Elizabeth Court

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.

At our last assessment we rated this key question 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.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them. Care plans were not always in place to support people safely or contained contradictory information

This included the use of covert medicines. Clinical tools such as malnutrition universal screening tool (MUST) and waterlow were in place to assess people’s needs.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services. There was no effective communication system in place. For example, handover records had limited information and only recorded whether a person had, had a good day or night. Not all staff were aware of people’s dietary information, upon discussion with staff, they were not all aware of people who required a fortified diet. There was evidence of the service working alongside other health professionals including district nurses and the dieticians. However, referrals were not always made in a timely manner. We identified people who were losing weight were not being monitored despite significant weight loss. Significant weight loss without monitoring places people at risk. Weight loss may be due to underlying health issues like malnutrition or illness, and without regular checks, these problems can go unnoticed and worsen. One staff member told us they felt team building was needed to improve relationships within the staff team.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. The home employed activity co-ordinators however they did not cover 7 days week, we saw little to no interaction with people who were cared for in their beds or stayed in their bedrooms.People’s care records evidenced they were not involved in their care planning. Therefore, we could not be assured they were being supported to make healthy lifestyle choices, such as eating well, staying active, or attending health appointments. One person told us, “Nothing goes on.” Another person stated, “Never get to go out, and there is nothing to do.”There was lack of signs or visual prompts around the home to help people find their way. This lack of signage could make it harder for people, especially those with memory or sight problems, to move around safely and independently.

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.

Outcomes for people were not clearly recorded or reviewed. Care plans lacked person-centred information and focused on the person’s needs rather than what they can achieve. For example, one person’s social care plan contained minimal information with the recorded goal only, ‘To ensure that [persons] social needs are met’. Where people were identified as losing weight, the plan of action was usually to weigh them weekly, however we identified this action was not always completed.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

Where a person lacked capacity to make decisions in relation to their care and support needs, we identified the principles of the Mental Capacity Act had not always been adhered to, this included ensuring people were supported to make their own decision. There was no evidence to demonstrate alternative methods of communication had been considered. When restrictions were implemented, the service did not ensure they involved the right people in the process to ensure decisions were made in the person’s best interest. For some people restrictions were implemented without evidence of a mental capacity assessment or best interest decision. We observed one person utilising a type of chair which restricted their movement, there was no mental capacity assessment or best interest decision made about this decision. The manager was not aware this was required.