ST ELIZABETH

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We assessed a total of 2 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was good. Our rating for this key question has deteriorated to requires improvement. We found the provider was failing to meet their legal requirements and were in breach of 1 legal regulation. We identified significant concerns in respect of people’s experience of person-centred care. We made observations and reviewed records which failed to demonstrate people received good standards of care to meet their individual needs, preferences and wishes. We were not assured the provider operated effective processes to ensure staff had sufficient information to support people with end-of-life care. We received feedback from people and relatives that there was a lack of meaningful activities and engagement for people and our observations and review of records supported this.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We were not assured people experienced person-centred care. We reviewed the personal hygiene records for a period of 40 days from 1 July to 9 August 2024 and identified significant shortfalls in recordings on the basic care provided to people including bathing, showering and oral hygiene support and was not in line with people’s preferred routines as captured in their care plans. Feedback from relatives in relation to personal care and belongings included, “I don’t think [loved one] gets showered much here.”, “[Loved one] gets a bath once a week.”, “The niggles we have is that sometimes [loved one] has someone else’s clothes on.” We were not assured staff had access to sufficient information to ensure people’s experience of care was person-centred. For example, records lacked sufficient information on people’s life histories, their likes, dislikes and hobbies. One person told us “I don't think staff know what I like or what I like to do, I used to like dancing." We received feedback that people did not always have opportunities to engage in meaningful activities to meet their interests. A person told us, "The doors are locked [front door], I used to be able to go out in my old place. I do go out with staff, we went to the pub at the beach last week that was lovely, but otherwise there's not a lot to do.", and a relative commented, “There used to be activities to stimulate them and once a month entertainment and now nothing”.

During discussions we were not assured people were involved in reviews of their care. Leaders told us, “Monthly reviews are completed by the head of care and residents and relatives are involved 6 monthly; however, this has not happened as yet.”. We discussed the shortfalls we found at this assessment and leaders told us they were aware care plans were not person centred. We could not see any actions had been taken to address this.

We observed limited interaction between staff and people during our on-site assessment. We were present at the service over 4 days and found people had little engagement opportunities. We reviewed people’s records which supported our observations and indicated people had limited social interaction and only task-based activities were recorded such as support with brushing hair, shave, and hair washing. We observed mealtime support provided to a person. During the 40 minutes support was being given, we observed limited interaction between staff and the person and support was not provided with a person-centred approach. This included the failure to explain to the person what their meal was or any attempt to engage the person in a meaningful way. We observed the environment lacked sufficient attention to detail to ensure care provided to people was person-centred and met their individual needs. For example, we saw several clocks were set at the incorrect time and the date and the weather board showed incorrect information. This did not support people, particularly people living with a diagnosis of dementia, whose impairment may impact on their ability to orientate to day, time and season.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We were not assured people always received good quality end-of-life care. For example, we identified a person who was being supported with end-of-life care did not have a call bell that was working. This meant they were unable to call for support in the event they required assistance. We received feedback from a relative that staff had sought information on their loved ones wishes, they told us, “One of them [staff] asked if [relative] had everything in place and they asked my permission if they could contact the funeral directors if anything happens”. However, another relative felt staff did not manage a sensitive conversation well with their loved one and told us, “A nurse turned up out of the blue to discuss a do not attempt cardiovascular resuscitation (DNACPR) with [relative], this scared [relative] to death. Why didn’t they chat with [relative] first to explain, they were so frightened”.

We were not assured staff had sufficient knowledge around people’s preferred wishes when receiving end of life care. Staff were not aware of people's preferred wishes for end-of-life care, and they confirmed care plans did not have detailed information, and some were blank. Out of the 4 staff we spoke with, 3 had not received relevant training to support people with end-of-life care and 1 staff member had received training but told us this was a long time ago.

The provider failed to ensure that there was a robust process in place to ensure people had a detailed advanced care plan in place. At the last inspection we recommended the provider review and embed best practice guidance to support people at the end of their life. At this assessment we found the provider had not made improvements. We reviewed the advanced care plans for 4 people and found they did not contain sufficient information to support and guide staff in how people wanted to be cared for during their end of life journey. For example, records lacked information on whether people had a valid ‘do not attempt cardiovascular resuscitation’ (DNACPR) or ‘Recommended Summary Plan for Preferred name Emergency Care and Treatment’ (RESPECT) form in place. There was no recorded information on people’s choices, their spiritual and cultural needs, their wishes around the levels of involvement of family and friends, reassurance about pain management, or rapid support to anticipatory medicines.