Archived: St Elizabeth's Care Home with Nursing

Updated 31 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2012, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

The inspection was carried out on 04 October 2017 by three inspectors and two specialist advisors. The specialist advisors were qualified nurses who had experience in working with people with learning difficulties and epilepsy. This inspection was unannounced. Before the inspection, the provider to completed a Provider Information Return (PIR). This is a form that requires them to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed other information we held about the service including statutory notifications. Statutory notifications include information about important events which the provider is required to send us.

During the inspection we spoke with nine people who lived at the home, six relatives, 15 care staff members, five care managers, three nursing staff and the registered manager. We also received feedback from two health care professionals. We looked at care plans relating to 13 people and six staff files. We looked at a selection of medication records to check if people`s medicines were managed safely. We also looked at a range of policies and procedures, quality assurance and meeting minutes held at the home.

We carried out observations in communal lounges and dining rooms and used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us due to their complex health needs.

Updated 31 January 2018

The inspection took place on 04 October 2017 and was unannounced. At our last inspection on 07 October 2015, the service was found to be meeting the required standards. St Elizabeth’s Care Home with Nursing accommodates up to 110 people in 13 bungalows within a campus style community. St Elizabeth’s Care Centre specialises in offering care and support to people with epilepsy, associated neurological disorders and other complex medical conditions. The centre is a registered charity, the only national epilepsy centre offering services to all age groups with learning disabilities, adults and for children within the autistic spectrum. At the time of the inspection there were 94 people living at St Elizabeth`s Care Home.

St Elizabeth Care Home is a part of the St Elizabeth's Centre, a 65 acre site, where there is a day centre, school, college, domiciliary care agency and a health agency that provides nursing and therapy services to adults and children. The service is set in its own extensive grounds in an outlying rural area. Whilst providing a good standard of care the size and location of the service is not in line with how CQC would register this type of service now.

At the last inspection on 07 October 2015 we rated the service Good. At this inspection we found the service remained Good.

We contacted local funding authorities to ask for feedback about the service and they told us that they were happy how people were supported in the home; however there were concerns that the location of the service presented challenges in supporting people to connect with the wider community. We have made a recommendation for the provider to consult relevant nationally recognised best practice guidance in relation to the location and scale of residential services for people with learning disabilities and people with autism.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People told us and we observed that the care and support they received was bespoke. People had a voice; they were listened and fully involved in setting out their priorities for care. Staff were innovative in finding ways and using equipment to effectively communicate with people who were not able to communicate verbally. People`s choices were respected by staff and managers and where people lacked capacity or if they lacked confidence to speak out independent advocates were involved in their care to ensure their voice was heard and wishes acted on.

There was a tight partnership working between consultants, psychologists, dieticians, other health and social care professionals and staff to ensure that people received well-coordinated care and support which met their needs holistically and consistently. Staff were extremely knowledgeable about the principles of the Mental Capacity Act 2005 and how this applied in their day to day work. Best interest decisions were taken following best interest meetings between a multidisciplinary team of health and social care professionals including the person and their rightful representatives when necessary.

The provider employed a wide range of nursing specialists through their health agency based on site. Specialist nurses offered around the clock support to people in addition to the nursing staff working in the home to meet people`s nursing needs. Specialist nursing staff and managers worked together to develop care staff`s knowledge to understand better people`s health and social needs and also to support care staff to develop further and progress in their career.

Each person who used the service had a social activity calendar which they planned from the beginning of each year choosing what activities they liked to try or continue throughout the year including holidays and days out. However people could choose ad hoc leisure activities available on the site or in neighbouring villages and towns including going to concerts or having fun on a go cart.

There were enough long standing staff employed safely and well trained to meet people`s needs at all times. Staff demonstrated their skills and abilities when supporting people with complex needs. Staff were well supported by managers and had regular supervisions, appraisals and had their competencies regularly checked to ensure they had up to date knowledge and followed best practice when caring for people.

Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally. Relatives and healthcare professionals were positive about the skills, experience and abilities of staff to deliver care and support to people in a safe, effective and caring way.

People`s care plans were very descriptive of people`s health and social needs and these were personalised to each individual living at the home. These were easy to follow and understand how and when people wanted and needed support from staff. There were comprehensive plans and guidance in place to help staff deal with unforeseen events and emergencies.

Care plans had comprehensive risk assessments and protocols in place and in many cases these were completed in partnership with a medical practitioner, the GP and a specialist nurse. Risk assessments were enabling and not disabling. People were able to live the life they wanted and take risks as safely as possible.

People who required aids and adaptations in place to maintain or re-gain their independence were promptly assessed by both physiotherapists and occupational therapists employed by the provider and working in the home. People achieved positive outcomes due to the well-coordinated and prompt support they received from staff and other professionals involved in their care.

People received care and support from staff who explored all means to establish people`s likes, dislikes and preferences for all aspects of their life and shaped the care and support they delivered to promote privacy, dignity and met people`s individuality. Some people had lived on the site since early childhood.

There was visible and effective leadership within the service. The service was effectively organised and well run with an open and transparent culture. The registered manager was supported by a dynamic well developed management structure and the management team demonstrated a holistic approach and had clear oversight of how the service was meeting people’s physical, emotional and social needs.

The strategic plan and statement of purpose for the service did not provide any detail of how the provider planned to develop the service to take account of nationally recognised good practice in relation to how people with learning disabilities and people with autism are supported to live. We would recommend that future plans and documentation reflect this more explicitly.

The provider`s management structure showed clear lines of responsibility and authority for decision making and leadership in the operation and direction of the different services located on the same site. The registered manager was supported by the specialist therapists and nursing team employed by the provider and based on the site. This helped people accessing specialist care and support promptly which had positive impact on their health and well-being.

The service actively encouraged and provided a range of opportunities for people who used the service and their relatives to provide feedback and comment upon the service in order to continue to drive improvement.

There was a comprehensive auditing programme carried out by the management team and the provider. Action plans were comprehensive in detailing actions taken, time frames and the responsible person for the actions.