Queen Elizabeth Care Centre

About the service

Queen Elizabeth Care Centre is a residential care home providing personal and nursing care to up to 74 people in one adapted building. The service provides support to people with various physical and mental health needs, this included people living with dementia and learning disabilities. At the time of our inspection there were 39 people using the service.

The home accommodates people over three floors, however, due to the reduction of people moving in since the last inspection people resided only over two floors.

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

Right Support: People were not always 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; the policies and systems in the service did not support this practice. We found concerns with some risk assessments in people’s care plans and it was unclear if staff were always aware of people’s individual risks. However, the management team had started to review all care plans. People received their medicines at correct times. However, there were some inconsistencies with the management of medicines, such as incorrect recording of topical creams and inconsistent counts of homely remedies.

Right Care: We saw improvements to person-centred care and the new permanent staffing team knew people’s individual needs well. Care plans didn’t always contain person-centred detail. Staff were kind to people and we saw staff respected people’s privacy. People didn’t always have access to activities that were in line with their hobbies and preferences.

Right Culture: Since the last inspection improvements had been made to the culture of the home. People, relatives and staff members were more included in meetings and making decisions about their care. There were still inconsistencies of how effective the changes were and how embedded they were to ensure sustainability.

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 inadequate (published 21 September 2022) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also added a condition to their registration, this ensured we could monitor their progress whilst they were in special measures.

At this inspection we found some improvements had been made. However, there were still some concerns which meant the provider remained in breach of regulations. These breaches were in safe care and treatment, good governance, person-centred care and consent. This service has been rated requires improvement or inadequate for the last three consecutive inspections.

This service has been in special measures since 21 September 2022. During this inspection the provider demonstrated that improvements in some areas had been made. The service is no longer rated as inadequate overall or in any of the key questions, therefore this service is no longer in special measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We found no evidence during this inspection that people were at risk of harm from concerns found. Please see the Safe and Well-Led key questions of this full report. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

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.

Enforcement

We have identified breaches in relation to safe care and treatment, consent, person-centred care and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Queen Elizabeth Care Centre is a residential care home providing personal and nursing care. The service provides support to people aged 65 and over and some people were living with a learning disability. At the time of our inspection there were 66 people using the service. Queen Elizabeth Care Centre accommodates up to 74 people in one adapted building over three floors. One of the floors provides care to people living with dementia.

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

People were not consistently kept safe from the risk of harm. Risk assessments lacked detail or had not been included in care plans. There were inconsistencies with the medicine management at the home and there were not always enough staff to meet people’s needs. We found infection control concerns where people were not always being kept safe from the risk of infection.

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; the policies and systems in the service did not support this practice. Staff required a more robust training programme to be effective in their role.

People were not always supported with their emotional needs and we received mixed feedback about how they are supported with their independence.

There were minimal organised activities for people to engage with at the home. People told us they were bored and missed the engagement and inclusion activities offered. End of life care plans had been introduced to care plans.

Audits were either not being completed or ineffective in identifying the concerns we found at this inspection. We found the provider had not supported the new management team to be equipped to carry out their roles effectively.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability (LD) and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The nominated individual, in the absence of a registered manager, was unaware that people living with LD were residing in the home.

Right support: Like all people living in the home, people living with dementia had very little in place to maximise their choice, control and independence. Due to staffing levels people were not supported to do daily tasks to encourage their independence.

Right care: The home was not offering people person-centred care. Care plans lacked person-centred detail and people were not taking part in activities in line with their hobbies and preferences. This meant people sat in communal areas or their bedrooms for extended periods of time without engagement.

Right culture: People did not feel included in the home. They were not engaged in activities and resident meetings had not been arranged for them to feel empowered by sharing suggestions or concerns.

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 03 August 2021). 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 the provider remained in breach of regulations.

At our last inspection we recommended that improvement was made to the management of medicines and person-centred assessments. At this inspection we found the provider had not acted on either of the recommendations to make improvements.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, infection control, training and lack of activities or person-centred care. A decision was made for us to inspect and examine those risks.

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 have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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.

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.

We have identified breaches in relation to person-centred care, safe care and treatment, consent and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Queen Elizabeth Care Centre is a care home providing personal and nursing care to 74 people aged 65 and over at the time of the inspection. The care home accommodates people across three floors, each having their own lounge and dining areas. At the time of our inspection, the third floor was not being used. On the day of inspection, there were 47 people living at Queen Elizabeth Care Centre.

The service had been identified for use by the Local Authority as a designated care setting in response to the Winter Plan for people discharged from hospital with a positive COVID-19 status. The service has a separate floor which is used for this purpose.

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

Although people told us they felt safe at the service, we found inconsistencies with information around risks to people and how staff should respond to these. Staff did not always follow good infection control practices, particularly in relation to the wearing of personal protective equipment and medicines practices required some improvement.

People gave mixed reviews on how quickly staff would attend to them, however they told us staff were kind and caring.

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; the policies and systems in the service did not support this practice.

There was a lack of person-centred approach within the service as people’s care plans did not contain information about their past history, hobbies or interests. In addition, due to difficulties with recruitment the service had been without their full cohort of activities staff for some time. This meant there was little going on for people and people told us they were bored.

People did tell us they enjoyed the food and they were involved in some aspects of their care, particularly around what time they would like to get up or go to bed. They also told us they would have no hesitation in raising a concern or complaint with staff.

Although auditing took place at the service and the registered manager had a drive to improve the service provided to people, we found shortfalls which had not been identified internally. The registered manager immediately addressed some of these shortfalls following our inspection, but there was further work to be done to ensure changes were embedded into daily practice.

Staff told us they enjoyed working at the service and people and their relatives said they were happy with what staff did for them and their loved ones.

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

Rating at last inspection

This service was registered with us on 25 November 2019 and this is the first inspection.

Why we inspected

This was a planned inspection as this service has not received an inspection since it had registered with us. We had also received some complaints about a lack of care to people and a lack of response to complaints made by relatives of people.

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 have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive 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.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. 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 until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.