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 inadequate. At this assessment the rating has changed to 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.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The culture in the service had generally improved. The management team and staff were more person-centred. The management team was going through a period of transition while members of the team changed, and roles were adjusted. The nominated individual said, “There is an embedded new culture, I want to ensure it remains. When I walk in, it’s so calm and under control, it’s a pleasant experience.”

Staff were more person-centred. One staff member said, “I love the residents.” Another staff member said, “I have no concerns about the residents here, we treat them like family.” One staff member said, “I like to work here, it’s a very nice place. I am very happy to work here.” Another staff member said, “We have a good staff team, everybody is treated equally, and the team works flexibly to support staff so we can change our days off if needed."

A professional who worked with the service said, “[The provider has] always been very pleasant and approachable and grateful for my advice/help.” They went on to say about the new registered manager, “I have found them approachable and very clear on what they are trying to achieve and grateful for any help I can provide.”

Leaders were compassionate; however, we could not be sure all leaders were able to fulfil their roles. There were 2 managers registered to manage the service. It was evident the registered manager who had been registered for a longer period was not involved in the day to day running of the service. Multiple staff, relatives and a visiting professional confirmed they did not often see this registered manager in the service. A relative said, “I never see [the previously registered manager] on the floor.” None of the records we were provided as part of the inspection had been completed or had documented involvement from the registered manager who had been registered for a longer period of time. The new registered manager was more visible and working consistently in the service and staff and professionals were universally complimentary about the new registered manager.

Notifications were submitted, as necessary. However, we had to prompt the submission of these following information being shared from the local safeguarding authority. The information submitted by the provider did not always provide enough information to understand what happened or what action had been taken. Notifications are events the provider is required to tell us about, such as allegations of abuse, serious injuries and deaths, for example.

The management team encouraged staff to speak up and also ask questions. One staff member said, “Management are very supportive, I know I could approach them anytime and they will try to help me.” Another staff member told us, “I feel supported by management, they are approachable and will listen and try to help.” Another staff member said, “[The new registered manager has] nailed it! Considering I was sceptical at first. Since the new registered manager has been here the improvement has gone through the roof, I think personally. They are easy to talk to so feel you can talk to them about work or home if you ever need support.” The new registered manager said, “I love that the staff ask, they are getting involved in things they haven’t been before.” A member of the management team also said, “The previous challenge was [staff would say] ‘That’s how we’ve always done it’, whereas now they know better. Everyone hid things; now they come to us with things."

Staff told us there were staff meetings where changes and improvements were discussed, and they could feedback. We saw the daily head of department meetings were documented for audit trail purposes.

A relatives meeting was already planned to take place after our inspection in order to engage with relatives and seek feedback. A relative also told us a previous relatives meeting had taken place, they said, “Residents’ family were called into a meeting and asked for improvements.” A relative told us about being more involved in their loved ones care, “I do feel involved now, I didn’t before.” Another relative confirmed a meeting had taken place prior to Christmas 2024 but went on to say, “They say they will get back to you, but it’s hard to get answers.”

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. However, the provider needed to ensure staff were able to effectively communicate with people, relatives and professionals.

There were staff from a range of backgrounds working in the service. One staff member said, “I think management respect my religious beliefs, they have allowed me to book time off for religious events.”

There were instances of a staff member struggling to communicate with us effectively, as English was their second language. The terminology they used when referring to people, was not always appropriate. They said, “We need to treat people like babies.” A relative told us, in relation to staff who spoke English as a second language, “Some staff are difficult to understand sometimes. They seem nice though.” A professional who worked with the service told us that, “communication has been a struggle on some visits” when interacting with staff who spoke English as a second language.

The provider had clearer responsibilities, roles and systems of accountability, but this was still being worked on as the management team had changed since the last inspection.

One visiting professional said, “It’s got better now, now the [new registered] manager is here. They have made a massive difference; the [new registered] manager is on the ball with stuff.”

An external consultant had been engaged by the provider and had been supporting the provider since the previous inspection. New systems and processes had been introduced to support the new registered manager to carry out their role in monitoring the quality and safety of the support people received.

A daily medicine check had been introduced; however, this was not being consistently used and there were more instances this had not been completed than it being completed. Therefore, this had not yet been fully effective as a system as we found instances when people had run out of medicine, but work was ongoing to embed this if the provider determined it would remain in use.

There were daily, weekly and monthly audits in place with designated folders containing these, so in the event of the new registered manager not being present in the home, for example over a weekend or on annual leave, senior staff could pick up the daily audits folder and continue with these so the home could run autonomously. A ‘Heads of Department’ (HoD) regular meeting had been introduced for information sharing. One staff member said, “We have HoD meetings. Everyone has their input on everything so anything needing addressing gets dealt with.”

The new registered manager had been trying different audits to find ones which suited the home. Some had only been completed once or a few times, so there was not yet an embedded and sustained process in place, but this was being trialled. There was not an established consistent review of accidents and incidents, as yet. The new registered manager was developing this, looking at weekly and monthly reviews. The new registered manager told us they reviewed people’s care plans based on what they knew about each person, but there was not a structured audit to prompt the review of the content of care plans. This meant if anyone else other than the new registered manager was to complete a review, they may not be aware of what to check for as there was no consistent review.

Tracking had been introduced for people’s bowel movements and fluid intake to ensure this could be addressed in a timely manner if problems arose with these. This was a more established process, and they were continuing to use this. We saw an example where this had been effective for someone who had not opened their bowels. We also saw an example where mattress checks had been effective at identifying concerns with 1 mattress and this was then replaced.

A member of the management team had recently left their role, so it was being determined who was going to pick up areas which had been that staff member’s responsibilities. A full medication audit had not been completed in the month prior to our inspection. We found, while there had been some improvements to medicine processes, issues remained which had not yet been addressed. Checks on water temperatures had not been completed, despite this being prompted on the list of regular audits. There were also no checks on the safety of valves on pipes to ensure they continued to work to reduce the temperature of hot water. Mealtime or any other audits had not prompted consideration of how people were supported to make a choice of meals, and we identified people sometimes struggled in this area.

There was an electronic care plan audit tracker in place, which was positive to show care records were being reviewed. This noted the date a person’s care plans were last reviewed, the actions needed and the date these actions had been completed. However, this was overwritten each time there was an audit so there was not an ongoing record of actions identified and when they had been completed. When we asked the new registered manager about this, they explained it was also added as a note on their electronic care planning system for each person and there was also a handwritten document. We discussed the risk of duplication, and the new registered manager said they would consider how best to continue recording this.

The provider did not document any monitoring or oversight of the service they completed, although the nominated individual did visit the home and offered regular support to the new registered manager.

The CCTV within the home was operated and registered in line with requirements. The management team were using Artificial Intelligence to write some documentation, including care plans. Consideration of data protection was not in place, but the provider put this in place following our feedback.

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.

The provider understood their duty to collaborate and work in partnership. The provider and management team were willing to work in partnership and listened to feedback.

People had access to other health professionals. One professional who worked with the service said, “The majority of referrals received are appropriate, but some are after the event and not preceding it.” Therefore, in 1 professional’s opinion the provider was reactive, rather than consistently proactive.

Improvements were needed to facilitating people’s access to the community. One person said, “I would like to go out more often, to go to town once a week. Nothing fancy, just once a week.” One staff member said, “We should take out residents more.” We observed there was an external person who visited once per week to undertake an exercise class. Our observations showed there continued to be a more task-orient focus rather than encouraging people to be part of a community. The local authority noted there was not dedicated resource to support people with this, and whilst care staff attempted to engage in this, there was not always enough time to do so.

The provider and management team had a clear desire and willingness to engage in order to improve the service. There was some mixed feedback about improvements to the service. One relative said they would now recommend the home to others. Another relative said, “It’s got better, definitely, in terms of the amount of staff and having [information] boards up of who is on duty” but they went on to say they would ‘probably not’ recommend the home to others and, “We considered whether to move my relative, but we didn’t want to mither my relative, so kept them there.”

However, another relative said, “I feel quite let down from what I was promised when my relative moved in, to now. We decided it was better off leaving my relative there, as now the provider knows the concerns they will be upping their game. My relative has some familiarity with the home, which is why we have left them there.” This relative would not have recommended the home to others. Another relative said, “I would say it has got better… but I would be tempted to say there’s not been much change, but I don’t know.”

The new registered manager was proud of the staff team. They said, “The thing I am most proud of is the staff. Everything they have had thrown at them since I have started; they have gained knowledge and done training. It’s the way they treat the residents. I’m proud of all the work we’ve done.”

The local authority fed back the provider had completed a number of actions set by them and improvements were ongoing.

There was an action plan in place following the last inspection to address concerns found at the inspection as well as actions the provider and external consultant found which needed addressing, and actions from other external professionals. This was not a static document and was being added to as new actions were found to be needed. However, it was not always clear when actions had been identified so it was not always possible to determine how long they had been ongoing as actions and determine the progress over time. There were some instances it was possible to determine when the concerns had been identified. Some actions were noted as a high priority but had been ongoing for a long time. It was not always clear what progress had been made against these. A member of the management team acknowledged updates were not always recorded and the priority level set did not always match the ‘due by date’ for the completion of the action. Not all actions had a clear action owner for accountability.