Elizabeth Court

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulations in relation to good governance.

This service scored 36 (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 have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities. When we asked nursing, care and ancillary staff about the home’s visions and values, how they know what they were and how they demonstrated them in their roles, they all told us they did not know what they were. Leaders at the service told us they didn’t know if the home had a mission statement but said they would look into it so it can be shared and displayed within the home. Staff had not received any training in relation to equality and diversity, not all staff were able to explain what it meant.

Although the manager demonstrated they were passionate about their role and committed to supporting people living in the home, their frequent involvement in delivering nursing care reduced their capacity to provide consistent leadership. A new clinical lead had just started, the introduction of this role may reduce the support required of the manager in their role as a nurse. This will be assessed on our next assessment.

People did not always feel they could speak up and their voice would be heard. Staff demonstrated awareness of the whistleblowing policy and reported feeling able to raise concerns with their manager, who was described as approachable. However, there were instances where suggestions were not acted upon.

There was limited evidence of meaningful engagement with people living in the home.

There was no evidence of feedback being sought from the people who lived within the service either through meetings or by obtaining information via surveys.

Although some individuals may have experienced communication difficulties, there was no evidence proactive measures had been taken to support their involvement.

Not all complaints were investigated fully to enable lessons to be learnt.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them. There was a recruitment policy in place, however all required information to ensure recruitment was safe was not readily available and accessible. We raised this with the manager and the information was shared the following day. One staff member told us how they had been able to change their hours for childcare reasons, which had enabled them to remain working at the home.

The provider lacked clearly defined responsibilities, roles, and systems of accountability, which contributed to ineffective governance. Decisions were not consistently informed by accurate or comprehensive risk information. Furthermore, the provider did not always notify the Care Quality Commission (CQC) of incidents requiring statutory reporting, indicating a limited understanding of regulatory responsibilities. While one individual described the home as well managed, their family expressed concerns that it could be run more effectively. Quality assurance processes, including audits, were insufficiently robust; they failed to identify significant issues, and where concerns were recognised, appropriate remedial action was not consistently taken.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement. There were mixed views in relation to community engagement, one person could not recall being given the opportunity to go on trips outside of the home. However, a relative of another person living at the home described how their loved one had been on outings including a visit to the park and a museum. The service worked alongside district nurses who visited to support people living on the residential unit with complex needs. The service received weekly visits from the frailty team to support individuals within the home. However, the working relationship had experienced some challenges, leading to a degree of tension between the parties.

The provider did not consistently demonstrate a commitment to continuous learning, innovation, or improvement across the organisation and within the local system. Opportunities to explore creative approaches to delivering equitable experiences, outcomes, and quality of life for people were not always encouraged. Additionally, the provider did not consistently contribute to safe and effective practice or engage with research initiatives.

There was limited evidence that lessons were learned following concerns being raised, and mechanisms for sharing information across staff teams appeared ineffective. Furthermore, systems to ensure all staff received appropriate training to safely support individuals were lacking. For example, essential training related to specific health conditions such as catheter care had not been completed.