Elizabeth House

Elizabeth House is a residential care home providing personal care to up to 35 people. The service provides support to older people and people living with dementia in 1 adapted building. At the time of our inspection there were 20 people living in the home.

People’s experience of using this service and what we found

Infection prevention control measures, maintenance of the environment and storage of equipment were not effectively managed or maintained to ensure people lived in a safe environment. Governance and quality monitoring processes were not effective when monitoring the environment and risk management. The registered manager was registered with another care home under a different provider. We raised concerns this may impact on their time and ability to oversee both services effectively.

People spoke positively about the care they received, and relatives told us their family members were safe. Staff knew how to keep people safe and protect them from harm. People received their medicines safely, when needed, by staff trained in medicine management. Staff were recruited safely.

Staff told us they felt supported by the registered manager and attended regular meetings. The provider and staff worked in partnership with other health and social care agencies to promote people's health and well-being.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 17 September 2022).

Why we inspected

The inspection was prompted in part due to concerns received about staff bringing their children into the home and leaving them unsupervised and we received concerns over staff recruitment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. Whilst we did not find any concerns relating to children and recruitment, we did raise concerns over the general environment, infection prevention control practices and quality control monitoring.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elizabeth House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the maintenance of the environment, infection prevention control and storage of equipment and to the overall governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Elizabeth House is a residential care home providing personal care to up to 35 people. The service provides support to people aged 65 and over in one adapted building. At the time of our inspection there were 26 people using the service.

People’s experience of using this service and what we found

People were supported by staff who were trained to recognise and report any harm or abuse. Risks to people were assessed, monitored and managed. People were supported by enough staff who were safely recruited to work at the home. People’s medicines were managed safely. The provider had effective infection, prevention and control systems in place. Lessons were learnt when things went wrong.

Managers and staff demonstrated a positive culture which was person-centred. The management team investigated incidents fully, and actions were identified to make improvements. Managers and staff were clear about their roles and improvements had been made to ensure we were notified of significant events within timescales. People, their relatives and staff were involved and engaged in the service. The provider had systems in place to monitor and review the service. The provider was working with health and social care professionals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 22 April 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elizabeth House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Elizabeth House is a residential care home providing personal care to 26 people aged 65 and over at the time of the inspection. The service can support up to 35 people in one adapted building.

People’s experience of using this service and what we found

The registered manager had notified us of incidents as required by law, however there appeared to be some confusion around the type of notification that is required to be sent to CQC. We have made a recommendation about this.

People told us they felt safe and there were enough staff to meet their needs. Staff knew people’s needs well. However, not all staff had received training in specific health conditions such as diabetes. The registered manager took action to rectify this issue.

People received their medicines as prescribed and lessons had been learned when things had gone wrong.

People's risks were assessed, and care plans reflected the support needed to manage individual risks.

The infection prevention control processes in place protected people from the risk of cross infection.

The registered manager promoted a positive culture that was person-centred and achieved good outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 17 January 2020).

Why we inspected

The inspection was prompted in part due to concerns received about medicines and how people were supported with their mobility. As a result, we undertook a focused inspection to review the key questions of safe and well led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elizabeth House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Elizabeth House is a residential care home providing personal care to 25 people aged 65 and over at the time of the inspection. The service can support up to 35 people.

Elizabeth House is situated on a residential estate close to local countryside. The home had bedrooms across two floors and the upstairs rooms could be accessed via stair lift. People had access to a large lounge area and a smaller lounge, as well as a secure court yard garden. A high proportion of people at Elizabeth House were living with dementia and the home was currently being refurbished in a dementia friendly way.

People’s experience of using this service and what we found

People received their medicine as prescribed and additional checks were in place to ensure this happened. People were safeguarded from harm by staff who knew how to recognise and were confident to report any potential abuse. Risk assessments were completed, and action taken when a safety risk was observed.

People were supported by sufficient number of staff, who had been safely recruited. The service had good infection control measures in place and reviewed accidents and incidents to ensure lessons were learnt if something went wrong.

People’s needs were assessed in line with best practice. Staff received relevant training and systems were in place to ensure new staff completed allocated courses. People were supported to maintain a balanced diet and had access healthcare services. The service worked with other agencies to support effective care and the building was adapted to meet people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were well treated, and staff had time to spend interacting with them. People were involved in decisions about their care and their right to refuse was respected. People’s dignity and privacy was respected, and independence promoted where possible.

Care was personalised to meet people’s individual needs and people’s religious beliefs were supported. People’s communication needs were assessed, and information was displayed in the home to ensure people had access to information about the service and what was happening. Personal relationships were supported, and people had access to a complaint’s procedure, in case they were not happy about any aspect of their care. End of life care was delivered with the support of external professionals and in-house training was planned.

Quality monitoring systems were in place and staff commented on the positive improvements that had been made since our last inspection. The service was aware of and acted upon their duty of candour. People and staff were given the opportunity to feedback on the service and plans were in place to improve the service further. The service worked in partnership with others.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 23 November 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At this inspection we found that whilst some improvements had been made more were needed and the provider was not meeting the regulations for safe care and treatment and governance arrangements. You can see what action we asked the provider to take at the end of this report.

Elizabeth House 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.

Elizabeth House can accommodate up to 35 people in one adapted building. At the time of the inspection there were 28 people using the service.

There was a not a registered manager in post at the time of our inspection. The provider had a manager in post and they had plans in place to make an application to register. 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.

The provider of the service had changed since the last inspection. The new provider had began a program of change to address the issues identified in the last inspection report and make quality improvements to the service.

Governance systems were not consistent in identifying concerns or driving improvements. Medicines were not always administered as prescribed. Staff were not consistently available to engage with people.

Staff had been safely recruited, however improvements were needed to documentation which supported this.

Risks to people were assessed and planned for, however they sometimes lacked detail. People received support from staff that were caring. However, improvements were needed to make sure that this was consistent.

Accidents were investigated and learning was in place to prevent further occurrences. People were protected from the risk of cross infection as staff were observed using effective infection prevention practices.

Staff received training and their competency was checked. Staff felt supported in their role and people received consistent support. Improvements had been made to the environment to ensure this was suitable for people and more were planned.

People were supported to have maximum choice and control of their lives and staff were aware of how to support them in the least restrictive way possible; the policies and systems in the service were supportive of this practice.

People’s communication needs were planned. People not consistently spoken about with dignity.

People’s preferences were clearly documented and staff understood these. People had access to activities. People had discussed their end of life wishes and these were documented in their care plans. People understood how to make a complaint.

People felt safe and were safeguarded from potential abuse. People were supported to eat and drink safely. People were supported to maintain their health and well-being.

Notifications were submitted as required and the manager understood their responsibilities.

We found people were engaged in checking the quality of the service.

The location has previously been rated as Requires Improvement. At this inspection the provider had not made all the required improvements. We may consider enforcement action if there is a continued lack of improvement at our next inspection.

Elizabeth House 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. Elizabeth House can accommodate 35 people in one adapted building. At the time of the inspection there were 32 people living in the care home.

There was a registered manager in post at the time of the 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.

People were not always supported by sufficient staff and this meant they had to wait for their support. Staff were recruited safely. People were protected from harm and they had risks to them assessed and managed appropriately. Medicines were managed safely and people had them administered as prescribed. Premises were safely maintained and staff understood how to prevent the spread of infection. The registered manager analysed incidents to help them learn when things went wrong.

Improvements were required to the environment, some decoration required updating and consideration of how the environment needed to be to support people with specific needs. We made a recommendation about creating an environment to support people living with dementia. Staff were trained to deliver effective support to people and had their competency checked. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People had access to a choice of meals and were supported to meet their needs and preferences for food. Health care professionals were involved in people’s care and there were systems in place to ensure the care people received was consistent.

The staff were kind and caring in their approach, however they were not always able to provide a caring service to people due to insufficient numbers of staff being available. People make decisions and choices and were supported to maintain their privacy and dignity. Relatives were encouraged to visit and made welcome by staff.

People’s needs were assessed and they received personalised care and support. People understood how to make a complaint and were confident these would be addressed.

The systems in place to monitor the quality of the service were not always effective. A registered manager was in post and was freely available to people, relatives and staff. People and their relatives found the registered manager was approachable. Staff were supported to provide consistent care and support.

The service had 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. There was also a manager who supported staff on a daily basis and they had made an application to become the new registered manager. We will refer to them as the manager within this report.

Assessments were not always completed to ensure that people were able to make decisions about their care and support. Some decisions had not been reviewed to ensure that they were in the person’s best interests and some restrictions on people were not legally approved. Staff were not always able to demonstrate how the training that they attended enabled them to support people effectively.

The provider was reviewing their procedures and quality systems and was in the process of implementing new ones. Some of them were not fully embedded to drive improvements to the service and not all of the staff team were aware of the changes or how they affected them.

Risk to people’s health and well-being were assessed and managed to ensure that people were safe. Staff were able to recognise signs of abuse and knew how to raise any concerns. People were supported to have enough to eat and drink and specialist diets were catered for. The provider worked closely with healthcare professionals to ensure that people’s health needs were met in a timely manner. Medicines were administered to meet individual needs and were stored securely. There were systems in place to ensure that the risks associated with them were reduced.

People told us that there were always enough staff to meet their needs promptly and that they felt safe. Their care plans were regularly reviewed to correspond with changing support needs. Staff developed caring relationships with the people they supported which were respectful and patient. They knew people well and provided care that met their preferences and respected their privacy and dignity.

People were encouraged to pursue interests and hobbies and regular activities were planned. Celebrations were organised for special events and visitors were welcomed at any time. People knew the manager and any complaints or feedback were responded to and learnt from.

You can see what action we told the provider to take at the back of the full version of the report.

We considered our inspection findings in relation to the following area of the service provision:

Is the service safe?

From our observations and from the information we saw set out in care plans, policies, procedures and audits the provider's safety monitoring systems were robust. The staff showed that they had a clear understanding of their role in providing care and safeguarding the people they supported. The staff demonstrated that they knew the people well and had read and understood the instructions set out in individual care plans.

We saw evidence that people were supported to make decisions and maintain their independence. The care plans set out detailed information for staff of each person's capacity to consent. When people lacked the capacity to make important decisions, meetings were held to make decisions for them that were in their best interests.

We saw that everyone was encouraged to eat a healthy balance diet. Where people needed support at meal times this was provided. The staff received regular training in nutrition and food hygiene.

From our observations and from the information we saw set out in policies, procedures and audits the provider's hygiene monitoring systems were robust.

The staff rotas showed that the management had taken people's care needs into account when making decisions about the number of staff required, the skills mix and experience staff would need. The rotas showed where necessary additional staff hours were being introduced. The night time staffing levels and on call system showed that the staffing provision was safe out of main hours.

We found no evidence to support the concern that locks could be set so that people were confined to their rooms at night.

There were systems in place to make sure that management and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This meant that people were benefiting from a service that was taking on board lessons learnt.

Is the service effective?

People's health and care needs had been assessed and detailed care plans were in place. There was evidence of people and their representatives being involved in assessments of their needs and planning their care.

We saw that Specialist health and social care professionals regularly gave support to the service. All care, activity and risk assessment plans were reviewed regularly. Every person had a representative and advocacy services were available if required.

We saw that the people who lived at Elizabeth House were supported to maintain their mobility and independence.

The provider/registered manager told us that there were no deprivations of liberty safeguards in place for the people who used the service. They said that in the light of new guidance they were in the process of reviewing the requirements.

Is the service caring?

We observed during our visit and saw in people's care plans that people were supported and encouraged to live full and active lives. People took part in a wide range of leisure and social activities. We saw evidence in care plans, from talking to relatives and through observation that the care provided was being constantly adapted to meet people's needs.

The people we spoke with who used the service told us they were very comfortable there. They said care and support they received was very good. One person said, "The staff are really caring." Another person said, "I can't fault it. Everyone looks after me and I have no complaints at all." Families we spoke with said their first impressions had been born out with the excellent care which was provided.

Staff showed people respect and maintain people's dignity at all times. We found no evidence to support the concern that locks could be set so that people were confined to their rooms at night.

The staff we spoke with demonstrated that they were committed to providing the best levels of care for the people who used the service. They demonstrated to they were aware of potential risks, people's rights and their responsibilities.

Is the service responsive?

We found that care plans were person centred and contained detailed information about people's choice and preferences. We saw that people's health and support plans were regularly up dated to reflect people's changing needs.

There was regular support from external social care and health professionals when needed this meant that people's health and social care needs were being monitored and addressed.

The families and people who lived at Elizabeth house said that if they had any concerns about anything they could talk with the manager or the staff as they were always there and addressed anything they raised.

We reviewed the accident/incident audits and the notes from staff and residents meetings and noted that any issues raised issues were taken seriously and action taken to resolve them.

We were told about and we saw that staff received regular training to meet the support needs of the people who used the service.

Is the service well-led?

Elizabeth House has had stable staff team for some years and there was a clear management structure. The provider/registered manager was knowledgeable about, the people and staff. They were able to tell us how they maintained their learning through appropriate professional bodies and information received.

The people we spoke with used the service and the staff said that the provider/registered manager was always around to give advice and support. Records seen by us showed that any identified shortfall were addressed. There were systems in place to provide feedback to staff about changes and developments.

We saw that the management had held discussions with people who used the service and staff relating to concerns people had about abuse or neglect in light of the recent national reports. All the staff we spoke with said that if they witnessed poor practice they would report their concerns.

Staff we spoke with told us that they had worked with the people who lived at the home for some time and really enjoyed their work. They told us that there was a good team spirit and everyone listened to any concerns raised and acted to resolve these. They said that they felt they were supported and involved in the development of the service.

The people who used this service told us they were happy with the care and support they received. One person said, "The care is excellent here." Another person said, "I can't fault it. I have no complaints at all."

Since our last inspection on 3 January 2013 the provider had made the necessary improvements to the management of medication ensuring that this was stored and audited more safely and effectively.

The visitors we spoke with were also very complimentary about the services provided to their relatives. A person said, "The owner goes out of his way to ensure that everything is right and nothing is too much trouble. All the staff are lovely here."

We observed staff to be attentive to the needs of people and saw that care and support was delivered according to people's individual needs and to how each person prefered it.

The manager and staff communicated well with people who used the service, including people with reduced mental capacity, ensuring that people were involved in their care.

People were cared for by a skilled staff team and the provider supported staff to maintain their professional development.

The provider maintained a programme of quality monitoring, ensuring that people received effective quality care.

People's privacy and dignity were respected. We saw staff knocking on people's doors and waiting for an answer before entering. People using the service were happy living at the home. They told us they enjoyed their lives there and they liked the staff who cared for them. One person said, 'They are very good here, I couldn't wish for better carers, they have time for you.'

The staff knew about the people they were caring for, and they felt that the management of the home was supportive and encouraging. One staff member told us, 'Support is always on hand. You can talk to the senior staff and the manager and they will always listen.'

We looked at the way medication was managed and saw that improvements were needed to ensure medication systems and practices were safe and suitable.

We looked at the recruitment procedures for staff and found that appropriate systems were in place to protect people using the service.

We checked records were stored safely and correctly. In the main systems were as required, where record keeping storage required improvement we were informed by the registered manager it would be done on the day of our inspection.