Elizabeth House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The provider had failed to adequately address concerns identified at the last inspection and act on further feedback from other professionals who had visited the service. The provider had failed to have sufficient oversight of the quality and safety of care. Staff were task focused and care was not always person-centred. While there were many caring and kind interactions, staff needed to be more mindful of their approach with people and to ensure there was a person-centred culture. The provider had failed to recognise and address this. The provider had failed to sufficiently train staff to ensure they always supported people appropriately. Records were sometimes inaccurate or did not have enough detail and this had not been fully identified and action taken to address this omission. Systems in place to management medicines were not always effective. These concerns had left people at ongoing risk. Staff were complimentary of teamworking and the support from the management team. Staff felt able to raise concerns. While the provider had not addressed concerns from other professionals in a timely manner, the provider was open to feedback and working in partnership. The provider and registered manager were approachable and knew people and relatives well.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received no feedback from staff in relation to Shared direction and culture.

The provider had failed to recognise and address the culture that had developed in the service. Their ineffective oversight and leadership meant people had been exposed to poor culture and care that was not always person-centred. While there were many caring interactions between staff and people, some improvements were needed. Staff were not always mindful of the terminology they used or how they interacted with people. Staff did not always explain each step of the support they were giving to people during moving and handling. Staff failed to always refer to people in a respectful way and did not always offer people choices. Staff were not always positive in their approach with people showing there was not an appropriate and person-centred culture in the service. Staff were not always supporting people to eat in appropriate ways, with 1 staff member supporting multiple people at the same time, not interacting with people and using an electronic device to record people’s care rather than engaging with them. This was not a positive culture and not supporting people in a person-centred way.

Staff were complimentary of the management team. One staff member said, “Management are visible at the home, and I feel they are supportive.” Another staff member said, “I like working at the home, it is a good staff team, and we work together well. I feel very supported by management.” Another staff member also said they felt supported. The provider clearly knew people and their relatives well. They knew people’s names, their relatives names and their individual situations.

Leaders at the service had not displayed that they were capable of making improvements to the service. There were widespread concerns within the service, as detailed in our safe and effective evidence. Due to this, we could not be sure leaders had the skills and experience to consistently recognise and address things, if they went wrong. Systems were in place to ensure that staff were supported. There were staff meetings and supervisions in place to support staff and to give them the opportunity to feed back. Some people who used and visited the service described the leaders as approachable. One person said they would go to the provider if they needed to report any concerns. One relative said, “I would speak with the owner or management. I see the owner in the home a lot.”

Staff felt able to raise concerns and felt the management team were approachable and supportive. One staff member gave an example of how they had raised an area for improvement, and they said the management raised this in a staff meeting and this improved.

There were mechanisms in place for staff to feedback. However, we could not be sure staff would always recognise poor practice or concerns to be able to report them. A poor culture had developed in the service, and this had not been recognised or challenged. Therefore, we could not be sure effective improvements would be made.

Staff said they were supported to complete their training in a way that was suitable for them, when they had needed additional support with this.

The provider had determined staff did not need equality and diversity training, according to the provider’s training matrix. This meant the provider had failed to follow best practice in relation to training staff in this area.

Staff did not share any feedback with us about Governance and assurance.

The registered manager managed multiple services. Whilst this was allowed, it was not clear how involved they were in the day-to-day management of the service. There were a number of management team staff to support the service. However, there were not clearly defined roles and responsibilities, so it was not clear who was supposed to complete different management tasks. The provider had failed to have sufficient oversight of the quality and safety of care. Concerns and areas for improvement had not been identified and action not taken to keep people safe. Medication audits were poorly completed and failed to identify the extent of concerns the CQC and the local authority had identified. Incidents had not always been effectively recorded and action not always taken. For example, 1 person had fallen and there were no incident and accident forms about this, it had only been recorded in care notes. Another person had been in discomfort following being supported by staff and there were no incident forms or body maps completed. The reviews of accidents and incidents only reviewed specific forms and not care notes, so there was a risk this would be missed. In addition to this, the providers accident and incident audit was of poor quality and failed to fully analyse all information appropriately. This showed the provider’s systems were ineffective which put people at risk. One person had been assessed as having capacity to make decisions and this had been reviewed recently. However, another record documented they did not have capacity, and restrictions had been imposed on them. This showed the provider failed to understand the Mental Capacity Act 2005 and systems had failed to identify the concerns in the person’s care records. There was no clear process to effectively monitor and escalate concerns in relation to people’s lack of bowel movements. The process to report concerns and to check the home environment had not been effective at identifying and addressing concerns.

People had access to other health professionals. People and relatives told us they felt staff would get input from medical professionals.

One staff member told us they felt the home was improving due to visiting professionals, they said, “The service is improving with the input from the local authority.”

A visiting health professional told us staff were able to answer their questions about people and they followed their advice. However, the same visiting professional also told us they felt staff needed more training to support people with dementia and people did not seem to partake in activities. The local authority had visited the service a number of times to check the quality of the service and had found concerns. They fed these concerns back to the management team to prompt a response and improvements.

We found swift action had not always been taken to address concerns from visiting professionals. For example, we continued to find multiple people being supported by 1 staff member at lunch time, and a clear bowel monitoring process had not been established, PRN protocols (although they had been reviewed) were still not always sufficient, some dried flowers which had been identified as a risk to 1 person had not been reviewed or removed and there continued to be ongoing issues with the management of people’s medicines. As there were not always effective systems in place to monitor and escalate concerns, we could not be sure appropriate referrals to other professionals would be made in a timely manner. The provider had failed to act on and address areas for improvement which had been highlighted by other professionals for an extended period of time. They had failed to recognise the amount of work which was needed to make improvements.

While the initial action taken to address concerns had not been fully effective, the provider remained approachable and willing to listen to feedback. They acknowledged they had not always got things right. The provider had relied on external professionals to identify and feedback areas to address. Following extensive feedback over an extended period of time, the provider engaged an external consultant to support the home. This was initially to cover a period of annual leave in the management team, however following continued feedback from external professionals, this support was extended to have a more hands on and in-depth approach.

The provider had failed to address concerns identified by the CQC at the last inspection in November 2023. The local authority had also visited the service earlier in 2024 where they had identified actions to complete to make improvements to the service. The local authority then returned in June 2024 to follow up and check progress had been made against the actions. However, effective progress had not been made and the local authority decided to increase the frequency of their visits to check on the safety of people. The local authority felt they needed to continue with this for a number of weeks due to the provider’s failure to effectively make the necessary improvements.