ST ELIZABETH

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people’s needs were not always met.

At our last assessment we found the provider was in breach of legal regulation in relation to person centred care. We issued a warning notice to the provider and registered manager.

At this assessment we reviewed 7 quality statements for this key question. We found not enough improvement had been made and there were continued breaches of legal regulation.

This service scored 43 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

The provider’s processes to ensure people received person centred care was not effective. For example, people’s care plans were very brief and lack personalised information about their preferences and the specific support they needed from staff. People's care plans did not always contain information about their personal, cultural, social and religious beliefs. Information about people’s individual needs was not up to date and did not reflect their current needs.

People’s records demonstrated how they had shared information with the service about how they liked to receive care as well as their nutritional likes and dislikes. However, people were not always provided with support with their personal care by their preferred gender of staff and their likes and dislikes in relation to food choices were not always respected.

The service did not understand the diverse health and care needs of people. The service did not ensure services were delivered and coordinated to consider people’s individual needs and preferences including those with protected characteristics such as, disabilities which impacted their mobility or communication. For example, there was no evidence to demonstrate referrals to dentist at home service had been requested when required. Not all people had an oral health care plans in place to give guidance and support to staff in the event of a referral needing to be made.

Hospital information packs, designed to ensure continuity of care between the service and hospital, were not always completed. Staff confirmed these were not used due to being incomplete. This meant there was a risk key information about people’s needs was not available to medical professionals.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff were able to tell us if people had communication difficulties and how they support them, for example, a person who had hearing aids would require staff to speak loudly.

The service did not use specific tools such as picture boards to help communication with people with limited communication due to an impairment. Whilst staff told they would use these, there were none available in the service.

Staff told us that they would print information in a bold format for people who may require this for sight impairments.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

We saw 7 feedback questionnaires that had been completed by relatives. Some of these included feedback where improvements could be made. For example, some indicated that they felt staff seemed to be rushed and they were not always introduced to new staff. There was limited evidence that actions had been taken in response to feedback to drive improvement.

A residents and relatives meeting that took place in January 2025 demonstrated that people were given the opportunity to speak up. However, we were not assured that actions discussed at the meeting had been listened to and actioned. For example, the minutes described there would be menus on the tables with pictures, the menus will have choices of meals however, this had not been implemented at the time of our visit.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

People’s needs, including their protected characteristics, such as age and disability, were not considered and were impacting people’s access to services. Where they had a disability which impacted their ability to contact health services or access health, care or wellbeing support outside of the home, or into the home if they were unable to leave, people were not consistently supported to have equitable access.

Barriers to accessing health and care services were not considered, and those with higher needs were negatively impacted as a result. People living with dementia had less access to activities and stimulation in the home, as well as access to the community outside of the home. There was limited evidence of how these people were supported to reduce the risk of social isolation.

Staff and leaders did not always actively listened to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

The provider had not considered or implemented all relevant best practice guidance for dementia friendly care environments, including ensuring all peoples bedroom doors had their names or other identification, ensuring that signage was accessible and that information displayed at the service was clear. For example, during our visit on 3 March 2025 the information board in the lounge for residents was showing the date as 20 February 2025.

This meant people were not supported to maintain their independence due to the lack of clear dementia friendly signage.

There were no tools in place to support people with dementia to make dietary and nutritional choices such as display plates or pictures. This meant people were not supported to maintain their independence of choice through other methods such as visuals where they had an impairment that may impact their ability to effectively communicate their choices.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People’s end of life care plans were basic, not person-centred and contained shortfalls in information. For example, whilst some contained information of the funeral directors and whether the person wished for a burial or cremation, there was no information or guidance to support staff between the beginning of the persons palliative journey to final breaths. This would be to ensure that people’s wishes during the final stages of their life was carried out and respected.

End of life care plans did not include or fully detail information in relation to people’s spiritual and cultural needs, involvement of family and friends, reassurance about pain management and rapid support to anticipatory medicines.

There were inconsistencies in a person’s record in relation to their ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) status. For example, advanced decisions around their care were not recorded clearly and some care records contained contradictory information about their wishes. This meant staff would not have the correct and up to date information to ensure the persons wishes were respected.