Elizabeth House

Elizabeth House is situated in Bognor Regis in West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. Elizabeth House is registered to accommodate 60 people. At the time of the inspection there were 57 people accommodated in one adapted building, over three floors, which were divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. These units provided accommodation for older people, some of whom were living with dementia. There were gardens for people to access and a hairdressing room.

The home had a registered manager. A registered manager is a ‘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 home is run. The management team consisted of the registered manager, a deputy manager and team leaders. An operations manager also regularly visited and supported the management team.

At the previous inspection on 14 and 17 February 2017 the home received a rating of ‘Requires Improvement’ and was found to be in breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to inform us of what they would do and by when to improve the key questions of safe and well-led to at least good. This was because there were concerns with regards to the sufficiency and deployment of staff to flexibly meet people’s changing needs and ensure their safety. In addition, there were concerns with regards to the completion of records to confirm staff’s actions and the failure to action issues that had been identified within audits. At this inspection improvements had been made and the provider was no longer in breach of the regulations. However, we found one area of practice that needed to improve.

The management team and staff had a good understanding of the Deprivation of Liberty Safeguards (DoLS) and had worked in accordance with this. However, although staff gained people’s consent before supporting them with day-to-day tasks, there was an inconsistent approach to formally assessing people’s capacity and gaining their consent. This is an area of practice identified as being in need of improvement.

The registered manager and staff worked hard to promote a welcoming, inclusive, friendly and lively atmosphere. People told us they were happy living at the home. Without exception, people, relatives and healthcare professionals told us that staff were consistently kind, caring and compassionate and our observations confirmed this. Comments from people were positive. They included, “I like it here very much; the staff are all very kind and attentive”. Another person told us, “Yes, the staff here are very kind, they could not be nicer. I am fortunate and do not have any medication or mobility problems, but I can see the amount of care that is given to some of the other residents. It is wonderful and I know that I would be looked after properly here if ever the time came”. People were treated with respect and dignity, their privacy maintained. Independence was promoted and encouraged and people could choose how they spent their time.

The provider had a clear set of values that encompassed a person-centred approach and these values were embedded in the culture and the practices of staff. The provider and management team had good quality assurance processes and audits that monitored the practices of staff and the effectiveness of the systems and processes at the home. Action plans were implemented as a result of audits to ensure that any improvements noted were planned for and completed. The provider, management team and staff, worked with external agencies and professionals and continually reflected on their practice and learned from incidents and occurrences to ensure that the service continually improved.

People received a service that was responsive and centred around their needs. People received timely interventions when they were unwell and had access to medicines to maintain their health. People were supported by external healthcare professionals and there were good links and communication to ensure that people received a coordinated approach to care. One person told us, “Yes, I see the doctor from the local surgery if I need to. I can also see the optician, dentist or chiropodist when I need to. I only have to ask one of the girls”.

Staff were had access to learning and development and support from external healthcare professionals to develop their skills and understanding about supporting people living with dementia. People were safe, there were sufficient staff, risks were assessed and managed and people were supported by staff that understood what to do if there were concerns about a person’s safety. People were protected by the prevention and control of infection and told us that the home was clean and our observations confirmed this.

The home was designed in such a way to enable people to orientate themselves around the building and enjoy time on their own as well as interact with others. People had meaningful interactions with staff and observations showed that people enjoyed themselves and had opportunities to partake in activities to occupy their time. The registered manager and staff were proactive in sourcing and providing pastimes for people to enjoy such as an interactive television so that people could access the internet to watch old films and listen to music. In addition, one person who enjoyed gardening was provided with a small garden area, tools and a shed. One person told us, “The home has a person to organise things every day. There is a notice board of the programme. They are really good and I usually attend. They are also willing to take suggestions of anything an individual would like to do, so we get a variety of things to enjoy. It works out that there is more than enough to do in the day”.

People were involved in the development of care plans and were able to voice their wishes and contribute to a plan of care that was specific to their goals and aspirations. People were involved in decisions that affected their lives at the home. Regular meetings ensured that people were able to express their wishes and preferences. The registered manager welcomed feedback and used this to continually improve the experiences of people. People received good end of life care and were offered the opportunity to plan for this to ensure that their needs and preferences were known.

People told us that they enjoyed the food and were provided with choice. People’s hydration and nutritional needs were met. One person told us, “The food here is generally good and they will change the menu for me if I want something different. I have no complaints. The staff will always being me a cup of tea or coffee whenever I want it”.

A comment made by one person, summed up people’s feedback about their experience living at the home, they told us, “I think this place is perfect, the whole experience”.

Elizabeth House provides accommodation and care for up to 60 people older people, most of whom have a diagnosis of dementia. The home is purpose built. It consists of six units, two on each floor, each equipped with a living and kitchen area. Bedrooms are en-suite and there is an assisted bathroom for each unit. There are lifts between the floors which people could access freely. Fifty of the beds at the home are commissioned directly by the local authority for dementia care. At the time of our visit there were 59 people living at the home.

The service has 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 registered manager had made improvements in how staff identified and responded to risks in people’s care. The breach in regulation was met. There had also been improvement in the activities available to people, with an increase in activity staff providing one to one support and company. One relative had written a note of thanks to staff saying, ‘I’d just like to say my Mother did well at Elizabeth House and all the staff are wonderful. It’s a good place with lots to do and lots of nice people’.

Although we found staff understood and managed risks to people’s health and safety, the provider did not have a system to adjust the staffing levels to respond to changes in people’s needs. This meant that staff were often stretched and were not always able to effectively monitor communal areas. There were not always sufficient staff on duty to keep people safe and we have asked the provider to take action.

The provider had not always ensured timely action to address areas identified as needing improvement. Records relating to people’s care were not always accurate or complete. At the time of our inspection, staff were in the process of transferring people’s care plans and records to a new format devised by the provider. The lack of accurate records could lead to inconsistent care being provided and would not support staff to identify and respond to changes in a person’s needs. We have asked the provider to take action.

In other respects, the systems in place to monitor and review the quality of the service and to track planned improvements worked well. Suggestions on improvements to the service were welcomed and people’s feedback encouraged through regular meetings and surveys.

Feedback from people and relatives was very positive. People told us they felt safe at the service, that they enjoyed support and friendship from a regular staff team and that they were regularly asked for their views and opinions.

People told us staff treated them respectfully and that they felt involved in decisions relating to their care. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. People received their medicines safely.

People had developed good relationships with staff and had confidence in their skills and abilities. There was an established team of staff at the home, which offered continuity of care for people. Staff had received training and were supported by the management through supervision and appraisal. Staff were able to pursue additional training, including in dementia care, which helped them to improve the care they provided to people.

People were involved in planning their care and in making suggestions on how the service was run. Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People enjoyed the meals at the service and were offered choice and flexibility in the menu. Staff monitored people’s weight to ensure that they were receiving enough to eat. Where concerns were identified, action had been taken.

Staff used handovers to share information and respond to changes in people’s health. Where appropriate, referrals were made to healthcare professionals, such as the GP, community nurses or dementia crisis team and their advice followed.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We spoke with the home manager and six other staff members. They all told us that they actively enjoyed working at the home and felt treated as valuable team members. One said, "This is the best place I have worked. The care here is great". Another staff member told us, "We have everything we need to do our jobs. The management will always listen if we need something".

One person said 'the staff are very friendly and respectful, they support me in my day to day life '

Visitors we spoke with said they were happy with the care their relatives received. One visitor told us: "I am very impressed with this home, my mother is so happy, it's a lovely place and I am fully consulted in my mothers care '

We saw that people's privacy and independence were respected. People experienced safe and effective care based on detailed care plans and risk assessments that documented peoples preferences and met individual needs.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. We saw policies on whistle blowing and safeguarding.

The provider employed sufficient staff to meet the current needs of people at the home. Staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting.

The Provider had effective systems in place to monitor quality assurance and compliance.