Elizabeth Court

Elizabeth Court is a residential care home providing personal and nursing care to up to 44 people. The service provides support to older people. At the time of our inspection there were 42 people using the service. Some of who live with dementia. Elizabeth Court accommodates people across two separate floors, each of which has separate adapted facilities.

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

Improvements were needed to the management of people’s medicines. Additional improvements were needed to the processes in place for the review, monitoring and oversight of records in use.

Sufficient staff were on duty to meet the needs of people. Systems were in place to safeguard people from harm and regular checks were carried out to ensure people’s living environment was safe. A system was in place to assess and plan for known risk to people.

A new manager had been appointed and had been in post for 5 weeks. An improvement plan was in place to make changes to the service. Work was underway to review and update procedures with the service. Staff worked with local health care professionals to meet people’s needs.

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 majority of policies and systems in the service supported this practice.

Improvements had been made in the management of infection prevention and control measures since the last inspection.

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 14 March 2022) and there were breaches 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 in some areas, however more improvements were needed and the service was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 28 January and 8 February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person centred care and good governance.

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 and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has remained requires improvement based on the findings of this inspection. Although some improvements had been made since the last inspection, we found evidence that the provider needs to make improvements in relation to medicines management and oversight of the service. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elizabeth Court on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicines management and oversight of the service. We have made a recommendation in relation to staff records. 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.

Elizabeth Court is a residential care home providing personal and nursing care to up to 44 people. The service provides support to older people. At the time of our inspection there were 43 people using the service.

Elizabeth Court accommodates people across two separate wings, each of which has separate adapted facilities.

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

Improvements were needed to ensure the registered manager was compliant with the most up to date current government guidance regarding COVID-19. This would ensure the rights of people were upheld in the event of a further outbreak at the service.

Improvements were also needed to ensure risk assessments; care plans and care monitoring records fully reflected people’s needs and were subject to an appropriate system of monitoring and review. Governance systems need to be updated to reflect this.

Medicines were not always managed safely. Records didn’t always accurately reflect prescriber instructions regarding prescribed creams.

People were protected from the risk of abuse. Systems were in place to monitor and appropriately report accidents and incidents to external agencies.

People received care from staff who knew them well. We observed caring interactions. Relatives also spoke highly of the care people received.

Appropriate checks on temporary (agency) and permanent members of staff were in place to ensure they were suitable for the role before working with people. Staffing levels were safely planned, which was determined by people’s needs.

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

Rating at last inspection

The last rating for this service was good (published 02 February 2021).

At our last inspection we recommended that the provider ensured up to date government guidance was followed in relation to infection, prevention and control. We also recommended the provider reviewed the effectiveness of their systems to monitor care records. At this inspection we found up to date systems and guidance were in place however, hadn’t always been followed or implemented by the registered manager. This meant improvements had not always been made.

Why we inspected

We undertook a targeted inspection as part of CQC’s response to care homes with outbreaks of COVID-19.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We inspected and found there was a concern with how the registered manager had managed visiting during the outbreak, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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 a failure to consult and involve people in decisions about visiting during the COVID-19 outbreak and in a failure to ensure provider polices and risk assessments were followed. We also found failures in accurate record keeping relating to peoples care 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Elizabeth Court is a residential care home providing personal and nursing care. The service can support up to 44 people within one building. Bedrooms and facilities are located on both floors of the building. Forty-two people were living at the service at the time of this inspection.

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

Systems for the management of infection prevention and control were in place. We have made a recommendation that up to date guidance in relation to preventing and controlling infection is implemented at all times.

Systems for the oversight and monitoring of the service people received were in place. We have made a recommendation that the provider continually reviews the effectiveness of the records monitoring systems.

People's needs and wishes were assessed prior to moving into the service. People received care and support from staff who had received training for their role. People were happy with the food available to them. People's healthcare needs were met by staff and community-based health care professionals.

People were protected from abuse and the risk of abuse. Regular safety checks were carried out on the environment and equipment to maintain people’s safety.

Recruitment procedures were in place to help ensure that only suitable staff were employed at the service.

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.

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 18 December 2019).

Why we inspected

This was a planned focused inspection based on the previous rating.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions 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 Court on our website at www.cqc.org.uk.

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 Court is a care home providing personal and nursing care for up to 44 people in one adapted building over two floors. One floor of the building supports people requiring nursing care. The service was supporting 34 people at the time of this inspection.

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

People were not always 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 did not support this practice. Improvements were needed to the management and oversight of Deprivation of Liberty Safeguarding in place for people.

The care planning and recording systems in place promoted the care and support people required however, information was not always person centred. People felt safe using the service and received their medicines when they needed them. Safe recruitment practices were in place to help ensure that only suitable people were employed at the service.

We have made recommendations in this report in relation to the implementation of the Mental Capacity Act and person-centred care planning.

Systems were in place to monitor the quality of the service that people received. People were able to voice their views and felt they were listened to. Sufficient staff were on duty to meet people’s needs.

People's needs and wishes were assessed prior to moving into the service. People received care and support from experienced staff who were supported in their role. People were happy with the food available to them. People’s healthcare needs were understood and met by staff and community-based health care professionals.

People were protected from abuse and the risk of abuse. People and their family members told us that the service was safe. Infection control practices were followed to minimise the risk of the spread of infection. Regular safety checks were carried out on the environment and equipment.

Staff knew people well and were knowledgeable about individual's needs and wishes and how they were to be met. People and their family members had access to complaint process information and how to raise a concern about the service.

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 August 2019).

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 and the rating had improved to requires improvement.

This service has been in Special Measures since January 2019. During this inspection the provider demonstrated that improvements have 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 was a planned inspection based on the previous rating.

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 Court is a residential care home providing personal and nursing care to 33 people. The service can support up to 44 people. The home provides accommodation on two floors in one building.

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

Systems in place to monitor the quality of the service were not effective and failed to highlight or address concerns identified during this and the previous inspection. Improvements were needed to make the service safe.

The care planning and recording systems in place did not ensure that up to date information was available in relation to people’s needs being planned for or met. Information available was poorly written, lacked detail and failed to demonstrate people’s individual needs in a person centred way. Improvements were needed to ensure that people’s medicines were safely managed.

People were not always protected from abuse as appropriate procedures were not always followed. Incidents and concerns were found to be recorded in generic communication books. These incidents had not been brought to the attention of the registered manager and no further investigations had taken place. This put people at unnecessary risk of harm.

People’s needs and wishes were assessed prior to moving into the service. People received care and support from appropriately trained staff but staff did not always have adequate or up to date information on people’s needs. Records on occasion were poorly written and failed to protect people privacy and dignity. People’s personal information had been recorded in generic communication books.

People were not always supported to have maximum choice and control of their lives and staff did not always 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.

Safe recruitment practices were in place to help ensure that only suitable people were employed at the service. The environment was clean and effective systems were in place to control infection.

People had access to a programme of activities. People and their family members spoke positively about the service and the changes made since the last inspection.

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 8 February 2019). At this inspection improvements had been made however, the provider was still in breach of regulations and further areas of improvement had been identified during this inspection. This service has been rated inadequate for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

At this inspection enough improvement had not been made sustained and the provider was still in breach of regulations.

Enforcement

We have identified breaches in relation to Regulation 9 person centred care; Regulation 11 need for consent; Regulation 12 safe care and treatment; Regulation 13 safeguarding service users from abuse and improper treatment; Regulation 17 good governance and Regulation 18 staffing at this inspection

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

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

This service has been in Special Measures since January 2019. During this inspection the provider demonstrated that improvements have been made, however further improvements are still needed. The service is rated as inadequate in safe and well-led sections and therefore is rated inadequate overall. Therefore, this service remains in Special Measures.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review.

There was a registered manager in post at the time of our inspection. 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.

During this inspection we identified multiple breaches of regulations 9, 10,11, 12, 13, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns with the delivery of person centred care, dignity and respect, safe and appropriate care, safeguarding people from abuse, the recruitment of staff, staffing levels, staff support and the governance arrangements at the home. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

During our visit, we found people’s needs and risks were not properly identified or managed. The majority of information in relation to people’s care was generic and meaningless and staff had little guidance on how to provide safe and appropriate person centred care. This meant people’s support was not always provided in a safe or dignified way and records showed that people did not always received the support they needed to maintain their well-being. There was also little evidence that staff were keeping track of people’s progress on a regular basis to ensure the support provided continued to meet their needs.

There was a lack of any meaningful and consistent activities to interest and occupy people and they sat for the majority of the day in the communal lounge with the television playing in the background. People told us there was not much to do at the home.

We found that some incidents of a safeguarding nature had not been appropriately identified, responded to, documented or reported in accordance with local safeguarding procedures and the legal requirements of CQC. This meant the provider did not have a robust system in place to protect people from the risk of abuse. Some people’s care was not always provided in such a way as to protect them from neglectful or degrading treatment. Furthermore some of the language used by staff to describe people’s needs was not always respectful or considerate.

People’s ability to make decisions about their care was not assessed in accordance with the Mental Capacity Act 2005. For instance some people had bed rails on their beds and deprivation of liberty safeguards in place without any evidence that they had consented to this or evidence that their capacity to consent to this had been explored. There was no evidence that any best interest decision making had been properly undertaken or that other least restrictive options had been explored. The capacity assessments that where in place in some people’s care files were generic and contrary to the MCA legislation designed to protect people’s human rights.

The provider had a formal method for determining the number of staff needed on duty to keep people safe and meet their needs. We found however that the provider had not applied this method correctly. This resulted in the number of staff on duty being incorrectly determined. And during our visit we observed that the number of staff on duty was insufficient to meet people’s needs at all times. The opinions of people who lived at the home and their relatives about staffing levels was mixed.

New staff were recruited after satisfactory pre-employment checks were undertaken. This meant there were systems in place to check that staff were safe to work with vulnerable people prior to employment. We found however that the manager had not ensured suitable recruitment and selection processes were subsequently followed when a staff member’s employment status within the home changed. For example, if they changed their job role or were given more responsibility. This meant that there was no evidence that the staff member’s competency for their new role had been assessed to ensure they were suitable. This was not good practice.

We saw that care staff had received regular supervision and appraisal in their job role but nursing staff had not. This meant that the provider had not ensured that nursing staff were given appropriate support to do their job role effectively.

We checked a sample of people’s medications. We found that the balance of medication that each person had in the medication trolley matched what had been administered. The way people were given their medication however did not always follow best practice guidelines and the time that medicines were administered was not recorded. This aspect of medication management required improvement.

The provider had audits in place to check the quality of the service but these were ineffective. For instance the inadequacy of people’s care planning information had not been picked up; deficiencies in the way people’s support was provided had not been identified and the lack of adherence to the MCA had not been addressed. There was little evidence that there were robust processes in place to gain people’s views on the quality and safety of the service or that staff practice at the home was monitored to ensure that it was safe and appropriate. This meant there was little evidence that the provider had robustly governed the service to ensure it was safe, effective, caring, responsive and well-led.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

- Ensure that providers found to be providing inadequate care significantly improve.

- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

- Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

This was an unannounced inspection carried out by an Adult Social Care inspector. During the inspection we spoke with eight people who lived at the service, seven members of staff, five visitors, the registered manager and the assistant 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.

The service did not always make sure that people’s capacity was determined and actions that meet best interests put into place. We saw that covert medicines (medicines that are hidden) were not managed in a manner that maintained people’s rights. The service sent us information following the inspection that showed what actions they were taking to address this.

People told us they were well cared for. They looked relaxed and comfortable in the home and with the staff who supported him. Everyone we spoke with complimented and spoke highly of the staff who supported them. Comments included, “The staff are all kind.” “They can’t do enough for you”.

People and their relatives told us that they had been included in planning and were in agreement with the care and support being provided. We saw that people had an individual plan which outlined some of the ways staff were to support individuals.

Staff we spoke with recognised the importance of knowing people’s routines, so that people received personalised support.

Staff took the time to get to know people and supported them in undertaking activities. We saw a number of activities taking place during the inspection, including a party for the queen’s birthday that was well attended.

The staff told us they were aware of their responsibility to protect people from harm or abuse. They knew the action to take if they were concerned about the safety or welfare of an individual. They told us they would be confident in reporting any concerns to management.

The service had completed training and an award in relation to end of life care. As a result they had undertaken a number of arrangements to assist bereaved families appropriately.

People said that, 'this home is wonderful now' and the staff were, 'very attentive and caring.'

People and their relatives were involved in planning and reviewing their care needs. Relatives said that staff always had time to talk to them and involved them in planning care. We saw that staff were particularly caring, and cared for and supported people according to their individual preferences and needs.

We saw that there were enough, suitably trained staff on duty at all times.

We saw that the provider regularly assessed and monitored the quality of the service provided and that records were managed appropriately.

Overall we found improvements had been made and people were given their medicines safely.

Elizabeth Court offers both a residential and a nursing care service; each service is delivered on a separate floor. The concerning information provided to us was related to people who lived in the nursing care unit and the level of care they were being provided.

During the inspection we found no evidence to support the concerning information or the safeguarding concerns raised. We looked in detail at each of the concerns raised and reviewed the care files for those individual people. We also spoke with their family members and care staff with regards to the details of the concerns.

During our inspection we spoke to people who lived in both areas within the home and their relatives. We invited them to share with us their views and experience of the care they received.

A relative told us 'My family member is happy here; I visit everyday and find they are clean and comfortable. My family member is always treated with dignity and respect by the staff who care for them.'

We looked at three care files. These were well organised with a person centred approach.

The care plan had been broken down into ten sections. All care plans had a monthly review.

Overall we found some improvements had been made since our last visit but found further improvements are needed to help make sure medicines are always administered safely.

Overall we found medicines were not safely handled and improvements are needed.