Elizabeth House

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 remained requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The provider was in continued breach of a legal regulation in relation to the governance of the service.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a more person-centred approach in the service. One staff member said, “I don’t think I have been shared the values of the service, but we are constantly encouraged to improve the care we provide to people. This is often in the morning meetings we have, but also at staff meetings. For example, from observations and feedback we were encouraged to spend more time talking to people when we are not doing something.”

Relative felt the registered manager was approachable and they could share feedback if they needed to. One relative said, “[The registered manager] is lovely, they always phone me up and chats.” Another relative told us, “[The registered manager] is very approachable, I feel like they have been a breath of fresh air compared to the previous manager.”

Our observations showed staff were more mindful of the terminology used when speaking with people or about people.

There was now just 1 registered manager in post, who led the service. They were enthusiastic, compassionate and committed to monitoring and making improvements to the service. They told us they ‘loved’ the new auditing system they had in place.

The registered manager had started to further develop people’s care plans to be inclusive and incorporate people’s and relative’s views into these. Audits had identified this as a need in some cases, but in other cases it indicated the fact a relative had a Lasting Power of Attorney and this was recorded in the person’s care plan, was evidence of involvement. This in itself was not evidence of involvement and this had not been recognised. It is important there is involvement from the person and those important to the person, where they want to be involved to ensure people have personalised plans and care individual to them. There was evidence some relatives had been contacted. However, this was a work in progress and not everyone had yet had the opportunity to contribute to care plans.

The registered manager fostered a positive culture where people felt they could speak up and their voice would be heard.

The registered manager had developed mechanisms for capturing more feedback, both positive and negative, from a range of people, relatives, staff and visiting professionals. There were more regular resident and relatives’ meetings. Social events, such as a Hawaiian-themed party and people’s birthday celebrations brought people together.

We saw evidence of where feedback had been acted on and the registered manager was proactive about sharing the outcome of feedback, on ‘You Said, We Did’ posters displayed in communal areas. The registered manager also kept a log of feedback received, both positive and negative, so the outcome and any learning could be recorded.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

There continued to be a range of staff with different backgrounds working in the home. Relatives or professionals did not raise concerns about communication with staff who had English as a second language, although did comment if staff did not understand what was being said to them, they would go and get another staff member. Terminology used by staff who had English as a second language was more appropriate at this inspection.

Staff felt supported in their role. One staff member said, “I feel supported in my role. Management are not pushy they are friendly and want you to do your best. I think staff work well as a team.”

The provider did not always discharge their duty to effectively and regularly monitor and evidence the monitoring of their service. Despite this, the registered manager was monitoring the quality and safety of people’s care.

The registered manager was using a suite of governance tools to monitor the service and had a dashboard to monitor the progress of actions, complaints and safeguarding incidents, for example. Checks were completed on physical items like checking the contents of the emergency grab bag, as well as environmental checks on fire doors, extinguishers and bed rails to ensure they remained safe. Other checks on equipment were carried out and routine professional checks on equipment took place. Reviews of care plans were being regularly completed, however these had not always identified when there had been changes for 1 person, so they had not been correctly updated.

There had previously been an external consultant engaged by the provider in order to support the service and embed good practice. The provider had decided the external consultant could now take a step back and allow the service to operate independently. The provider retained the ability to approach the consultant for advice and for them to carry out spot checks in the future, if needed. There was a schedule of what audits were due and how frequently these needed to be carried out, as determined by the service. The registered manager was fulfilling their role and completing the audits they were assigned to complete. However, the provider had not completed their documented due diligence since the external consultant had stepped back, despite this being a requirement on the auditing schedule. This meant there were no additional verification to ensure the checks being completed by the registered manager were effective. The provider told us they had not completed this as they were awaiting a copy of the audit tool they were going to use to monitor the service. However, they had not put anything else in place in the meantime. The provider ultimately retains responsibility for the quality and safety of the service, even with the involvement of an external consultant and with the appointment of a registered manager. We have asked for evidence of these checks on an ongoing basis to ensure they commence and embed this.

There was an overall action plan for the service and a separate action plan for the environmental works within the service. We had to ask for confirmation of who was responsible for some of the actions on the action plan, as this was not clear. The provider was mainly responsible for the works on this action plan. A number of actions had been going on a long time, passing the completion date set by the provider. In some cases, action had not been started. While we found many improvements to the environment, we continued to find concerns as detailed in our safe key question. The concerns about unsafe hot water temperatures had not been added to the environmental action plan by the provider. Despite this concern being identified, the provider had failed to either resolve it or put protective measures in place until it could be resolved. This had left people at risk. This shows the provider had not been effectively monitoring, completing or progressing actions to make improvements.

At the last inspection there had been external contractors on site during the inspection. The provider expected contractors to sign in on arrival. This had not been done so there was no audit trail about which named people had been on site. This continued to be an issue at this inspection.

The provider understood their duty to collaborate and work in partnership. However, people were still not always effectively supported to access the community. One person told us, “I miss outside. This is not a life, it’s an existence.” The same person also told us they did not get much chance to sit and chat with staff. There continued to be a weekly exercise group, and the registered manager was holding more events and themed days in the service to try to improve people feeling part of a community and partaking in activities. More work was needed to ensure people were able to access outside space, go out into the community and feeling of community within the home.

Professionals who worked with the service were positive about the registered manager and improvements to the service. One professional said, “[The registered manager] seems lovely, they are putting a lot of effort into the place. 100% can go to them [with feedback, if needed]. The home are good at calling us, or if we come in, they ask us to look at someone. I think we work well [together].” Another professional said, “The [registered] manager is very approachable, they obviously engage with residents as they are knowledgeable of them when I have spoken to [the registered manager].” A professional also said, “I’m proud of them with how much they have changed, you can see a massive difference.”

The registered manager was proactive at seeking views from other professionals and clearly valued feedback from partner agencies and took action when needed. Feedback, both positive and negative, was added to feedback logs so trends could be monitored.

The provider focused on continuous learning and improvement. A relative said, “It has improved. It was satisfactory before, but it has improved. The care is more… staff go out of their way.”

Staff felt there had been improvements to the service. One staff member told us, “I feel the home has improved massively since I started. [The registered manager] is aware of everything that is going on and the service is more organised as a result. People are getting better care as we have more time because we know what we are doing and organised. I would recommend working here, I would not have done so in the past. But the recent improvements have made it a good place to work.” Another staff member told us, “I think the management at the home is good and the registered manager has been amazing and driven the improvements. The registered manager often stays late and will help us if we need it. They know what is happening on the floor.”

The registered manager had set up a social media page for the home so updates and appropriate photos could be posted there, so loved ones could see these updates. The registered manager told us this was set up in response to feedback and was going well so far.

There had been a lot of improvements to the quality and safety of care to people. There had been a lot of work to put new processes in place to monitor the service and to make changes. However, further work was needed to continue this improvement and ensure it was sustained. The provider and registered manager had completed a large amount of work and actions. The registered manager had achieved a lot in the time since they had started in their role. The registered manager was dedicated to using feedback from other stakeholders to address concerns and improve the service for people.

The registered manager had continued to use Artificial Intelligence when creating some documentation. This included developing some easy read posters for display around the home and evidence of case studies. These had been received positively by people and staff. The provider had put in a data protection policy around the use of Artificial Intelligence following our feedback at the last inspection. Care needed to be taken when using this technology as this was in its infancy and some output did not form real words or sentences and this had not been identified and addressed.