safe recruitment practices. Medicines were not managed safely.

The service was not clean. Equipment used as part of people’s care was not clean. Food was not consistently stored safely. Similar issues from our last inspection had not been acted on. Lessons were not learnt when things went wrong. There was no evidence of learning from accident or incidents. Staff told us they knew how to report concerns about abuse. However, we observed care practices that put people at risk which staff had not reported.

People continued to be put at risk because the provider and registered manager failed to ensure suitable quality assurance checks identified issues with care and support. Audit systems were not comprehensive or robust. Systems and processes to assess risk and monitor quality were insufficient and ineffective in driving improvements.

People were put at risk of harm as the registered manager did not demonstrate they had the required skills and competency to manage the service effectively and safely. The provider and registered manager had failed to act on the issues identified on our last two inspections.

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 Inadequate (published 11 March 2020) and there were multiple breaches of regulations. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns from the local authority in relation to risks associated with people’s health conditions, management of medicines, unsafe recruitment practices, and unsafe food storage. As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elizabeth House Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to Regulations 7, 12, 17, and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Please see the action we have taken at the end of this report.

Following representations and appeals, CQC have acted to cancel the provider and registered manager's registration.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. We will work with the local authority to monitor progress. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Elizabeth House Residential Care Home is a care home which can provide personal care for up to 16 people. Accommodation is provided over two floors. The service supports people who have needs associated with ageing or are living with a dementia related illness. At the time of this inspection up to eight people were using the service.

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

At our last inspection we found a wide range of concerns. At this inspection we found that insufficient improvements had been made. Elizbeth House Residential Care Home remained unsafe for people and continued not to be well led. The service provided to people had deteriorated.

Where people were at risk of harm insufficient action had been taken to ensure that the risks were fully assessed and understood by staff. Clear plans were not always in place or implemented to reduce risks to people. People were at increased risk of harm due to the provider's failure to take appropriate action when risks had been identified.

The provider failed to ensure there was a lack of robust evaluation of care, meaning concerns were not always identified and addressed. This put people at risk of harm. Governance systems had not been effective in identifying and addressing shortfalls and unsafe practices.

The building and equipment were not safe for people to use. The environment, including the fire detection system needed updating and refurbishment. Infection prevention and control practices were not always followed. This meant the provider failed to ensure people were protected against the spread of infectious diseases. The home was not satisfactorily clean. Medicines were not always managed safely.

Documentation was not fully completed, contained some inaccurate information and in some cases, was missing. This put people at increased risk of not receiving the appropriate, individual level of care they required. People's preferences and wishes were not always detailed in care plans and there was limited evidence that their views had been sought. People were not given opportunities to engage in meaningful activities.

Appropriate pre-employment checks of staff were not carried out. The provider failed to ensure people were protected from the risk of unsuitable staff being employed. Staff did not receive the training, induction and support they needed to carry out their roles safely. The provider did not ensure staffing levels and deployment met people’s needs. People told us they liked the staff who supported them however, staff were on occasions, task focused and did not always respect people's dignity.

Safeguarding systems and processes were not always followed. Incidents had not always been notified to CQC in line with legal requirements. We are dealing with this outside the inspection process

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way and in their best interests; the policies and systems in the service did not support this practice.

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, with an inadequate rating in the well-led key question (published 24 December 2018). There was a breach of regulation 17 related to good governance. 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 service had deteriorated to an overall inadequate rating and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to person centred care, dignity and respect, need for consent, safe care and treatment, premises and equipment, good governance, staffing, fit and proper persons employed, requirements of registered managers and notification of incidents at this inspection.

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 concluded.

Since the last inspection we recognised that the provider had failed to notify CQC of all incidents in line with legal requirements. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

We referred our concerns to the local safeguarding authority and asked the provider to send us evidence of improvements and action points. This was used when decisions were made about our regulatory response.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time frame and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Elizabeth House Residential Care Home provides a service for up to 14 people in Mansfield Woodhouse Nottinghamshire, who have needs associated with ageing or are living with dementia. On the day of our inspection eight people were living at the service.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run

At our last inspection on 10 November 2016 we rated the service ‘Requires Improvement’. Shortfalls in the fundamental care standards were identified in how people received their medicines, the cleanliness of the service, the choice of activities available and the systems in place to monitor quality and safety. At this inspection, we found ongoing concerns and some new shortfalls in the care and support people received. We also took account of the inspection history; the service had continued to not reach the minimum fundamental care standards people should expect.

Staffing levels and deployment of staff meant people did not consistently receive quality care. Staff had to multi-task and had limited time to spend with people, this compromised how people received care and support. Safe staff recruitment checks were completed before staff commenced their employment.

The management of medicines did not consistently follow best practice guidance. Hand written entries on medicine administration records did not always have two staff signatures, to ensure information recorded was accurate. Topical creams did not routinely have the date recorded of when they were opened and some prescribed creams were left in a communal area.

The recommendations made by the local commissioning group infection control audit in 2017 and 2018 had not been fully complied with.

There was no analysis of accidents and incidents to consider themes and patterns. Staff were aware of risks associated with people’s needs, but these were not consistently recorded and may have impacted on people receiving inconsistent care and support.

Safeguarding procedures were in place to protect people from abuse and avoidable harm and discrimination. Staff received refresher training and opportunities to discuss their work and development needs.

People received a choice of meals. Where a pureed diet was required, there was no consideration in how this was presented. Staff were aware of people’s needs but information available for staff was not consistently up to date. People were supported with any health conditions

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were aware of the principles of the Mental Capacity Act 2005.

Staff were kind and caring, but people did not consistently experience dignity and respect in how their needs were met because staff were over stretched and task focused. People were seen to not have a positive lunchtime experience. Staff were seen to assist people with their eating needs standing up and were frequently interrupted to assist other people.

The social activities, stimulation and opportunities for people continued to be limited. The activity plan on display did not match the activities available. We have made a recommendation about the social activities and opportunities available for people.

People had access to the complaint procedure. Advocacy information leaflets available for people were out of date. Considerations of people’s end of life care had been discussed with them.

As part of the provider’s quality assurance process, people and their relatives received an opportunity to share their experience about the service via an annual questionnaire. People who used the service, relatives and staff were positive about the registered manager.

There were systems and processes in place to monitored quality and safety, but these required further development to provide sufficient assurance improvements would be made and sustained.

During this inspection we found one breach of the of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Elizabeth House Residential Care Home provides a service for up to 16 men or women who have needs associated with ageing or a dementia type illnesses and is situated in Mansfield Woodhouse Nottinghamshire. On the day of our inspection 11 people were using the service.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run

There were enough staff with the right skills and experience to meet people’s immediate needs. We found that medicines were stored correctly, however they were not always administered safely. People’s care records showed that any risk to their safety had been identified and measures were put in place to reduce these risks, but the cleaning schedule in place had not identified debris behind the tumble drier which could have presented a hazard. People who used the service and staff at Elizabeth House knew who to report any concerns to if they felt anything untoward had occurred.

People were supported by staff who had received the training they needed to support people effectively. People had consented to the care that they received. People’s rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

People spoke positively about the food they received. They were able to have choice in what they ate at each meal and received support to eat if required. People had regular access to their GP and also other health care professionals when required.

People were supported by staff who were caring and treated them with kindness, respect and dignity. Staff encouraged people to remain independent wherever possible and where people showed signs of distress or discomfort, staff responded to them quickly. There were no restrictions on friends and relatives visiting their family members.

A complaints procedure was in place and people felt comfortable in making a complaint if needed. People received the care they needed in a way that met their needs. We saw staff provide planned care well. While a range of group activities were planned none were taking place on the day of our inspection. Care plans were written with the involvement of each person and their family. They were reviewed regularly to ensure staff responded appropriately to any change in need a person may have.

Processes were in place to check on the quality of the service, but there was no overall action plan to demonstrate improvement. The atmosphere within the home was warm and friendly. People living in the home were asked for their opinions with regard to the service that they received. Staff understood the values and aims of the service and spoke highly of the registered manager, who had a good understanding of their regulatory responsibilities.

We carried out this inspection to answer five key questions; is the service safe, effective, caring, responsive and well-led. Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found people's care and support was not planned and delivered in a way that ensured their safety and welfare. Staff told us that one person had needed to explain to staff how to carry out a procedure as the information in the care file did not explain how to do so.

A visiting doctor told us they felt people who used the service were safe at the home. A person who used the service said, 'I feel very safe here.' However staff did not know how to respond to any allegation of abuse. Staff told us they had not done any safeguarding training and were unclear about what whistleblowing was.

Staff on duty who administered medication had not completed the training required to do so safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. The manager told us they understood when an application should be made, and how to submit one.

Is the service effective?

The provider was unable to demonstrate how they involved people in planning their care, and obtaining people's consent for this to be provided.

We found mental capacity assessments had not been completed correctly. Staff did not understand the principles of the Mental Capacity Act (2005) and had not received training on this.

Care plans did not always contain details of the care and support people needed. One care plan referred to a person going to a local church. A staff member said, 'I don't know anything about that, I don't read the care plans.'

Staff were keen to respond to people's needs and requests, however we observed occasions when this could have been done more effectively. We saw three staff tell one person how they would support them after lunch differently, which could have confused the person.

The majority of entries on the activity records consisted of things along the lines of, 'Relaxing in lounge', 'Listening to music' and 'Watching television.' We asked a person who used the service if there was much for them to do. The person said, 'No, I am happy here, but they could organise more for us to do.'

Is the service caring?

We found staff interacted with people who used the service in a sensitive and caring manner. We observed staff to be attentive, caring and well intentioned. A person who used the service said, 'We get individual attention.' Another person said, 'They help me, they are very good.'

We saw people were provided with the assistance they needed to eat their meals. A person who used the service said, 'I can't fault the meals, they are very nice.'

Is the service responsive?

We found care workers responded appropriately when people had the capacity to make decisions about their care and welfare. A person who used the service said, 'I think staff listen to me.'

People who used the service were happy with their health care. One person said, 'The doctor comes to see us regularly when we need it.'

We found the provider responded to the views of people who used the service. A person told us the manager was, 'Easy to talk to.' We also heard a person say to the manager, 'I am being looked after very well.'

Is the service well-led?

There were not management structures and procedures in place to ensure staff received the support and supervision they needed to carry out their duties. Staff described their induction as, 'Brief.' A person who used the service said, 'They are trained, they don't just employ anyone, they are vetted first.'

A person who used the service said, 'The staff are very nice, I trust them with anything.' However we found the staff training matrix and supervision records were not up to date.

The manager told us they did not carry out routine audits within the home as they tended to deal with things at the time. This meant they did not make use of opportunities to identify and improve the service. We also found there was a lack of planning for the maintenance and upkeep of the home.

Prior to our visit we reviewed all the information we had received from the provider, including an action plan detailing how they would comply with the compliance action we set at the previous inspection. During the visit we spoke with the registered manager, a senior care worker and a care worker. We also did a tour of the communal bathrooms and toilets and looked at the cleaning schedules.

We found the provider had made the required improvements to become compliant with this outcome.

People who used the service told us they were happy and settled, and that they felt they were well cared for and supported. Comments included, 'I get up at the time I choose. They (staff) are always obliging and help me when I request support.' And, 'I'm happy here; I'm settling in well and getting to know people.'

Relative's comments included, 'This home is better than the last one my mum was in.' And, 'If I had to mark the home out of 10, I would give it 11. They (staff) not only look after my husband but support me too.'

A visiting professional told us, 'The staff are helpful and polite, I get good feedback from my patients that live here. It's a nice relaxed atmosphere, people are well looked after.'

People who used the service and relatives told us they found staff to be caring, experienced and competent. A relative told us, 'I wanted my dad to come here, he couldn't be better looked after.'

We saw improvements had been made to the cleanliness of the home but we found further work was still required.

As part of our inspection we spoke with three people who used the service and two relatives of people who used the service. We also spoke with the registered manager, two members of staff, looked at service information and records and did a tour of the building.

People told us they were treated with dignity and respect and their care needs were well met. One person told us, 'I'm happy living here, I feel content. The girls (staff) are very caring.'

Another person said, 'There are enough staff for the people here at the moment. The food is lovely and you get a choice.'

Relatives we spoke with were positive about the care provided. One relative told us, 'It's lovely here, the staff are caring, as good as gold. I'm always made welcome when I visit, I can't find no fault.'

Another relative said, 'We were involved in my father's assessment, we have signed care plans and had a meeting with the manager whilst my father has been here. This home was recommended to us, my father was apprehensive at first but after a short time said, 'This is the place for me', and you can't get any better than that.'

We found care plans did not always reflect people's needs and there were some concerns with the lack of infection control measures in place.