Background to this inspection
Updated
1 September 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Elizabeth House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Elizabeth House is a care home [with/without] nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced. Inspection activity started on 5 July and ended on 25 July. We visited the service on the 5 and 11 July 2022.
What we did before the inspection
We reviewed information we had received about the service. We sought feedback from the health protection team and the local authority safeguarding and quality monitoring teams who work with the service. We used all this information to plan our inspection.
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection
We spoke with eight people who used the service and the relatives of two people, to seek their feedback about the service provided. We also spoke briefly with a visiting community nurse.
We spoke with eight members of staff. These included the quality manager, registered manager, care staff and maintenance staff.
We reviewed a range of records. These included the care records for four people, three staff recruitment files, audits and monitoring systems and health and safety checks. We also looked at the management and administration of people’s prescribed medicines.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
Updated
1 September 2022
About the service
Elizabeth House is registered to provide care and support for up to 18 people. Accommodation is provided over two floors, with bedrooms on both the ground and upper floor. The home is close to Bury town centre and easily accessible to public transport and local amenities. At the time of the inspection there were 12 people living at the home.
People’s experience of using this service and what we found
Risk to people and the environment were identified. Effective risk management plans were not in place to guide staff in the support people needed to keep them safe. Work was still required following completion of a fire risk assessment. We also identified concerns to a gated stairwell and the call bell system.
Robust governance systems had not been implemented and embedded to evidence good oversight of the service provided. Managers spoke with were aware of improvements required across the service however this had not been used to inform the development of a business improvement plan.
People were supported to have maximum choice and control of their lives and we observed staff supported them in the least restrictive way possible. Applications to deprive people of their liberty had not been made to ensure people were not being unlawfully deprived of their liberty. Capacity and consent were considered when planning people’s care and support.
We found staffing levels were not sufficient. Following discussion with managers staffing levels were increased so people received timely support. We have made a recommendation about staffing arrangements being kept under review. A programme of staff training was available. Improvements were needed to the induction of new staff and on-going supervision and support. This helps to ensure staff are clear about their role and responsibilities and what is expected of them.
Systems were in place to help manage people’s prescribed medicines. Staff responsible for the administration of medication completed training and assessment to check their practice was safe. Records needed expanding upon providing clearer direction for staff and records clearly evidenced what people had received.
People told us enjoyed the meals served. Kitchen staff were aware of people’s dietary needs. Where necessary, additional support was sought where people were at nutritional risk. We have made a recommendation about additional aids to assist people and promote their independence.
The registered manager worked with the local authority safeguarding team to address any issues or concerns about people’s safety.
Good hygiene standards had been maintained within the home. The registered manager was reminded of the guidance provided by the health protection team in relation to the wearing of masks by staff.
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 1 January 2019)
Why we inspected
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 received concerns in relation to safe care and treatment, medication and staffing levels and practice. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
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, effective 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 and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
At this inspection we have identified breaches in relation to risk management and fire safety, deprivation of liberty safeguards, staff support systems and good governance and record keeping. We have also made two recommendations regarding staffing levels and aids to support independence.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.