Elizabeth Court

Elizabeth Court is a purpose-built residential care home providing accommodation and personal care for up to a maximum of 59 people. The service has three floors which are divided into separate living areas, each with their own dining room and lounge. The service provides support to people living with dementia, or with long term health conditions. At the time of our inspection there were 42 people using the service.

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

People were well cared for by staff at the service, although we identified some inconsistencies in relation to the level of engagement and activities on offer to people. We have made a recommendation to the registered provider in respect of this.

People were happy living at Elizabeth Court and told us staff were kind and caring towards them. Relatives reporting feel their family member was well cared for and said they knew who to talk to should they have any concerns.

People lived in an environment that was suitable for their needs. Rooms were personalised and homely and the premises were checked for their safety.

People were safe with staff. Staff identified potential risks to people and took action to help prevent accidents or incidents. Staff knew how to recognise and report safeguarding concerns.

People received the medicines they required and were supported to access healthcare professional input when needed. People were monitored to help ensure they maintained a good level of health and provided with a sufficient amount and choice of food and drink to support this.

People were cared for by trained staff who were appropriately deployed around the service. People said they did not have to wait to receive care, but they were also encouraged to remain independent and make their own choices in their care.

Staff knew people well and provided individualised care to people. People’s social histories were used to help develop activities they liked and the manager planned further opportunities for people, such as external outings.

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.

The manager was making a good impression at the service as relative’s told us she was responsive to them and staff said they felt supported. The manager had plans for where she wished to take the service and had already created links with the local community to broaden people’s experiences.

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 good (report published 19 September 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elizabeth Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

There were enough staff available to keep people safe and meet their needs. There were vacancies for care staff at the time of our inspection, which meant agency staff were used regularly. However, the registered manager had arranged exclusivity with some local agencies, to ensure that agency staff were dedicated to the service. This meant agency staff got to know people and the risk of cross contamination was reduced.

People who lived at the home were supported to access testing for COVID-19 and to have their COVID-19 vaccinations. If people contracted COVID-19, they were supported to self-isolate in their bedrooms. People were encouraged to take trips out with family members, but also reminded to be cautious when visiting public places. A lateral flow test was carried out on their return.

The service had put measures in place to enable safe visiting. Visitors were required to provide evidence of a negative lateral flow test and to complete COVID-19 screening. Family visits were planned to ensure there were never multiple visitors in the home simultaneously. Professionals visiting the home also had to demonstrate their COVID-19 vaccination status.

Staff took part in a COVID-19 testing regime. Any staff who contracted COVID-19 did not return to work until they had completed an appropriate period of self-isolation.

The premises were clean and hygienic. Additional cleaning had been implemented since the advent of the pandemic and standards of infection prevention and control (IPC) were audited regularly. Staff had access to the personal protective equipment (PPE) they needed and had attended training in its use.

Staff told us they felt supported and could speak with management at any time if they were concerned about COVID-19. They said they were pleased at how well they had coped with the pandemic and by ensuring they followed good infection control processes, they had kept any COVID-19 outbreak within the service to a minimum. In turn, the registered manager said they had been supported by higher management and were able to access other external support or training when needed.

We found the following examples of good practice.

Elizabeth Court had been creative with their new admissions process as their website had been updated to provide a short, welcoming video and tour for potential residents. This meant that people could get a good view of the home and its features and see the Registered Manager herself, as well as having a discussion by telephone.

Staff came up with innovative solutions to the communication difficulties posed by staff having to wear masks in the home. They laminated pictures of themselves smiling which they wore on a lanyard so that the people who live there could recognise them and were reassured.

Staff had been supported with decisions around social distancing by providing them with a traffic light style handout giving ideas on how they could do the same things as before, but in a different way due to the virus, eg. Offering snacks to residents, changing mealtime arrangements, interacting with residents etc.

Staffs wellbeing had been thought of by introducing a “Chill Out” room with easy chairs, inspirational posters, thank you cards and photos of people and visiting children smiling and laughing to raise their spirits. Bowls were placed on a table containing sweets and small gifts for staff to help themselves to as a thank you for their hard work during this period.

This unannounced inspection took place on 25 July 2018. At the time of our inspection 39 people were living in the home.

There was a registered manager in post. 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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection.

We last inspected this service in August 2017 where we carried out a focused inspection to check action had been taken in response to some enforcement action we had taken following our inspection in March 2017. In March 2017 we identified breaches of Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to person-centred care, medicines and risk assessments, good governance and staff deployment. We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 as the registered manager had failed to notify us of significant events that had taken place in the service.

At our focused inspection in August 2017 we found the service had started to improve, however we felt those improvements needed to be embedded into the service. A new manager had just started at the service at that time and they subsequently registered with CQC. We used this inspection to check improvements had been sustained and continued progress had been made. We found the registered manager had made significant improvements to the service and as such our concerns in relation to medicines management, staff deployment, risk assessments, activities, record keeping, good governance and notifications had been addressed.

Information for people was provided in a way they would understand and where there were restrictions in place staff followed the principals of the Mental Capacity Act 2005 (MCA). We did identify however that some documentation was a bit muddled in that some people had best interests decisions despite having capacity make decisions and have made a recommendation to the registered provider in this respect. People’s care plans were detailed and where a person’s needs changed staff responded to this. However, we did find some further work was needed to ensure people’s end of life wishes were recorded. We have made a recommendation to the registered provider in this respect.

People’s medicines were handled in a safe way by staff and people received the medicines they required. We saw staff attending to people’s needs on the day in a prompt way which demonstrated a sufficient number of staff were deployed at the service.

People were cared for by staff who were kind, caring, attentive and showed respect towards them. People could have privacy when they wished it and they were given the opportunity to contribute to their care decisions.

People were cared for by a consistent staff team who felt supported by the registered manager. Staff had access to the training and supervision they required in order to carry out their role. It was clear the culture within the service was good as staff worked well together. Staff met on a regular basis to discuss all aspects of the service.

Staff ensured people had access to health care professionals when they needed it as well as to a range of nutritious food to help keep them healthy. Staff used national guidance to support them to provide effective care. Where people had accidents or incidents staff took appropriate action and as such reflected on incidents to aid their learning.

Risks to people had been identified and guidance was in place for staff. Before people moved into the home their needs were assessed to ensure staff could provide effective, safe and responsive care. The home was adapted to meet people’s needs and staff ensured people were not at risk of infection or abuse because they understood their responsibilities in respect of these. This was aided by the registered provider’s robust recruitment process.

Health and safety and quality assurance processes were in place to check the environment that people lived in was safe and the service people received was of a good quality. In the event of a fire there was fire information available for staff and the emergency services.

People were given the opportunity to give their feedback on the care they received. People had access to a range of activities and were happy with the care they received from staff. They told us they were confident if they had any concerns or complaints these would be addressed.

The registered manager had developed a positive culture within the home. One that was open and transparent. They had worked well with the local authority safeguarding team to investigate any concerns and had developed relationships with other external agencies in order to improve the care people received at the service.

The inspection took place on 9 August 2017 and was unannounced.

The home did not have 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. Since our last inspection, the manager who was present on the day had left the service and a new manager had been recruited. The new manager would be commencing with their application to CQC to become registered manager.

We carried out a comprehensive inspection of this service on 2 March 2017 where we found five breaches of legal requirements. One breach relating to good governance within the home was a continued breach and as such we issued a warning notice to the registered provider. We gave the registered provider until 30 June 2017 to become compliant in the areas covered in our warning notice. This included deployment of staff, maintaining contemporaneous records, acting on shortfalls identified in quality assurance audits and responding to feedback received from people living in the home.

Following that inspection, the provider’s regional and district manager’s provided us with monthly action plans to inform us of their progress against the areas we identified. We undertook this focussed inspection to check that they had followed their plan and to confirm that they now met the legal requirements. This inspection found that the registered provider had partially met the requirements of the warning notice. We spoke with the district manager and manager at the end of the inspection in relation to our findings. We informed them we will be carrying out another comprehensive inspection sooner than scheduled to check that they have fully addressed all areas.

This report only covers our findings in relation to the leadership of the service. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Elizabeth Court on our website at www.cqc.org.uk.

The management and staffing team at Elizabeth Court had been working hard to improve the standard of record keeping across the service. However we found there was still a lack of contemporaneous record keeping for people. Some of this was down to the time team leaders had available to them to review and update the care plans. Deployment of staff within the home was better managed and staff told us they felt things had improved with regard to the support they received from team leaders and senior staff.

There were much improved systems in place to regularly audit and improve the service delivered. Where shortfalls had been identified we saw that action had been taken.

People were able to give their feedback and where people made suggestions in regard to the service, we heard from them that they had been listened to. Activities had improved slightly in that an external outing had taken place and a further two had been organised, however more focus was needed to help ensure people had access to activities that interested them.

This was an unannounced inspection which took place on 2 March 2017.

The home was without a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 was a new manager in post who had started the process of applying to register with CQC.

We carried out an inspection to Elizabeth Court in March 2015 where we found breaches in relation to staff not following the requirements of the mental capacity act and a lack of contemporaneous records held about people. Following that inspection the provider sent us an action plan on how they planned to address our concerns. We carried out this inspection to check that the provider had taken the appropriate action. We found improvements had been made, however we identified concerns in other areas during this inspection.

There was a lack of appropriately deployed staff to meet people’s needs and staff did not feel valued or supported. People were not provided with enough activities to keep them stimulated and there was a lack of opportunity for people to go on outings. People’s individual preferences in the way they wished to be cared for were not always recognised by staff and people may not receive responsive care because information relating to their needs was not always included in their care plan.

Staff did not follow safe medicines practices and where people were at risk of harm these risks had not always been addressed or recognised by staff. Regular audits of the service were carried out to review the quality of the service provided. However, not all actions identified were addressed.

The manager and provider had not always notified CQC of important events, such as safeguarding notifications. Accidents and incidents were not monitored to identify trends relating to people.

A complaints policy was in place and people knew how to make a complaint. Residents and relatives told us they were involved in the running of the home through residents and relatives meetings. However we noted recurrent issues raised by residents/relatives which had not all been resolved.

People were cared for by staff that were attentive and showed kindness and empathy towards them. People’s dietary needs were respected by staff and should they have a change in their health needs, staff engaged advice and input from appropriate healthcare professionals. People were supported to maintain relationships with people who were important to them.

Staff understood the requirements of the Mental Capacity Act 2005. Staff ensured people were supported to make their own decisions and these were respected by staff. Training was provided to staff and staff received supervision and staff appraisals.

Staff understood how to safeguard people and knew what steps they should take if they suspected abuse. Prior to starting work at the home recruitment checks were completed to help ensure only suitable staff were employed. There was a contingency plan in the event of an emergency and evacuation plans had been written for each person to help support them safely in the event of an emergency.

During the inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. We also made two recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.

At the time of our inspection the service provided care and support to 52 people. As part of our inspection we spoke with four people who used the service, ten staff and six relatives. We also looked at people's care plans and other associated paperwork.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

We found that people were being cared for in a clean, well maintained environment. We saw that, where appropriate, extra security had been installed to ensure the safety of the residents, for example a key pad entry system to the stairs.

When we looked at a sample of care plans we found that risk assessments were in place to provide information to staff to help minimise any identified risks. One person who used the service that we spoke with told us, 'They don't like you to go out on your own in case you fall.' A relative told us 'I do not have any worries she's going to be harmed.'

We saw that the recruitment practice was safe and thorough to ensure that only staff suitable to work with vulnerable people were employed by the service. One member of staff who had recently started work at Elizabeth Court told us the interview process had included, 'A lot of questions about dementia.'

Is the service effective?

People, or their relatives, were involved in writing the plan of their care and support. We saw that people's care plans had been regularly reviewed which ensured they remained up to date in order to reflect their needs.

One relative we spoke with said, 'They (staff) adapt to the needs of a person.'

At our last inspection we found that there were not always enough staff on duty to meet people's needs. At this inspection we found that the provider had increased the staffing hours. Whilst this had improved people's experience in terms of their care, people and relatives that we spoke with said that staff rarely had time to stop and talk with them.

Is the service caring?

We saw that people were supported by kind and attentive staff. Staff were seen to interact with people well.

One person who used the service that we spoke with told us, 'People are all very nice.' One relative told us, 'Very satisfied with caring and safety aspects.' And another said, 'It's good to know she's in the right place.'

Is the service responsive?

We saw that where people's needs had changed, or their health deteriorated, staff responded by involving an appropriate health care professional.

Is the service well-led?

We heard from one person who used the service that if it had not been for the quick response of staff they would have become very unwell.

The provider had systems in place for monitoring the quality of the service. Relatives had the opportunity to meet on a regular basis to discuss any concerns they had or make suggestions on how to improve the service.

People told us that they were provided with sufficient information that helped them make a choice about moving into the home.

A relative of a person who used the service told us that they had looked at our last report on the web site to help them in their choice of home for their relative.

We were told that people are listened to in making choices regarding their care and treatment and that relatives are often consulted in the care planning process.

We had good comments and feedback regarding the standard of catering. People said that they enjoyed their food and that the meals were delicious and well prepared. A person who used the service told us "I am a fussy eater but the chef always manages to prepare something that I like".

Staff told us that they enjoyed working in the home but felt that the staffing levels should be improved to enable them to spend more time with people who required more time.

Staff had a good understanding of people's assessed needs and felt that they had the training required to enable them to undertake their roles.

People were aware of the complaints procedure and felt they would not be discriminated against for making a complaint.