CQC report explained · a nursing home
What the CQC found at Elizabeth Court
Rated Inadequate: inspectors found the home performing badly and the CQC has taken enforcement action.
What inspectors found, February 2023
Elizabeth Court rated Requires Improvement; inspectors found medicines and management systems were not reliable enough, although some improvements had been made.
The CQC carried out an unannounced focused inspection on 19 and 21 October 2022. Inspectors spoke with 10 people using the service, a visiting family member and seven staff. They also reviewed care, medicines and management records.
The home had enough staff to meet people's needs. Safeguarding systems, risk assessments, environmental checks and infection control had improved. Staff worked with health professionals, and most mental capacity and safeguarding training was up to date.
There were important problems with medicines. Some paraffin-based creams were stored unsafely, information for medicines given when needed was missing, and a medicines audit could not be found. Records about care, care plan reviews and risks were also not consistent or detailed enough.
The overall rating remained Requires Improvement. Safe and Well-led were both rated Requires Improvement. The home had a new manager and an improvement plan, but the provider was still in breach of regulations 12 and 17.
Enough staff
Inspectors found enough staff were available to meet people's needs.
“Sufficient staff were available to meet people's needs.” from the report
Infection control improved
The home had improved its infection prevention and control arrangements and was supporting visits and safe admissions.
“We were assured that the provider was preventing visitors from catching and spreading infections.” from the report
Safeguarding systems
Systems were in place to protect people from abuse and record safeguarding concerns.
“Systems were in place to protect people from abuse.” from the report
Improvement plan
The new manager had an improvement plan and was carrying out audits to identify changes needed.
“The manager was working to an improvement plan to make changes to the service.” from the report
Health support
Staff worked with district nurses, GPs and the local frailty team to support people's health needs.
“Staff worked with local health care agencies to support people with their health needs.” from the report
Weak management checks
seriousManagement systems did not identify or correct problems with medicines, care records, care plan reviews and risk monitoring. Inspectors said this placed people at risk of harm.
“Systems were either not in place or robust enough to demonstrate people's health were effectively monitored.” from the report
Incomplete recruitment records
minorFive staff files were missing required information. The CQC recommended that the provider review its recruitment practice.
“Five staff recruitment files were found to be missing a piece of required information.” from the report
Uneven staff interactions
minorStaff interactions were warm and positive on the ground floor, but were sometimes brief, directional and focused mainly on tasks on the first floor.
“However, interactions on the first floor were on occasion minimal, directional and task based.” from the report
- 01How are paraffin-based creams now stored, and what risk assessments are in place for them?
- 02How do you make sure instructions are available for medicines given when needed or in variable doses?
- 03When was the most recent medicines audit completed, and can you explain what it found?
- 04How are care records, care plan reviews and risk assessments checked for accuracy and detail?
- 05What progress has been made with the improvement plan since the new manager started?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive were carried over from the previous inspection. This explanation was written from the published report of 3 February 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, March 2022
Elizabeth Court is rated Requires Improvement; inspectors found caring staff and safe staffing, but concerns about visiting, medicines records and oversight.
This was an unannounced inspection on 28 January and 08 February 2022. Inspectors spoke with two people, seven relatives and 12 staff. They observed care and checked care plans, medicines records, staff files and management records.
The home was not always safe or well-led. During a COVID-19 outbreak, indoor visits were stopped except for people at the end of life. The home had not properly involved people or families in decisions about visiting. Records about risks, care, fluids and prescribed creams were also not always complete or properly checked.
There were also positive findings. Staff knew people well and treated them kindly. Staffing levels were safe, recruitment checks were completed, and systems were in place to protect people from abuse and review accidents.
The overall rating changed from Good at the previous inspection to Requires Improvement. The Safe rating changed from Good to Requires Improvement. Well-led remained Requires Improvement.
Kind, familiar care
Staff knew people well and inspectors observed caring interactions. Relatives also spoke positively about the care.
“People were treated in a caring manner by staff who knew them well.” from the report
Safe staffing
Inspectors found staffing levels were safe. Recruitment checks were completed for permanent and temporary staff, and agency workers were used consistently.
“Staffing levels were safe. We reviewed rotas. Where agency was used, workers were consistent, which helped to ensure people received continuity of care.” from the report
Protection from abuse
Staff had safeguarding training and knew how to raise concerns. Safeguarding referrals and investigations were recorded.
“People were protected from the risk of abuse; policies and procedures supported this.” from the report
Infection control measures
Inspectors were assured about several infection control arrangements, including PPE, testing, admissions and hygiene practices.
“We were assured that the provider was using PPE effectively and safely.” from the report
Visiting during the outbreak
seriousIndoor visits were stopped during a COVID-19 outbreak except for people at the end of life. People and families were not properly consulted about their wishes or involved in decisions.
“All indoor visits to the service had been stopped; unless a person was receiving care at the end of their life.” from the report
Incomplete medicines records
seriousThere was no system to record when prescribed creams were given. Inspectors could not be assured that people received all their medicines as prescribed.
“There were no systems in place to record the administration of prescribed creams.” from the report
Risk and care records
needs fixingSome care plans did not identify risks linked to COVID-19, and records about fluid monitoring were not being properly checked. This could delay identifying risks.
“Whilst we found no evidence people were dehydrated, records were not being suitably monitored to identify risks in a timely way.” from the report
Weak management checks
seriousAudits did not identify important gaps in care plans and medicines records. The home had not made the improvements recommended at the previous inspection.
“Audits and regular checks to review the quality of care being delivered were not always effective.” from the report
- 01What individual visiting arrangements are now in place if there is another COVID-19 outbreak?
- 02How do you record and check that prescribed creams have been given as directed?
- 03How are care plans and risk assessments checked to make sure they reflect each person's current needs?
- 04How are fluid monitoring records reviewed, and what action is taken if records show a possible risk?
- 05What action has been completed in response to the breaches of Regulations 9 and 17?
This inspection began as a targeted COVID-19 outbreak inspection and was widened to focus on Safe and Well-led; the report did not give fresh ratings for Effective, Caring or Responsive. This explanation was written from the published report of 12 March 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Elizabeth Court
7 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- February 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2022Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- February 2021Goodup from Requires improvementSafe: GoodWell-led: Requires improvement
- December 2019Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- August 2019Inadequatestayed InadequateSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- February 2019Inadequatedown from GoodSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- June 2016GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- March 2014
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 28 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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