Archived: St Elizabeth's Health Agency Also known as The Congregation of the Daughters of the Cross of Liege

St Elizabeth's Health Agency is part of the St Elizabeth Centre. St Elizabeth Centre is located on a 65 acre site and comprises of a school and children`s home, college, domiciliary care agency, adult residential and nursing services with accommodation and the health agency. The centre provides education, care and nursing support for people of all ages who have epilepsy and other complex needs. There were 154 people using the service at the time of the inspection out of which 46 were children under the age of 18.

St Elizabeth’s Health Agency provides intensive epilepsy, health and therapeutic support to people of all ages using the centre`s services with epilepsy, autism and complex needs. Nurse led clinics are also run for adults and younger people who use the school, college and home on site.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC 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.

People, their relatives and health care professionals told us that the specialist care and support people received was exemplary. People told us they felt the service was safe.

The agency employed a significant number of nursing staff and health care professionals with different specialisms to ensure they were able to meet people`s complex care and support needs. There were specialist epilepsy nurses, behaviour support nurses, physiotherapists and occupational health therapists employed. In addition there was additional specialist support available by either employed professionals or other specialists visiting the service regularly.

There were sufficient numbers of nursing staff with a range of specialist skills sets on site at all times to ensure people`s nursing needs could be met in a timely way. Safe and effective recruitment practices were followed to ensure all staff were suitably qualified and experienced.

The specialist care and support people received from staff was very effective and we saw that due to the continuity of the support people received and the highly skilled nursing staff their health and well-being improved significantly.

People, relatives and professionals gave very positive feedback about staff`s knowledge and dedication to their roles. Health professionals told us they appreciated staff`s knowledge and feedback about people`s health needs which helped them ensure that the treatment they prescribed was effective and met people`s needs.

The specialist nursing staff worked closely with neurologists and lead physicians in developing new treatment rolled out for children and adults with epilepsy. We found that staff closely monitored the effect of these treatments and had measurable outcomes for the people using these. Lead specialists valued feedback from staff and were closely analysing the positive results achieved to ensure these treatments could be then rolled out nationally and more people could benefit from these.

Systems and processes were in place to safeguard people. Staff received training in adults and children safeguarding procedures and they effectively used their knowledge to safeguard people using the service. Risks to people`s well-being were identified discussed in multi-disciplinary meetings and agreed risk management plans were developed which promoted people's independence.

People had support plans in place and they were involved in their care. The support plans outlined their needs, risk and plans to manage these risks. We saw that where people were able they actively participated and took decisions regarding the care they received and needed. The nurses ensured that where people lacked capacity to make decisions with regard to their health, decisions were made following the best interest process in a multi-disciplinary approach.

Nursing staff educated people, their families and care staff working in the home and college on the site about people`s condition, treatment plans and how to deliver care in a personalised way that met people`s needs. We saw many positive examples where people`s behaviour and well-being improved due to the specialist care and support they received which was led by the nursing staff from the agency.

There were nurse led clinics organised at the agency and these were for people who were not always able to attend appointments outside the site due to anxiety levels or their health. These clinics were run by nurses with input from GP and a neurologist regularly visiting the service.

People`s medicines were managed effectively and safely by staff and we saw that where people were able they were supported to administer their own treatment.

There was a constant learning culture promoted by the registered manager who ensured nursing staff had opportunities to keep up to date with the latest studies and best practice recommendations by attending conferences and study days to keep up with their professional registration and knowledge.

A team of physiotherapists and occupational therapists were working closely with staff from across the site and assessed regularly if people had the right equipment in place for maximising their abilities as well as supporting people to improve their mobility, posture and increase or maintain independence.

People received health support from staff that knew them well and understood their individual needs. The confidentiality of information held about people’s medical and personal histories was securely maintained within the agency. Health support was provided in a way that promoted people’s dignity and respected their privacy. People received health support that met their needs and took account of their preferences. Staff were knowledgeable about people’s specific needs and preferences.

Staff were suitably recruited, inducted, trained, supervised and supported. This enabled them to have the right skills and training to support people effectively. People were supported by an established staff team who worked well together to benefit people.

People and their relatives were aware of the complaints procedure and knew how to raise concerns. They confirmed issues raised were addressed. People were asked for feedback on the service to improve practice. The registered manager and the provider audited the service to satisfy themselves the service was running effectively. Where issues were identified action was taken to make improvements.

The management team were accessible, approachable and supportive. People who used the service and relatives were very positive about the management team.

The registered manager ensured they were closely monitoring the quality and the safety of the service they offered to people. Statistics were run and thorough analysis of referrals, efficiency of the treatment people received and outcomes were done monthly. In addition a range of audits were done including medicine audits, infection control audits, equipment safety checks and record keeping.

The registered manager and the provider worked together with lead neurologists and epilepsy specialists and participated in innovative projects and new treatment trials with very positive results. Their work was appreciated by the physicians they were working with who were able to share nationally the positive results of these studies so more people could benefit from it.

Nursing and therapy records we saw gave staff clear guidance on how to communicate with, and obtain consent from people who the health agency provided support to, when they required nursing or therapy intervention. They showed that people were respected as individuals and encouraged to take part in basic decisions about their care.

We observed staff treating people with respect and kindness.

Support for St Elizabeth's Centre, with regards to medicines was provided by the nursing staff from the health agency. We saw evidence that staff had received training in medicines management. We also saw that staff were trained and their competency assessed to ensure safe practice.

When we inspected the health agency on 28 August 2013, we looked at the staff rotas and spoke to the nursing and therapy staff, who confirmed that staff levels were appropriate. One staff member told us, 'On balance there is almost always enough staff.'

St Elizabeth's Health Agency, had a system of audits in place to ensure the welfare and safety of the people who required support.

People told us that they were happy with the care and support they received. They told us they felt safe and staff were friendly and supportive. One person said 'The staff are very nice and I especially enjoy my visit to see my therapist. We always have a cup of tea and talk honestly to each other.'

We reviewed the health care records for five adults and three younger people currently using the service. We saw they were offered support which ensured their specific medical needs were met. People said that they felt able to approach the medical staff if they had any issues or concerns.

Staff were able to demonstrate a good understanding of safeguarding processes and told us what incidents or concerns they would report.

We reviewed staff files for five permanent staff and one volunteer to verify what pre-employment checks had taken place. The pre employment checks corresponded with those specified within the recruitment procedures outlined by the provider.

We saw that there was a comprehensive complaints policy available to people, which described a robust procedure. People were made aware of the complaints system, which was provided in a format that met their needs.