Queen Elizabeth House

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.

The last rating for this key question was 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.

The service was in breach of legal regulation in relation to people’s consent.

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.

People told us they and their family members were involved in planning for their care needs. One person said, “Me and my daughter took part in the planning.” A relative told us they and their whole family were involved in planning for their loved one care needs. Despite the positive feedback we found the provider did not always ensure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

At the time of our assessment care plans and records were in the process of being transferred from being paper based to being on the providers new electronic care planning system. We found that assessments and care plans were not always completed, detailed, comprehensive and individualised. Reviews of people’s assessed needs and risks were not always carried out when required to ensure care plans remained up to date and reflective of people’s needs and risks, particularly when there were changes in people’s conditions or circumstances and this required improvement.

The provider demonstrated a good understanding of evidence-based practice, with monitoring tools in place to support the delivery of care in line with recognised guidance. Nationally recognised assessment tools, for example the Malnutrition Universal Screening Tool (MUST) for monitoring people’s weight were embedded within the providers new electronic care planning system to help guide staff in delivering safe and effective care. However, assessments of people’s needs, risks and care plans had not always been completed, detailed, comprehensive and individualised and this required improvement.

People's nutrition and hydration needs and preferences were met. A person told us, “Sometimes I like the food and sometimes I do not.” Another person said, “The food is ok, and I can manage without help.” A relative commented, “It is good traditional food, and [loved one] loves it, they don’t need help to eat.” Another relative said, “My loved one doesn’t need help at mealtimes, the food wasn’t great but has improved.”

The cook was knowledgeable about people’s nutritional and dietary needs; they showed us daily menus that offered people a choice of 2 meals at lunchtime. They told us people could choose something else if they didn’t like the options. They showed us up to date information held about each person’s dietary needs; this included details such as their likes and dislikes, food texture and consistency and any food allergies. We saw guidelines from a speech and language therapist on a notice board in the kitchen that included dietary advice for a person using the service.

There was a catering committee consisting of people using the services and the cooks where they talked about what was on the menu, what people would like changed, and new ideas and preferences. The cook told us they also discussed dietary needs during staff 11 at 11 meetings each morning in case people’s needs had changed. Staff also updated kitchen staff if there was involvement from health care professionals.

We observed how people were supported at lunch time in the dining room. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. People were offered meals from the choices on offer and were offered a range of drinks including juices, tea and coffee. The atmosphere in dining areas was relaxed, with music playing in the background. Staff appeared busy and task focused with little friendly interaction with people. There was 1 staff member in the dining room to assist 15 people seated at tables.

We recommend that the provider reviews their current staffing level arrangements at the service. The current staffing levels appeared stretched and could potentially leave people at risk of not receiving appropriate care promptly.

Staff worked well across teams and services to support people. There were systems in place to support and enhance better staff communication. Regular meetings were held including daily staff meetings where information was shared across the staffing team.

People told us they were supported by staff with their health needs. One person said, “I get all sorts of help from hospitals, the GP, speech and language therapists and so on.” A relative commented, “Any instructions from the GP are meticulously followed by the staff.”

We saw staff communicated and worked effectively with other professionals. These included the local authority, regular GP visits, community mental health teams, palliative care teams and dietitians amongst others.

Staff supported people to manage their health and wellbeing to maximise their independence, choice and future support needs. People told us they had access to health care professional when they needed them. A person told us, “The doctor is here once a week but if we need to see someone sooner, they [staff] will arrange it.”

People were supported to access a range of health and social care professionals when required to support their physical and emotional wellbeing. Care records showed that people were seen by professionals such as GPs, nurses and other relevant health care service when needed. People were supported to attend appointments, and referrals were made promptly to ensure timely intervention and continuity of care.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Due to the issues, we found with medicines management, care plans and care records, and mental capacity assessments we could not be assured that people were experiencing positive and consistent outcomes or that these were being effectively monitored.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. Staff promoted people's rights but did not always work within the principles of the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. We found an inconsistent approach to ensuring the principles of the MCA had been followed. Some people had not been appropriately assessed when they lacked capacity to consent to aspects of their care and this required improvement.

This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had requested legal authorisations where restrictions were in place. Decisions around these were made in people’s best interests and for their safety.