Archived: Elizabeth House

We found the following examples of good practice:

All staff, contractors and visitors used appropriate personal protective equipment (PPE).

The home had sufficient supplies of appropriate PPE which was stored hygienically. Alcohol gel stations were accessible around the home. Hand washing facilities were available for staff.

A visiting pod was being built in the garden in preparation for face to face visits commencing.

Staff followed national guidance about putting on, taking off and disposing of PPE safely.

Staff supported people's social and emotional wellbeing. Activities were carried out on a one to one basis or in small groups.

Cleaning schedules were in place for all areas of the home and records of cleaning were completed.

All staff, including catering and housekeeping staff had undertaken training in infection prevention and control. This included putting on and taking off PPE, hand hygiene and other Covid-19 related training.

Elizabeth House is a large, purpose built detached building set within its own grounds. It provides personal care for older people. It is registered to provide care to a maximum of 34 people. At the time of our inspection 31 people used the service.

Elizabeth House is a 'care home.' People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered 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.

At the last inspection in June 2016 we rated the service 'Good.' At this inspection we found the evidence continued to support the rating of ‘Good’. There was no evidence or information from our inspection or on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff followed policies and procedures to protect people from harm and abuse. Systems were in place to make sure lessons were learned when incidents took place. Risk assessments and guidance were in place to minimise the risk of harm to people. Safe recruitment procedures were in place and there were sufficient staff on duty. Medicines were administered safely and infection prevention and control was well managed.

Staff received the training they need to be able to carry out their roles and had regular supervision and annual appraisals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, further work was needed to ensure decision specific mental capacity assessments and best interest’s decisions were recorded when people lacked capacity to make their own decisions.

People told us they enjoyed their meals and had a choice of food. People’s weight was monitored so any issues could be addressed and food was nutritious. Health and social care professionals were involved in people’s care where needed.

People were supported by staff who knew them well. Care was delivered in way that responded to people's needs and preferences. Plans of care were drafted following assessment of people’s needs and these were reviewed regularly. Privacy, dignity and independence were consistently promoted. The policies and practices of the home helped to ensure that everyone was treated equally.

People had access to a wide range of activities and leisure opportunities and were encouraged to maintain personal relationships.

The environment and equipment had been regularly maintained. Emergency contingency plans were in place.

People were aware of how make a complaint. The management team completed regular audits and sought feedback to monitor and improve quality. Staff and people using the service were involved in decisions about how the service was run through regular meetings. The service worked closely with a range of health and social care professionals. Staff told us they felt supported by the management team and provider.

Further information is in the detailed findings below.

Elizabeth House provides support and accommodation for up to 34 people living with a dementia and / or a physical disability. At the time of inspection there were 34 people using the service. The service was located in a residential area within its own grounds and located very close to local amenities.

The registered manager became registered with the Commission in December 2014. They had previously worked for the registered provider as a carer and had been supported to progress with them. 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.

Staff understood the procedures they needed to follow to raise a safeguarding alert. Staff had received up to date training and could provide examples of the different types of abuse which people at the service could be at risk from. All staff told us they felt confident in whistle blowing [telling someone]. When safeguarding incidents occurred, the service worked quickly to carry out an investigation and minimise the risk of harm to people.

Risk assessments for people and for the day to day running of the service were in place and had been regularly reviewed. This meant the registered provider had procedures in place to recognise the importance of risk management delivering care and support in a safe way to people.

Up to date health and safety certificates were in place to show the service was safe to deliver provide care and support to people. Regular maintenance was also carried out at the service. All staff participated in planned fire drills which were scenario based and included questions designed to test staff knowledge.

Robust recruitment procedures were in place. Potential candidates were invited to attend two taster days at the service to determine their suitability. Staff only started work once two checked references and a Disclosure and Barring Services (DBS) check had been obtained. This helped the registered provider to ensure people employed were of suitable character to work with vulnerable people.

People and staff told us there were enough staff on duty during the day and at night. The registered provider regularly monitored staffing levels and dependency tools were completed each month. This showed there were sufficient staff on duty to provide safe care and support to people.

People received their medicines when they needed them by appropriately trained staff. Topical cream records and ‘as and when required’ medicine protocols were in place.

All new staff participated in a robust induction process which included training and shadowing more experienced staff. Staff training, supervision and appraisals were up to date for all staff. This showed the registered provider supported staff to remain competent in their roles.

People were supported with their nutrition and hydration. Appropriate risk assessments and care plans were in place for people who were at risk of dehydration or malnutrition. The service referred people to dieticians when further support was needed.

The service was decorated to a high standard and had good quality furnishings in place. People’s rooms contained their personal belongings, furniture and photographs. People had access to a wide range of communal areas at the service and a dementia friendly garden had been put in place by the registered provider.

People and their relatives spoke highly about staff and the care provided at the service. Everyone told us they enjoyed living at the service. We could see staff knew people and their relatives well. People told us that care was given when they needed it.

People were involved in planning and reviewing their own care. Staff gave people the information they needed to make their own decisions and told us they were not rushed to do so. Relatives told us the service kept them up to date about matters affecting people. When people were unable to make their own decisions, staff contacted advocacy services for people. This showed the service actively supported people to make sure care and support met their needs and wishes.

During the inspection we saw that people’s privacy and dignity was maintained. People confirmed this to be the case and told us doors and curtains were closed and they were covered over with a towel when personal care was taking place. Discussions about people’s needs were carried out in private.

The service encouraged people to keep in touch with the people important to them. Relatives told us they were invited to all events taking place at the service and were welcomed by staff when they visited. People had access to the telephone, internet and Skype to keep in touch with people.

All staff were trained in end of life care. The service had implemented the gold standards frame work for end of life care. This meant people had advanced care plans in place and staff had informal discussions with people about their wishes.

People’s needs were assessed before they moved into the service to make sure the service could support them. When people moved into the service, personalised care plans were put in place which were reflective of their needs, wishes and preferences. Care plans were reviewed regularly and updated when needed.

The activities co-ordinator and staff carried out activities with people at the service. These were complemented by external activities and visitors to the service. People and relatives told us they enjoyed the quality of activities provided.

From speaking with people, relatives and staff, we could see there was a positive and open culture at the service. All staff spoken to told us they enjoyed working at the service and felt supported by the registered manager and registered provider.

The registered manager and deputy managers all spent some of their working time on the floor with people and staff. They told us this helped them to keep up to date with people. People, staff and relatives spoke highly of the registered provider and felt supported by them.

Robust quality assurance processes were in place. All safeguarding incidents, accidents and other types of incidents occurring at the service were promptly dealt with. Investigations were carried out to try to reduce any repeated incidents. Regular audits were carried out and action plans completed where needed which included dates any actions had been addressed.

The registered provider contacted the Commission in December 2015. They told us they had identified through their own quality assurance processes that the registered manager had not always notified the Commission about incidents at the service when required to do so. We issued the registered provider with a fixed penalty notice which they paid in full. The Commission has since received required notifications from the service.

Regular meetings were held for people and their relatives and staff. A regular newsletter was also produced for the service. This meant each were kept up to date about any changes occurring at the service.

At this inspection we found that improvements had been made and records were now being completed more comprehensively. We found that care plans had been amended to include more person centred information, although it was acknowledged that there was further work to do. We saw that charts that detailed people's food/fluid and repositioning in bed has been appropriately completed. The recording of nformation that related to incidents of challenging behaviour had improved and care plans for diversional activities had been introduced. This helped to ensure that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We also spent time and observed how staff interacted with people who lived at Elizabeth House. We saw that people were treated kindly and we saw that staff provided gentle encouragement to people when mobilising.

A relative we spoke with said, 'There is a really nice atmosphere. The staff are marvellous and he/she has settled really well.'

All of the people we spoke with were very satisfied with the care they had received. Comments included, " 'The girls always knock on my door before they come in. I always get asked if I am OK and am I alright. The staff is so kind and will do anything for me.' " The staff are so lovely, very kind and thoughtful; they do anything you ask of them." Relatives comments included, 'Because mum is not really able to make a lot of decisions, I help her. I am kept fully informed about mum's health and her care; I think the staff do an extremely difficult job with a great deal of commitment and care.'

We saw that staff were attentive and treated people with dignity and respect. Staff responded quickly when people called for help. We saw that staff communicated well with people and explanations of care were given.

We found that people lived in an environment that was homely, clean, well maintained and safe.

We saw that there were systems in place to monitor the quality of the service, however some of the analysis could be more detailed.

We found that people had their care needs assessed, however we found that records were not always detailed enough, appropriate or fully completed.

People said they were well cared for and said that they liked living at the home. People had support plans and risk assessments in place which helped staff to understand and meet people's needs. We observed staff helping people to maintain their independence and make choices for themselves.

The home had policies and procedures which helped to protect people. People told us that they felt safe and that their concerns would be listened to.

Staff had received sufficient training to enable them to meet the needs of people living at Elizabeth House. One person said 'I like the staff, they are all nice."

People's views were being sought about the quality of the service provided. We saw that the management team acted upon any issues to make sure that people remained happy with the service they received.