Archived: Elizabeth House

Elizabeth House is registered to provide care and support for up to 18 people. Accommodation is provided over two floors, with bedrooms on both the ground and upper floor. The home is close to Bury town centre and easily accessible to public transport and local amenities. At the time of the inspection there were 12 people living at the home.

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

Risk to people and the environment were identified. Effective risk management plans were not in place to guide staff in the support people needed to keep them safe. Work was still required following completion of a fire risk assessment. We also identified concerns to a gated stairwell and the call bell system.

Robust governance systems had not been implemented and embedded to evidence good oversight of the service provided. Managers spoke with were aware of improvements required across the service however this had not been used to inform the development of a business improvement plan.

People were supported to have maximum choice and control of their lives and we observed staff supported them in the least restrictive way possible. Applications to deprive people of their liberty had not been made to ensure people were not being unlawfully deprived of their liberty. Capacity and consent were considered when planning people’s care and support.

We found staffing levels were not sufficient. Following discussion with managers staffing levels were increased so people received timely support. We have made a recommendation about staffing arrangements being kept under review. A programme of staff training was available. Improvements were needed to the induction of new staff and on-going supervision and support. This helps to ensure staff are clear about their role and responsibilities and what is expected of them.

Systems were in place to help manage people’s prescribed medicines. Staff responsible for the administration of medication completed training and assessment to check their practice was safe. Records needed expanding upon providing clearer direction for staff and records clearly evidenced what people had received.

People told us enjoyed the meals served. Kitchen staff were aware of people’s dietary needs. Where necessary, additional support was sought where people were at nutritional risk. We have made a recommendation about additional aids to assist people and promote their independence.

The registered manager worked with the local authority safeguarding team to address any issues or concerns about people’s safety.

Good hygiene standards had been maintained within the home. The registered manager was reminded of the guidance provided by the health protection team in relation to the wearing of masks by 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 1 January 2019)

Why we inspected

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.

We received concerns in relation to safe care and treatment, medication and staffing levels and practice. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. 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 House on our website at www.cqc.org.uk.

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.

At this inspection we have identified breaches in relation to risk management and fire safety, deprivation of liberty safeguards, staff support systems and good governance and record keeping. We have also made two recommendations regarding staffing levels and aids to support independence.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Good supplies of personal protective equipment (PPE) was available. Items were easily accessible throughout the home. Further items had been sourced to ensure the safe disposal of clinical waste during the recent outbreak. Domestic staff were also completing extra cleaning of surfaces to help minimise the risk of cross infection.

The home was part of the testing programme. Additional monitoring such as temperature checks and oxygen levels were carried out so that people’s changing needs could be quickly identified and responded to.

Good practice guidance had been shared with the team and was displayed in the home so easy to refer to. Staff had received training in the safe donning and doffing of PPE as well as infection control procedures. The manager said the team had worked hard, particularly during the outbreak, with staff described as ‘brilliant’ and had ‘stepped up’ to ensure the home had enough cover.

People maintained contact with family through telephone calls or ‘facetime’, which had enabled people to see each other. Whilst visits were not currently taking place, the management team were exploring ways in which the premises could be altered to help facilitate safe visiting from family members.

Where able, people were involved and consulted about their care and treatment. Virtual tours of the home were offered to prospective new residents and their families. Staff continue to work closely with relevant health and social care professionals so that people's needs were appropriately met.

The manager carried out quarterly infection control audits to check procedures were being followed and hygiene standards were maintained.

This was the first inspection of Elizabeth House since it was registered under new owners. At the last inspection in February 2016 we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as staff recruitment procedures were not sufficiently robust. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question ‘is the service safe’ to at least good.' At this inspection we found improvements had been made and the service was no longer in breach of this regulation.

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. It is registered to provide care and support for up to 18 people. At the time of our inspection 16 people were living at Elizabeth House. The home has two floors, with bedrooms on both the ground and upper floor.

The service had 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.

The people who lived at Elizabeth House told us they felt safe. There were enough staff to meet the needs of the people who currently lived there, and appropriate precautions were taken to ensure that staff had the right character to work with vulnerable people. The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

The building was secure, clean and well maintained, and staff ensured any environment hazards were minimised. However, the layout of the building was unhelpful, as narrow corridors made manoeuvring wheelchairs difficult, and the service could not easily accommodate people with difficulty mobilising on the upstairs landing.

Care records were well kept and easy to follow. They gave a good indication of resident’s abilities and provided a good description of their likes and dislikes. Where risk had been identified, risk plans were in place to minimise the risk of harm occurring. Senior staff were trained to administer medicines and we saw people were assisted to take their prescribed medicines in a way they were comfortable with by staff who understood their needs.

People were supported by a stable staff team who knew the residents well. We saw that the staffing ratio reflected the needs of the people living at Elizabeth House. The people we spoke with believed the staff were competent and knowledgeable. We saw from training records that all new starters received a thorough induction and ongoing refresher training to maintain their competence.

Staff communicated well with each other and we saw that information was exchanged between staff informally throughout the working day, and a detailed handover meeting took place at the start and finish of every shift. This ensured that care staff were aware of any change in peoples’ needs and of any tasks which might need to be completed.

The registered manager and the care staff we spoke to, demonstrated a good understanding of capacity and consent. When people were being deprived of their liberty the correct processes had been followed to ensure that this was done within the current legislation.

People liked the food provided, and attention was paid to their dietary needs and preferences. However, the choice of main meals was limited. Lunchtime was not a sociable occasion and there was little conversation as people ate their meals.

Care staff at Elizabeth House monitored people’s general health, and where specific healthcare needs were identified the service liaised with health care professionals to provide an appropriate level of support.

We saw people were comfortable and well cared for. Staff were vigilant to people’s needs and were able to respond in a timely way to people’s requests for assistance. They respected people’s need for privacy, but understood the risk of social isolation and ensured supervision and regular checks were made when people retired to their rooms.

Regular reviews showed that people’s needs and abilities were closely monitored and any changes were noted and amended in care plans. There were some activities, and stimulation was provided at a pace conducive to people’s needs. The service supported people to plan for the end of their life and considered their needs and wishes ensuring their comfort and dignity.

Staff worked well together and encouraged a culture of mutual respect. They recognised that Elizabeth House was people’s home and understood their role to support vulnerable people.

The registered manager was respected by staff, people who used the service and their relatives, and had a visible presence throughout the home.

The service sought feedback from people and some monitoring systems were in place, but information collected by the service could be used more effectively to improve the quality of the service.