Archived: St Elizabeth's Care Home with Nursing

Updated 21 January 2023

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team was made up of three inspectors, a pharmacy inspector, a specialist advisor who was a qualified learning disability nurse and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

St. Elizabeth Care Home with Nursing, is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and partner agencies who worked with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with five people who used the service and 17 relatives about their experience of the care provided. We spoke with 18 members of staff including the registered manager, director of care, bungalow managers, senior care workers and care workers and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. Some people were unable to verbally tell us about their experiences of care, therefore, we spent time observing their interactions with staff.

We reviewed a range of records. This included 20 people’s care records and 11 medication records. We looked at three staff files in relation to recruitment. A variety of documents relating to the management of the service, including quality assurance and training records, were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 21 January 2023

About the service

St Elizabeth’s Care Home with Nursing provides both nursing and personal care to up to 110 people in 11 bungalows and three single occupancy flats, within a campus style community. The service specialises in offering care and support to people with epilepsy, associated neurological disorders, a learning disability and other complex medical conditions. At the time of the inspection there were 86 people living at the home.

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

People were at risk of not having their needs met in a timely manner. The provider acknowledged that there were not enough staff available to meet people’s needs. They told us they were having to prioritise personal care and safety over supporting people to go out or learn new skills.

The majority of risks in relation to people’s health, safety and well-being had been identified and assessed. However, these assessments did not always enable people to be in control of taking calculated risks. Furthermore, records indicated that risk assessments were not always followed by staff, for example, in relation to repositioning, choking or dehydration risks.

We identified a number of issues relating to the environment and repairs required. This included cracked tiles and flooring in bathrooms, exposed hot water pipes and a light fitting hanging from the ceiling in one of the bungalows. Staff told us they had reported these concerns but there was a long waiting list for repairs. Immediate risks were reported to the management team on the day of inspection and interim measures taken to ensure people’s safety.

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. Not all staff we spoke with were aware of the principles of the Mental Capacity Act and these principles were not consistently embedded in their practice. This meant there were restrictive practices in place, such as locked doors. There was no evidence that the provider had considered if this was the least restrictive action to take.

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 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. Staff did not always consider people’s individual needs nor promote choice and control. The language used in care plans and by staff did not always promote a respectful, personalised approach and this had not been identified by the management team. For example, care plans referred to people “absconding” from their own homes. A staff member also told us, “This is where people come to die”, in reference to the bungalow they were working in.

People’s independence was not promoted. For example, in meeting minutes for one bungalow, it stated, “Cooking in the bungalow by residents still needs to be organised as it is time consuming and as staff are busy, it would be as time allows and needs to be planned in advance.” This suggested that the development of people’s independent living skills was not embedded in the day to day operations of the service

We found that people were not always treated with dignity and respect. For example, staff did not knock on doors when entering people’s rooms and we were shown into rooms where people were in bed or being supported with personal care. Care and support plans did not always focus on positive outcomes to improve people’s quality of life. There was limited evidence that staff supported people to identify aspirations for the future. Where wishes were identified they were not always personalised or meaningful to the individual.

Due to living within a campus style community, in a rural location, people were dependent on staff to leave the site safely. However, people did not have control over when they could leave, and staff confirmed it would be difficult for them to facilitate any spontaneous trips out, with this situation exacerbated by staffing difficulties and the COVID-19 pandemic. Daily records indicated that people had a limited choice of things to take part in during the day, and infrequent opportunities to leave the St Elizabeth campus.

The management team had not identified issues we found regarding the culture of the service. They had produced a service improvement plan; however, this did not include actions around how they intended to embed the principles of Right support, right care, right culture at the location.

The provider did not clearly distinguish between the responsibilities of the staff employed by the care home and those employed by the on-site health agency. St Elizabeth’s Care Home with Nursing is registered to provide both personal and nursing care. However, all nursing care was provided by the on-site health agency. This arrangement meant that records were sometimes disjointed or missing. For example, health records held at the bungalows were not always up to date. We were told this information was managed by the on-site health agency. This meant important information was not accessible to the staff supporting people on a daily basis.

The provider’s systems for understanding what was happening within the home were not effective, they had failed to operate effective monitoring of the quality of care. We identified gaps in care plans, risk assessments and daily records. These had not been identified by the provider. Continuous learning was not promoted within the service, with lessons learned following incidents and safeguarding concerns not shared with all staff.

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 January 2018). Since this rating was awarded the provider has altered its legal entity. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned 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 COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.’

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 monitor the service and will take further action if needed.

We have identified breaches in relation to management of risk, staffing, the environment, restrictive practices, developing care that is personalised and the provider’s oversight of quality at this inspection.

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.

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.