Elizabeth House

Elizabeth House is a purpose-built residential care home providing personal and accommodation for up to 43 older people. They were providing care and support to 38 people at the time of inspection.

People’s experience of using this service and what we found

Improvements had been made to the processes for the understanding and recording of consent. There were clear, embedded practices in place. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were enough staff on duty. However, we did receive some mixed feedback about staffing levels. Changes to the mandatory requirements of vaccinations for care workers in England had proved to be challenging for the home. The manager and regional operations manager told us they would keep this under continual review.

People, their relatives and staff told us Elizabeth House was a safe place to be. People’s care and support were helped by robust risk assessments which enabled them to live their life the in a safe way. Staff had a good understanding of safeguarding and there were clear reporting procedures both within the home and outside. The home had made all necessary referrals to ensure people were protected from harm.

Medicines were managed safely, and environmental checks ensured people could enjoy their surroundings and be safe and comfortable. Lessons were learned and there was a continual improvement plan in place. People were supported by staff who were recruited safely and well trained. Staff had the opportunity to discuss their work within formal supervisions and felt they could request support at any time.

People were offered the foods and drinks they enjoyed. Access to healthcare was available and input was regular. Health and social care professionals who worked with the service were complimentary. Specialist and routine healthcare appointments were sought in a timely manner.

Quality assurance systems operated effectively within the home. Audits monitored all aspects of the care, support and home’s operation. The manager was supported by an established team, well thought of by all and seen as approachable and reliable. Staff felt proud to work at Elizabeth House and told us they were one big family, putting people at the centre of all they did.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 September 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 9 July 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve need for consent.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Elizabeth House is a purpose-built residential care home providing personal care and accommodation for up to 43 people aged 65 and over. At the time of the inspection the service was supporting 31 people. Accommodation is provided on two floors with a lift to access the first floor.

Peoples experience of the service and what we found

Infection control practice was not always robust. For example, there were no records to demonstrate frequent touch points were cleaned. Seating in all but one of the communal areas was close together. This did not encourage social distancing. We raised these issues with the provider, and they were immediately rectified.

The provider had an up to date infection prevention and control policy, covid-19 policy and quality audits. The provider had created a Covid committee. This met regularly to communicate changes and provide updated information to all the provider’s homes including Elizabeth House.

Pre-arranged visitors were welcomed to the home with a procedure that helped to reduce risks of infection. This included face masks and hand sanitisers at the entrance. Visitors completed a health questionnaire.

Staff had a designated area for putting on, removing and disposing of personal protective equipment (PPE). They had received training to do wear and remove this equipment correctly and in line with government guidelines.

The provider was admitting people safely to the service. The provider ensured people were tested prior to admission to the home, re-tested and supported to self-isolate for 14 days on moving in.

The home had routine testing for staff and for people living at the home.

Elizabeth House is a purpose-built residential care home providing personal care and accommodation for up to 43 people aged 65 and over. At the time of the inspection the service was supporting 36 people. Accommodation is provided on two floors and the service’s gardens were accessible to people who used wheelchairs.

People’s experience of using this service and what we found

Staff and managers did not fully understand the requirements of the Mental Capacity Act 2005 and necessary applications to ensure peoples legal rights were protected had not been made. This meant people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests.

Records of incidents had not been accurately maintained to support the identification of areas of learning and improvement.

Quality assurance systems were not fully effective. The gaps we identified during the inspection had not been highlighted by the provider’s governance systems; however, prompt action was taken to address the issues.

People were relaxed and comfortable at Elizabeth House and told us, “This is a jolly place here, [It has a] nice atmosphere”. Staff understood their role in protecting people from abuse and avoidable harm and were confident any concerns they reported would be addressed.

Staff were recruited safely and there were enough skilled staff on duty to meet people’s needs. Training was regularly updated, and staff reported they were well supported by their managers. People were complimentary of their meals and refreshments were served regularly throughout the day. The service was well maintained, and the garden was accessible with seating and shade to enable people to enjoy summer weather.

People and their relative were complimentary of the staff team’s compassionate and caring approach. Staff respected people’s decisions and acted to ensure their dignity and privacy was protected.

Care plans were accurate and up to date. They provided staff with enough guidance to ensure people’s needs were met. Details of people’s life history, interest and hobbies were provided to help staff understand how the person’s experiences could impact on their current support needs. Activities coordinators were present in the service every day and supported people on and individual and group basis regularly. However, while providing individualised support in was noticeable that there was a lack of things for people to do in communal areas. We have made a recommendation in relation to this to issue.

The service’s leadership were effective and the staff team were well motivated. They told us the managers were supportive and approachable. There was a registered manager in post and appropriate additional management support had been provided during a period when the registered manager had been absent. The managers told us they were well supported by the provider and records showed the operations manager had regularly visited the service to support its managers.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At our previous inspection the service was rated Good. (Published 24 February 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the service’s compliance with the Mental Capacity Act and associated Deprivation of Liberty Safeguards at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This unannounced inspection took place on 16 and 18 November 2016. One inspector and a specialist nurse advisor visited the service on the first day of the inspection. On the second day, two inspectors visited the service.

The service had a newly registered manager. ‘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 2008 and associated Regulations about how the service is run.

People felt safe and staff had a good understanding of abuse and what action to take if they were concerned or worried about someone. Risks to people were robustly managed and the actions taken reduced the potential for a reoccurrence of accidents or incidents.

Staff were supported through regular meetings with their manager and all the staff we spoke with felt they had been well trained. People’s health needs were met by staff who understood when someone might need additional medical support. People told us they enjoyed the meals and there were systems in place to ensure that where people required specialist diets these were in place.

People told us staff were caring and listened to them. One person said, “They are fantastic here”. Observations showed staff had an unhurried approach with people, taking time to chat and make sure people were happy.

Care plans provided detailed guidance about people’s needs. Staff told us they were easy to read and helped them to understand how they could best support people.

There was a complaints system in place and the procedures were visibly displayed to ensure people and their relatives understood what to do if they were unhappy about something.

People and staff views on the service were sought and acted upon to continuously drive forward improvements. Quality assurance mechanisms were in place to make sure people were safely cared for.

The aim of the inspection was to follow up on a compliance action that was made at the last inspection of the home in June 2014.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found.

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Is the service safe?

At this inspection we only inspected standards concerning medicines as we were following up on a compliance action made at the last inspection in June 2014. We found medicines were being stored safely and in line with regulations. There was also good recording to make sure people were given medicines prescribed to them. Medicines were administered safely.

Is the service caring?

As we were following up on compliance with standards about medicines, we did not look at standards concerned with caring for people. At the last inspection in June 2014 people told us that they felt well cared for and there were no concerns about how people’s needs were met in a caring manner.

Is the service responsive?

The provider demonstrated responsiveness by taking action to address the non-compliance at the last inspection concerning medicines.

Is the service effective?

We found that staff who administered medicines had been assessed for competency in administration since the last inspection, to make sure that they abided by the policies and procedures of the home.

Is the service well led?

The registered manager had taken action to address the shortfalls we identified concerning management of medicines within the home.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five

questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found-

Is the service caring?

People were treated with consideration and respect. One person told us, “The staff are very kind and helpful.” One person’s relative said, “The staff are really friendly.” A further person’s relative commented, “They always say hello to people as they pass.” We saw that staff spoke with people in a compassionate manner. For example, staff reassured and spent time with a person who was anxious to pay for their meal until they were satisfied with the staff’s explanation as to why they did not need to pay.

Is the service responsive?

People could access healthcare professionals as necessary. A person’s relative told us, “He can see the doctor when needed. They will always let me know if the doctor has been.” Another person’s relative said, “They will get hold of the doctor if he needs one.” We spoke with two healthcare professionals who were visiting people living at the home. These professionals told us that their advice was followed and appropriate referrals were made when necessary. Advice from healthcare professionals was documented in people’s care records. For example, regular visits from a chiropodist were documented for a person with diabetes.

Is the service safe?

People’s needs were assessed and care was planned and delivered to meet their needs. One person told us, “I can’t fault the staff. They are very good. It’s a good place to be.” Where risks were identified care was planned and delivered to reduce these risks. For example, two of the four people whose records we looked at had been assessed as being at a high risk of skin damage. We found that plans had been developed to reduce the risk of skin damage which included the use of pressure-relieving mattresses and assistance to change position at regular intervals. These mattresses were present on the people’s beds and charts demonstrated that the people had been assisted to re-position at the assessed frequency. The home had a system to ensure pressure-relieving air mattresses were set to the correct level and were regularly checked.

People’s medicines were not always given safely. We saw two staff giving people their medicines. One member of staff wore a red tabard indicating that they should not be disturbed and the other member of staff did not. These staff spoke with others while giving out medicines. This meant that there was a risk of error as staff attention was not solely focused on the giving of medicines. Staff remained with some people while they took their medicines. However, we saw three people’s medicines were left in front of them and staff did not remain with them, or watch to ensure that they took the medicines. We were told that no one living at the home administered their own medicines. The registered manager told us that staff should remain with people while they took their medicines.

Staff were skilled in the roles they performed. One person’s relative told us, “The staff are quite good at looking after him and his dementia.” Another person’s relative said, “They are very skilled and very caring. There always seems to be enough staff.” A further person’s relative commented, “There are enough staff and they appear to know what they are doing.” We looked at the staff training records and found that staff had attended relevant training. For example, we found that the majority of staff had received training in moving and handling and fire.

The provider had an effective system to identify people who were at risk of being deprived of their liberty. The provider had made a number of applications for DOLS authorisations.

Is the service effective?

People were supported to eat and drink enough to meet their needs. For example, one person told us, “The food is alright. You never go hungry.” A person’s relative said, “They are always offering drinks and food.” A further person’s relative commented, “He enjoys the food here. He always looks forward to afternoon teas.” We saw that jugs of drink were available in the lounges and staff prompted people to drink if they were unable to help themselves. The registered manager told us that the home had a rolling meal service which allowed people a greater freedom of when to eat. The chef told us that they marked a chart when people attended the dining room and the meal they were given to ensure that all people received food. We looked at the records which confirmed this. The chef told us that they ordered the food and were able to order sufficient quantities of food and drink to meet people’s needs.

Is the service well led?

The provider undertook a variety of quality monitoring activities. The provider’s quality and compliance manager told us that they had recently completed a baseline audit of the home and had made a number of recommendations. For example, the audit had suggested that the provider’s whistleblowing policy be placed in the staff room to ensure that staff had access to it. We found that this action had been taken.

The provider had undertaken audits of practice on topics such as privacy and dignity, dining experience and infection prevention and control. Where improvements were highlighted by these audits an action plan was present. For example, the dining experience audit indicated the need for dietary information to be available in the dining area. We found that this information was available.

We warned Elizabeth House that the service needed to comply with essential standards of care in relation to maintaining people's physical health and wellbeing by 18 October 2013. At this inspection we reviewed whether the support or care people needed had been delivered as planned.

In this report the name of a registered manager appears who was not in post and not managing the home at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. An interim management team was in place at the time of the inspection.

As part of this unannounced inspection we spoke with three people, a relative, and five members of staff including the manager.

People we spoke with told us they felt well cared for at Elizabeth House. One person we spoke with told us, 'I like it here, they're very good'.

One staff member we spoke with told us, 'We have got a good, happy atmosphere', and another said they could, 'Spend time with residents'.

At this inspection we found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

In this report the name of a registered manager appears who was not in post and not managing the home at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. An interim management team was in place.

Elizabeth House had three units, Kensington, and Windsor, and Sandringham which was a secure unit for people with dementia.

We talked with four people using the service, one relative and six care staff. This was so that we could evaluate how people's care needs were assessed, planned and delivered.

One person we talked with said their bedroom was, 'Fine' and there were 'no problems' with the support they received.

We found shortfalls in the planning of the care or support people needed and in the delivery of care people experienced.

People were not always supported to be able to eat and drink sufficient amounts to meet their needs.

Appropriate arrangements were in place to manage medicines.

There were not always sufficient numbers of skilled staff deployed within the home to fully meet people's needs.

The provider did not have an effective system to regularly assess and monitor the quality of service that people receive.

We looked at other aspects of safe medicine handling, storage and administration. We found that some areas were appropriately managed, for example storage of medicines. However we found problems with some people's medicines records that meant we could not be sure whether people always received their medicines in the correct way.

On the day of the inspection there were 35 people living at the home. We spoke with one relative, six staff, the manager and the organisation's service manager.

One person we spoke with told us 'I've been here three years and I get on very well with all of the carers'. Two people said they felt that Elizabeth House was 'their home' and 'the staff are very helpful'.

There was as a relaxed and friendly atmosphere in the home. We saw people sitting and talking with each other and people participating in the daily routines of the home such as laying tables, sweeping up after lunch and gardening.

People had the opportunity to walk freely around the home. We observed that people were in positive moods and frequently laughed, smiled and talked with staff.

Staff gently reassured and supported people when they became unsettled or anxious.