CQC report explained · a residential care home
What the CQC found at Elizabeth House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff, safe medicines systems, suitable risk assessments and good infection control. The home had improved its staffing and was no longer in breach of the regulation identified at the previous inspection.
- Effective?
- Requires improvement
- Staff had training and worked well with healthcare professionals, and people's health, food and drink needs were met. However, capacity assessments and consent processes were inconsistent and did not always relate to specific decisions.
- Caring?
- Good
- People, relatives and healthcare professionals described staff as kind, caring and compassionate. Inspectors saw people being treated with dignity and respect, with their privacy and independence supported.
- Responsive?
- Good
- Care plans were personalised and reviewed, and people could influence their care. The home offered varied activities, supported contact with family and friends, and dealt with complaints according to its policy.
- Well-led?
- Good
- Inspectors found a positive, person-centred culture and visible management. Audits and action plans were used to improve the service, and the previous concerns about records, staffing flexibility and management oversight had been addressed.
What inspectors found, May 2018
Elizabeth House was rated Good overall; inspectors found kind, safe and responsive care, but consent and capacity checks needed improvement.
This was an unannounced inspection on 28 February 2018. Inspectors spoke with 21 people, eight relatives, nine staff and three members of the management team. They reviewed care records, medicines records, staff records, audits and incidents. They also observed care, medicines, meals and activities.
The home was rated Good overall. Safe, Caring, Responsive and Well-led were rated Good. Effective was rated Requires Improvement because staff did not always follow the legal process for checking whether people could make particular decisions and for recording consent.
The home had improved since the previous inspection in February 2017. Staffing levels and management checks had improved, and the home was no longer in breach of the regulations identified then. Inspectors found people were treated with kindness and dignity, had access to activities and healthcare, and were supported by staff who knew them well.
Kind and respectful care
Staff were consistently described as kind and caring. Inspectors observed warm interactions and found that people's dignity, privacy and independence were respected.
“People and relatives consistently told us that staff were kind and caring and that people were treated with kindness and compassion.” from the report
Improved staffing
There were enough staff to meet people's needs at the time of inspection. Staffing levels had increased since the previous inspection, and temporary staff were used from only two agencies to support continuity.
“By ensuring that people's needs were appropriately assessed and aligned with others and by increasing staffing levels, the registered manager had ensured that staffing levels were safe.” from the report
Personalised activities
People had a wide choice of activities and were supported to follow individual interests. Inspectors saw meaningful conversations, music, gardening and other activities taking place.
“People were not at risk of social isolation and enjoyed access to a range of activities and stimulation.” from the report
Good management oversight
The management team used audits, action plans, feedback and learning from incidents to improve the home. Management was visible and staff said they felt supported.
“Good quality assurance processes ensured the delivery of care and drove improvement.” from the report
Some care records were incomplete
minorSome topical cream application charts had not been completed, although other records indicated that staff had provided the support. The manager had raised this with staff and was working to improve record keeping.
“Records showed that not all records had been completed, such as people's topical cream application charts.” from the report
- 01How will you complete capacity assessments for each specific decision my relative may need to make?
- 02How do you involve relatives, advocates or other relevant people in best-interest decisions?
- 03How do you check and record that someone claiming lasting power of attorney has the legal authority to make decisions?
- 04What checks now make sure topical cream charts and other care records are completed accurately?
- 05How will you review staffing levels if my relative's needs change?
This was a full inspection covering all five CQC questions, including care, staffing, medicines, records, activities and how the home was managed. This explanation was written from the published report of 4 May 2018 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. The report was longer than we could read in one go; the later sections may not be reflected.
What inspectors found, March 2017
Rated Requires Improvement; inspectors found kind and responsive care, but staffing and care records were not reliable enough.
Inspectors visited unannounced on 14 and 17 February 2017. They spoke with people living at the home, relatives, staff and health and social care professionals. They observed care and checked care records, medicines, staff files, rotas, audits and complaints.
The home was rated Good for Effective, Caring and Responsive. People were treated with kindness and respect, staff understood dementia care, people received suitable food and healthcare, and activities had improved.
The home was rated Requires Improvement for Safe and Well-led. Staffing could not be increased quickly when people's needs changed. Inspectors also found gaps and inconsistencies in care records, including records about oral care, creams and skin injuries.
Two regulations were breached. The provider was asked to take action and send a report explaining what it would do. The previous breach about managing risks had been met, and activities had improved since the last inspection.
Kind and respectful care
Inspectors saw staff showing patience and compassion. People and relatives said staff treated them with dignity and knew them well.
“Throughout our visit we saw that people were treated with respect. Staff were caring and showed compassion.” from the report
Improved activities
The home offered group activities and one-to-one time. Inspectors found that activity provision had improved since the previous inspection.
“At this visit, we found that activity provision had improved.” from the report
Staff training
Staff had training in areas including dementia care, safeguarding and moving and handling. They also received supervision and appraisal.
“Staff received training to enable them to provide effective support to people.” from the report
Safe medicines systems
Inspectors found clear records of medicines being given, and staff had training and competency checks.
“Medicines were managed safely.” from the report
Staffing was not flexible enough
seriousStaffing levels did not change quickly when people's needs increased. Inspectors saw communal areas without staff supervision and people were not always supported to use walking aids.
“There were not always sufficient numbers of staff on duty to keep people safe.” from the report
Incomplete care records
seriousSome records did not accurately describe people's current needs. Records of oral care, creams and skin injuries also had gaps.
“Records relating to the care delivered were not always complete.” from the report
Slow action on known improvements
needs fixingAudits had identified record-keeping problems, but action had not always been completed promptly. The new care plan system was still being introduced during the inspection.
“The provider had not always ensured that timely action was taken in response to areas of concern.” from the report
Some guidance lacked detail
needs fixingGuidance for some as-needed medicines did not explain clearly how a person's condition would appear. Staff later received written pharmacy guidance for one medicine.
“We found that guidance on some PRN medicines lacked detail.” from the report
- 01How do you now review staffing levels when a person's needs increase, such as when someone is at high risk of falling or receiving end-of-life care?
- 02How do staff make sure communal areas are supervised and that people have their walking aids when needed?
- 03Have all care plans been transferred accurately to the new format, and how are changes checked?
- 04How do you now check that oral care, topical creams and skin injuries are recorded every time?
- 05What action was taken in response to the two breached regulations, and when was it completed?
This was an unannounced inspection covering all five CQC questions; the previous breach about risk management had been met and activities had improved since the November 2015 inspection. This explanation was written from the published report of 31 March 2017 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 House
3 rated inspections over 2 years: the service has improved, from Requires improvement to Good.
- May 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- March 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- October 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 17 December 2010.
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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