Elizabeth Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home offers purpose built accommodation for to 44 people. At the time of our inspection, there were 41 people living in the home.There was a registered manager in post at the time of our inspection. 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.
During this inspection we identified multiple breaches of regulations 9, 10,11, 12, 13, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns with the delivery of person centred care, dignity and respect, safe and appropriate care, safeguarding people from abuse, the recruitment of staff, staffing levels, staff support and the governance arrangements at the home. You can see what action we told the provider to take at the back of the full version of the report. 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 been concluded.
During our visit, we found people’s needs and risks were not properly identified or managed. The majority of information in relation to people’s care was generic and meaningless and staff had little guidance on how to provide safe and appropriate person centred care. This meant people’s support was not always provided in a safe or dignified way and records showed that people did not always received the support they needed to maintain their well-being. There was also little evidence that staff were keeping track of people’s progress on a regular basis to ensure the support provided continued to meet their needs.
There was a lack of any meaningful and consistent activities to interest and occupy people and they sat for the majority of the day in the communal lounge with the television playing in the background. People told us there was not much to do at the home.
We found that some incidents of a safeguarding nature had not been appropriately identified, responded to, documented or reported in accordance with local safeguarding procedures and the legal requirements of CQC. This meant the provider did not have a robust system in place to protect people from the risk of abuse. Some people’s care was not always provided in such a way as to protect them from neglectful or degrading treatment. Furthermore some of the language used by staff to describe people’s needs was not always respectful or considerate.
People’s ability to make decisions about their care was not assessed in accordance with the Mental Capacity Act 2005. For instance some people had bed rails on their beds and deprivation of liberty safeguards in place without any evidence that they had consented to this or evidence that their capacity to consent to this had been explored. There was no evidence that any best interest decision making had been properly undertaken or that other least restrictive options had been explored. The capacity assessments that where in place in some people’s care files were generic and contrary to the MCA legislation designed to protect people’s human rights.
The provider had a formal method for determining the number of staff needed on duty to keep people safe and meet their needs. We found however that the provider had not applied this method correctly. This resulted in the number of staff on duty being incorrectly determined. And during our visit we observed that the number of staff on duty was insufficient to meet people’s needs at all times. The opinions of people who lived at the home and their relatives about staffing levels was mixed.
New staff were recruited after satisfactory pre-employment checks were undertaken. This meant there were systems in place to check that staff were safe to work with vulnerable people prior to employment. We found however that the manager had not ensured suitable recruitment and selection processes were subsequently followed when a staff member’s employment status within the home changed. For example, if they changed their job role or were given more responsibility. This meant that there was no evidence that the staff member’s competency for their new role had been assessed to ensure they were suitable. This was not good practice.
We saw that care staff had received regular supervision and appraisal in their job role but nursing staff had not. This meant that the provider had not ensured that nursing staff were given appropriate support to do their job role effectively.
We checked a sample of people’s medications. We found that the balance of medication that each person had in the medication trolley matched what had been administered. The way people were given their medication however did not always follow best practice guidelines and the time that medicines were administered was not recorded. This aspect of medication management required improvement.
The provider had audits in place to check the quality of the service but these were ineffective. For instance the inadequacy of people’s care planning information had not been picked up; deficiencies in the way people’s support was provided had not been identified and the lack of adherence to the MCA had not been addressed. There was little evidence that there were robust processes in place to gain people’s views on the quality and safety of the service or that staff practice at the home was monitored to ensure that it was safe and appropriate. This meant there was little evidence that the provider had robustly governed the service to ensure it was safe, effective, caring, responsive and well-led.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
- Ensure that providers found to be providing inadequate care significantly improve.
- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
- Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.