Archived: St Elizabeth's Care Home with Nursing

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.

is the service responsive, is the service safe, is the service effective and is the service well led? The inspection was carried out by three inspectors over one day.

Below is a summary of our findings.

Is the service safe?

During our inspection we looked at twelve care plans and found that these were detailed and centred on the person's needs. People who used the service, their families and or advocates were involved with the care they received. One person said, "I am always involved in any changes, to do with [Relatives] care." The care plans were reviewed monthly and any changes had been recorded in the person's care plan.

We looked at 10 randomly selected staff training records. Each staff training record we looked at showed that they had completed the safeguarding training and a yearly refresher. We saw in each bungalow, displayed on notice boards a copy of the, 'Hertfordshire's Safeguarding People from Abuse Procedure.'

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We noted mental capacity assessments and best interests had been completed. We saw 'Standard Authorisation' applications had been made for DoLS.

During our inspection, we found that there were systems in place for the safe administration of medicines for people using the service. The staff members we spoke with said that they had received training in the administration and management of medicines.

Is the service effective?

The care plans had risk assessments for moving and handling, management of epilepsy and nutrition. For example, there were details about the different types of seizures and triggers that may affect an individual's epilepsy. Each person who lived with epilepsy had a 'seizure intervention box' which contained medication and procedures for managing their seizures. Staff had received training in the management and supporting people living with epilepsy.

We spoke with staff about their training and they confirmed they had received regular training and were up to date with their training commitments. We looked at staffs training records and these reflected what we had been told by staff. We saw records for training that covered: Safeguarding, epilepsy, infection control, moving and handling and administration of medication.

Is the service caring?

We spoke with one member off staff who said, "I would be happy for my sister to stay here." We spoke with a person who used the service and they said, "I am happy here, I love making the jewellery." Another person said, 'They liked the people they lived with and felt the staff understood their needs.' One relative said, 'My [Relative] comes home Friday and Saturday but when they wake up they just wants to come back. They prefer living here and my [Relative] is very happy. Staff gave fantastic care and they look after me as well."

Is the service responsive?

During our inspection we observed good interaction between staff and people who used the service. For example we saw people in the kitchen assisting with food preparation. People were spoken to in a respectful way.

We saw the complaints procedure and the complaints log. Complaints were dealt with in line with service policy.

Is the service well-led?

There were systems in place to assess and monitor the quality of service. We saw that yearly surveys were sent out to people, family and or their advocates. All the surveys we saw were produced in an easy to read format with pictures. There were 'Employee opinion surveys' for staff. 'Residents' meetings were held monthly. This meant that people and those who were involved in their care were able to air their views about the quality of service.

We found that people experienced care and support that met their needs and protected their rights. People were consulted about their care. Records provided detailed information for staff about how to meet people's needs.

We observed staff treating people with respect and consulting them about how their care was delivered.

We found there were sufficient staff to meet people's needs. People told us they liked the staff who supported them. One person said, 'The staff are my mates. They listen to what I say.'

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There was an effective complaints system available. People told us that they felt able to raise concerns with staff but had not had the need to do so. They told us they felt listened to by staff.

We visited the central office, met with the Chief Executive, visited one of the bungalows, Vincent House, where we observed care for people who did not have the ability to communicate verbally.

We saw that people were well cared for, respected and treated with dignity and protected as much as possible by staff support and close supervision. We saw a staff member preventing the fall of a person and we observed a staff member preventing one person from hitting another due to their disability. This corresponded with their risk assessment.

The staff knew how to identify and respond to potential abuse and were able to explain the correct safeguarding procedures.

We found that staff were up to date with training that was relevant to their roles and that they were supported by an effective supervision process.

We found that the provider had in place systems to monitor the quality of the service that included surveys, staff and 'residents' meetings and regular audits.