10 April 2015
During a routine inspection
This inspection took place on 10 April 2015, was unannounced and was carried out by one inspector and a specialist advisor.
The Elizabeth Anne Nursing Home is a privately owned service providing nursing care and support for up to 27 older people and people who may have mental health needs. The needs of the people varied greatly. Some people were very frail and immobile and other people were independent and able to go out on their own. Some people also had behaviours that challenge and communication needs. There is a registered nurse on duty at the service every day and night. There were 14 people living at the service at the time of the inspection. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them.
We last inspected The Elizabeth Anne Nursing Home in October 2014. At that inspection we found the provider had not taken action to meet outstanding breaches of the regulations identified at previous inspections in November 2013, July 2014 and October 2014. These were in relation to the care and welfare of people who use the service. We found at the October 2014 inspection the provider was in breach of the regulation that related to consent to care and treatment. The provider was meeting this regulation at this inspection but did not meet the regulation relating to people’s care, welfare and support. We are currently in the process of taking enforcement action against the provider.
In October 2013 we issued a Notice of Decision preventing the registered provider from admitting any more people to The Elizabeth Anne Nursing Home. This notice was still in force at the time of this inspection.
At the time of the inspection the service did not have a registered manager in post. The service had not had a registered manager since 2012. 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 and associated regulations about how the service is run.
Since our last inspection the Nominated Individual had changed. A Nominated Individual is the person who must be employed as a director, manager or secretary of the organisation with responsibility for supervising the management of the regulated activity.
Safeguarding procedures were in place to keep people safe from harm. On one occasion these procedures had not been followed by the manager as they were unaware of the full facts of an incident that had occurred. The local authority safeguarding team had not been informed of the incident which they should have been as part of the provider’s safeguarding procedures. People told us and indicated that they felt safe at the service; and if they had any concerns, they were confident these would be addressed quickly by the manager. The staff had been trained to understand their responsibility to recognise and report safeguarding concerns and to use the whistle blowing procedures.
Everyone had a care plan which was personal to them and that they or their representative had been involved in writing. The contents, information and quality of care plans varied. Some care plans were clear and precise, while other care plans did not record all the information needed to make sure staff had guidance and information to care and support people in the way that suited them best and kept them safe. Some people were at risk because of their medical conditions and their complex needs. Potential risks to people were not always identified. There was either no information or guidance for staff on how to reduce the risk and keep people safe and meet their individual needs or the guidance was unclear and inaccurate. This left people at risk of receiving unsafe or inappropriate care and treatment.
The staff did monitor people’s healthcare needs but they did not consistently act on issues that were identified and any changes in people’s health conditions. Staff, including a nurse,were inconsistent and unsure, when we asked, about how they would meet some people’s health needs. This left people at risk of their health conditions deteriorating further as they were not always receiving the consistent care, support and treatment they needed to make sure their health was promoted.
People with behaviours that challenge were not given consistent care and support as there was no individual guidance available on how to manage the behaviours.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager showed that they understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). When people lacked the mental capacity to make decisions the service was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. People had been assessed as lacking mental capacity to make complex decisions about their care and welfare. Individual DoLS applications had been made for people living at the service but no decisions had been made yet. Applications were still being processed by the DoLS office. Urgent DoLS restrictions had been granted. The staff had received training in DoLS and MCA.
Staff were caring and respected people’s privacy and dignity. People were involved in activities which they enjoyed. Staff were familiar with people’s likes and dislikes, such as if they liked to be in company or on their own and what food they preferred.
People said and indicated that they enjoyed their meals. People were offered and received a balanced and healthy diet. They had a choice about what food and drinks they wanted. If people were not eating enough they were seen by dieticians or their doctor and supplement nutrition was provided. People received their medicines safely and when they needed them and they were monitored for any side effects. If people were unwell or had deteriorating needs the staff contacted their doctors or specialist services.
There were positive and caring interactions between the care staff and people. When people could not communicate verbally staff anticipated or interpreted what they wanted and responded quickly. Staff were respectful and kind when they were supporting people. People appeared comfortable and at ease with the staff. A system of recruitment was in place to ensure that the staff employed to support people were fit to do so. Staff had the appropriate safety checks prior to working with people to ensure they were suitable. The staff had received basic training but were not all competent in the skills needed to meet some people’s health needs. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed.
Staff had support from the manager to help them care safely and effectively for people. Staff had received regular one to one meetings with a senior member of staff. Staff had completed induction training when they first started to work at the service and had gone on to complete other basic training provided by the company. There were regular staff meetings. Staff said they could go to the manager at any time and felt they would be listened to. They said the new manager was very supportive.
The complaints procedure was available in a format that was accessible to people. Feedback from people, their relatives and healthcare professionals was encouraged and acted on wherever possible. Staff told us that they felt the service was well led and that the management team were supportive and approachable. Staff said the there was a culture of openness at service which allowed them to suggest new ideas which were often acted on. Quality assurance systems were in place. Audits and health and safety checks were carried out but they were not always effective in that not all of the shortfalls had been picked up and or acted on.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took enforcement action and cancelled the provider's registration for this service.