This inspection was carried out on the 17 January 2017 and was unannounced.Elizabeth House is registered to provide accommodation and personal care for up to 22 people. Most people were living with Korsakov’s syndrome and had a history of alcohol dependence. Korsakov’s syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). People required support with processing and retaining information and the service supported them to be as independent as possible.
The service is situated close to another care home service run by the same provider and shares staff and management with the other service. The provider had recently renovated a house adjacent to Elizabeth House, containing six additional bedrooms and people were due to be moving in shortly. Downstairs there was a kitchen, dining room and lounge. Each person had their own bedroom and there were multiple bathrooms throughout the service.
The service had a registered manager in post. A registered manager is a person who is 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 management team had identified that some training and regular one to one meetings where staff could reflect on their practice were overdue. Staff were directed to physically intervene in extreme circumstances, but had not received the training to do so safely. There was a plan in place to rectify this, but it had not yet been completed; so this was an area for improvement.
Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. However, the paperwork relating to this could not be immediately located. The gas certificate for the service was out of date and the registered manager booked someone to come and check it was safe immediately. Regular fire drills were completed.
People were actively involved in writing their support plans and risk assessments. They identified goals to work towards and these were consistently met. An in-house cognitive behavioural therapist worked with people to help them understand their condition and how it impacted on their lives. People took part in a variety of activities inside and outside of the service. Some people lead their own activities, and on the morning of the inspection a current affairs session took place. Complaints were investigated and responded to promptly.
Staff knew how to recognise and respond to abuse. The registered manager was aware of their responsibilities regarding safeguarding and staff were confident the registered manager would act if any concerns were reported to them.
There was enough staff to keep people safe. Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLS applications had been made to the relevant local authority, in line with guidance.
People were supported to eat and drink a range of healthy and nutritious food. Food appeared home cooked and appetising.
Risks relating to people’s health and mobility had been assessed and minimised where possible. People received their medicines when they needed them. Staff had sought advice and guidance from a variety of healthcare professionals to ensure people received the best care possible. Staff followed guidance and advice given by health care professionals.
People told us that staff were kind and caring. Staff knew people well and people were supported to be as independent as possible. People were treated with dignity and respect.
People and staff told us they thought the service was well led. Staff told us they were supported by the registered manager and there was an open and inclusive ethos within the service. The provider told us the aim of the service was to, “Promote independence” and, “Ensure everyone is able to achieve their full potential.”
The registered manager and the provider were experienced in working with people living with Korsakov’s syndrome and providing person centred care. The CQC had been informed of any important events that occurred at the service, in line with current legislation.
The registered manager and other senior staff regularly carried out audits to identify any shortfalls and ensure consistent, high quality, personalised care.