31 January 2018
During a routine inspection
Elizabeth Peters House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Elizabeth Peters House is a residential care home for six adults with mental health needs and at the time of our inspection five people were using the service. The premises has three floors and five out of the six bedrooms have ensuite facilities. There are communally shared bathrooms, a kitchen, a lounge and dining area, and a rear garden.
The service had a registered manager who was present on both days of the inspection. A registered manager is a person who has registered with the 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.
At the previous inspection we had found that staff were not receiving regular supervision. At this inspection we noted that staff were receiving supervision, with further supervision dates scheduled for the future. The staff we spoke with stated that they felt well supported by the registered manager and were able to discuss any queries or concerns as they arose.
The registered manager had not notified the CQC of events at the service that we needed to be informed about, in accordance with legislation. This meant that we could not effectively monitor the safety and welfare of people who use the service. Improvements were required in the management of medicines, to ensure that people consistently received their medicines safely.
Risk assessments were in place to identify any risks to people’s safety and wellbeing. Guidance was provided to mitigate these risks and support people to lead more independent and safer lives. Safe infection control practices were used to protect people from the risk of cross infection.
The recruitment files we saw showed that staff were appointed in a safe manner. We saw that there were enough staff available to meet people’s needs during the inspection, although additional staff might be required from time to time in the future if more people using the service wished to be supported by staff to use community resources, for example visit theatres and cinemas.
Staff did not receive mandatory training, and other training about mental health to meet the specific needs of people who use the service. Staff were provided with individual supervision but there was no evidence that they reviewed their performance each year with their line manager, through the appraisal system.
People were consulted about their wishes and supported to make their own decisions. Their needs were assessed before they moved into the service to ensure that Elizabeth Peters House was a suitable place to live. Individual care plans had been developed, which took into account people’s initial assessments, their current needs, and their own views and aspirations. Staff supported people to attend health care appointments and follow any guidance from health care professionals.
The registered manager demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). We observed that people were asked for their consent before staff provided care and support. Staff were not always clear about the MCA, as refresher training on this subject was overdue.
People and their relatives told us that staff were kind and supportive, and respected their privacy and confidentiality. We saw friendly interactions between people who used the service and staff. People had some community activities but these were limited. We did not find that the provider had implemented a structured approach to encouraging people to engage more with leisure, recreational and educational facilities and groups in their area.
People had received information about how to make a complaint but there was outdated details on the complaints guidance. We noted that records did not evidence that one complaint had not been satisfactorily resolved; however the provider later advised us that appropriate action was taken.
The registered manager was regarded as supportive and helpful by people who use the service, their relatives and staff members. However, we found limited evidence of how the provider supported the registered manager with her role and responsibilities.
The provider had not taken action to address known deficits at the service, including the provision of staff training and appraisals. Although people using the service had been asked for their views through a questionnaire and residents meetings, there were insufficient effective processes in place that demonstrated how the provider monitored the quality of the service.
We have made a recommendation in regards to the provider supporting people to develop meaningful and fulfilling activities. We found four breaches of regulations in this report. These breaches were in relation to the provider not informing us of notifiable events, the need to improve the safety of the medicines system, the lack of staff training, development and appraisals, and the provider’s failure to effectively monitor and address the quality of the service. You can see what action we told the provider to take at the back of the full version of the report.