ST ELIZABETH

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls.

At this assessment we reviewed 5 quality statements for this key question. We identified breaches of legal regulation in relation to person-centred care and dignity and respect.

This service scored 35 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not treat people with kindness, empathy and compassion, or respect their privacy and dignity.

People's preferences in relation to their personal and intimate care needs were not being met. For example, a personal hygiene care plan for a person describes, “I require the assistance of 1 female carer to help meet my personal care needs.” However, daily records indicated that male staff were tending to the person’s personal care needs.

During our visits we observed that the communal bathroom and toilet did not have a lock. During the inspection we observed four occasions when other people had walked into the toilet when in use by people living in the service and no staff were present at the door. We requested assurance this had been rectified on both site visits, with no action taken. We received confirmation from the registered manager on 6 March 2025 that a lock had been fitted. We were not assured that staff and leaders had considered the impact on people’s privacy and dignity on this matter.

Throughout this inspection we made observations of staff practices that were not kind, compassionate or considerate of the impact on people. For example, the back lounge area was at colder temperature and not consistently warm due to the conservatory door being used frequently by a number of staff to access the external office and garden. The dividing doors to the lounge area were not double glazed. 3 people were sat at the table for their lunch, during their meals they made comments such as, “It’s not warm is it”, “Why should we be out in the cold. Shall we do something about it” and “It’s cold”. One person also commented that the seats were uncomfortable, we later noted that the padding on some of the dining chairs had worn thin. A staff member sat in the room with the three people for most of the lunch period. It was a very quiet time and there was little conversation or engagement from staff. This did not demonstrate that people were treated kindly or with compassion dignity and respect.

Most people spoke warmly about the care staff, comments included, “They’re very good to us”, and “They’re very good”. However, a person told us that they felt staff were more interested in paperwork instead of looking after the people living in the service. Not all people felt they had a good relationship with all of the staff.

Feedback from relatives included, “[Loved one] says no-one calls [loved one] by name but when I am there, they do use their name, I feel staff are pretty good,” “Staff mainly make me feel welcome and offer cup of tea (but not always)” and “some staff stand over people.”

We received negative feedback from relatives in relation to people’s laundry. Comments include, “[Loved one] not always in own clothes despite labelling”, “I had to help [loved one] change their T-shirt as it was covered in stuff, have had a few mix ups over clothes, [loved one] did have plenty”, “Clothing and laundry gets muddled, clothing is labelled, mostly cardigans but also other things,” and “Clothes disappear, [there] all labelled, [I’m] keeping an eye.” This further demonstrates a lack of kindness and respect to people and their belongings.

The provider did not treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. The provider did not take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Care plans did not always contain sufficient guidance for staff to manage specific conditions and enable them to provide consistent support to people. For example, a person living with dementia had a lack of detailed information in their care plan to support staff to understand how their dementia impacted them as a person and how to support the person through their dementia journey.

We observed 4 people sat in the front lounge, this area was quite noisy as the television was on, the radio in the kitchen was also playing music at a level that could be clearly heard in the lounge and the buzzer system was also going off at intervals. As people’s dementia progresses, they can be negatively impacted by overstimulation of loud and competing sounds. A staff member came into lounge to ask people what they wanted for lunch. A person interpreted the staff’s voice as loud and replied, “Stop shouting”, the staff member apologised, suggested a lunchtime choice for them, turned to her co-worker and said, “We’ll give a soft option as [person] will need that with their teeth”. This was not kind or respectful to the person.

Records of activity provision demonstrated limited provision for people, this included people who spent time in bed or in their rooms. Activities recorded were task based, for example, “hairbrush”, “shave”, “TV”, and “stayed in room”. Over a 61-day period there was less than 6 hours of social activity recorded for 3 people in total.

Other than assisting people in practical tasks, we observed little interaction between staff and people other than the television being on most of the time. Whilst staff got a karaoke machine out for a short period of time, it was mostly staff singing and there did not appear to be choices given to people as to what they wanted to do. One person told us “They [staff] don’t do a lot,” and “We do card games and a bit of singing.” Other comments included, “They just have karaoke from the screen which they can’t read, need other games, not sure why it’s taking so long. [Loved one] just sits there with the TV in the lounge,” “Not much happening with activities but not much communication”, and “[Loved one] is not overly happy at present, lack of activity, bored out of mind.”

We asked if people and relatives if they sit out in the garden, comments included, “The garden gets full of their own people [staff]” and “A lot of staff smoke, they were told not to smoke in garden but now smoking back in garden, [I] heard staff say, ‘Can’t come at the moment as all outside having break’ but 2 – 3 [staff] outside at once. [I] think 3 or 4 staff on duty.”

In a residents and relatives meeting in January 2025, the registered manager agreed that more activities needed to be done, however, during our visits in March 2025, there was no evidence to demonstrate this has been implemented.

The provider did not promote people’s independence, so people did not know their rights and have choice and control over their own care, treatment and wellbeing.

We were not assured that baths, showers and oral hygiene were regularly offered or provided to people to maintain their basic hygiene needs and ensure they are supported in a dignified way.

An in-depth review of records showed that baths and showers were not an option for some people and washes were the recorded choices on the system. We were concerned people were experiencing a lack of choice and control over their personal care needs.

A person’s personal care record describes them as having a shower and hair wash every day prior to their admission to the service. We reviewed the hygiene records for a 59-day period between 1 January – 28 February 2025, this showed that there had been no showers given during the 59 days and there was no option for a bath or shower, only washes.

Another person’s personal care record describes them as liking to have a shower daily however, the hygiene records showed that there had only been 4 showers given during the 59-day period.

We were not assured people received food in line with their preferences. We noted people recorded as disliking certain foods, however, records demonstrated that these foods had been given. The providers records demonstrated a lack of choices were given to people at mealtimes and everybody seemed to have the same thing.

We received feedback from staff around meal choices which included, “Think they [people] should have more choice. Choice depends on who is cooking, they are supposed to have a choice between 2 or 3 things but some days it is like this is what we have got”. When asked how people decide what they want to eat we were told “The staff normally go round and ask people what they would like” and “It’s normally written on a scrap piece of paper”, however when asked to see this for today’s choices we were told, “They [staff] didn't ask them today and besides I know what they like”. This demonstrates that people were not given a choice of what they would like to eat. The menu board in the lounge showed one option and from review the last 2 week of the food diary only one option was written down for the main meal.

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

There was a lack of training and processes in place for the detection of early signs of deterioration in people’s health. Therefore, we were not assured the service worked effectively or that support from external healthcare professionals was requested in a timely way. We found examples where staff did not take appropriate action in response to people presenting as unwell. This included a lack of physical observations and a failure to seek timely medical attention. The delay in getting medical attention in a timely way meant the person continued to experience discomfort and health deterioration.

The provider did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

During this inspection we spoke with 7 staff who mostly stated they felt supported and listened to however, staff surveys indicated issues with the quality and amount of staff supervisions and the training opportunities offered. There were no records to demonstrate that staff’s wellbeing had been appropriately supported, as leaders had not taken action to address these issues. Therefore, we were not assured that systems and processes in place to support staff wellbeing and enablement were effective.

The registered manager told us they did not currently have processes to support staff recognition and this was an area they were working on.