CQC report explained · a residential care home
What the CQC found at Elizabethlodge
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found safe recruitment, enough staff, effective safeguarding, safe medicines management and suitable arrangements for managing risks, accidents and infections.
- Effective?
- Good
- People's health, dietary and communication needs were supported. Staff had relevant training and worked with health professionals. Some care plans were still being updated to make them more person-centred.
- Caring?
- Good
- This key question was not inspected during this focused visit. Its rating was carried forward from the previous inspection.
- Responsive?
- Good
- This key question was not inspected during this focused visit. Its rating was carried forward from the previous inspection.
- Well-led?
- Good
- Managers were visible and approachable. They carried out audits, acted on improvements and worked with health and social care professionals.
What inspectors found, June 2022
Rated Good; inspectors found safe, kind care and clear improvements since the last inspection, although some care plans were still being updated.
Inspectors made an unannounced, focused visit on 25 May 2022. They spoke with four people, eight relatives and five staff. They also spoke with managers and reviewed care records, staff recruitment files, risk assessments and quality checks.
The home was rated Good for Safe, Effective and Well-led. Inspectors found enough staff, safe recruitment, safe medicines management and suitable infection control. People were treated kindly and staff understood their individual needs.
The inspection checked whether the home had completed its action plan after the previous inspection. Inspectors found that improvements had been made and that the home was no longer in breach of regulations.
This report did not inspect Caring or Responsive. Their ratings were carried forward from the previous inspection when calculating the overall Good rating.
Safe staffing
Inspectors found sufficient staff and safe recruitment checks. Relatives also described a stable team and good relationships with staff.
“People were supported by sufficient numbers of staff.” from the report
Kind and personal care
Staff were described as kind, understanding and compassionate. They knew people's individual needs and supported their communication.
“Staff were kind, understanding, and compassionate.” from the report
Safe medicines
Medicines were managed using care-plan information, clear protocols, staff competency checks and regular audits.
“Medicines were managed safely, Information regarding the support the person needed with their medicines was recorded within their care plans.” from the report
Improved management
Managers used audits, meetings and feedback to improve the service. The home was no longer in breach of the regulations identified at the previous inspection.
“The provider acted on their findings to improve the quality of care.” from the report
Some care plans needed updating
needs fixingSome care plans did not yet reflect fully person-centred care. Managers said they were updating the remaining plans.
“Some of the care plans had not reflected person centred care, the registered manager told us they were in the process of making care plans person centred,” from the report
- 01Have all care plans now been made person-centred, and how are they reviewed when someone's needs change?
- 02How do you check that staffing levels remain sufficient on every shift?
- 03How are relatives told about changes in a person's needs or incidents?
- 04How do you check that medicines remain safe, including 'as required' and refused medicines?
- 05How do you involve a person and their representatives in best-interest decisions when the person cannot decide for themselves?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their ratings were carried forward from the previous inspection. This explanation was written from the published report of 22 June 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.
What inspectors found, November 2019
Elizabethlodge rated Requires Improvement; inspectors found kind, personalised care, but problems with recruitment checks, consent records and oversight.
This was an unannounced inspection on 10 and 11 September 2019. One inspector spoke with people living in the home, relatives, staff, the manager and the provider. They also checked care records, staff recruitment files, risk assessments and management records.
The home provided care and accommodation for 16 older people, with places for up to 18. People were treated kindly, their privacy was respected, and care was generally personalised. Staff supported people with food, drink, activities, healthcare and end of life choices.
However, some important checks were not reliable. New staff could start before required safety checks were complete. Bedroom alarms were used without recorded best interests decisions for people who could not consent. Audits had not found these problems, and some medicine instructions and safety assessments were incomplete.
The overall rating was Requires Improvement. Safe, Effective and Well-led were rated Requires Improvement, while Caring and Responsive were rated Good. The previous overall rating was Good, published on 3 March 2017.
Kind and respectful care
People and relatives described staff as caring and supportive. Inspectors saw staff respecting privacy, dignity and personal choices.
“People felt cared for and were treated well.” from the report
Personalised activities and care
Care plans described people's needs, communication and choices. The activities co-ordinator offered group activities and individual time for people who preferred to stay in their rooms.
“The activities co-ordinator undertook group activities but also spent time with people in their rooms if they chose to stay there.” from the report
Food and drink choices
People could choose meals, where they ate and, when needed, different foods or meals at different times.
“People were supported to eat and drink enough and had a choice of meals.” from the report
Support in health emergencies
Staff knew people well and acted when they noticed signs that someone was seriously unwell, including calling emergency services when needed.
“This meant people received the emergency health care they needed.” from the report
Recruitment checks
seriousNew staff could start before Disclosure and Barring Service or Adult First checks were complete. Some application forms also lacked employment or identity information.
“The lack of a safe and effective recruitment procedure was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Bedroom alarm consent
seriousBedroom movement alarms were used for most people who were not considered able to consent, but formal best interests decisions had not been recorded.
“The lack of a system to ensure best interests decisions were in place was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Weak quality checks
seriousThe home's audits did not identify the recruitment and consent problems found during the inspection. This was a breach of the good governance regulation.
“The lack of an effective system or process to ensure compliance with the requirements of the regulations was a breach of Regulation 17 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Medicine instructions
needs fixingSome people had as-required pain relief without care plans explaining when it should be offered. Instructions for medicines given covertly did not explain how to make sure the full dose was received.
“There were not any PRN care plans in place to ensure staff offered the medicines consistently and appropriately.” from the report
Safety and privacy details
needs fixingA boiler cupboard was unlocked and equipment blocked access to a fire extinguisher until this was pointed out. Lists showing who had received a bath or shower could compromise privacy.
“This could compromise people's privacy or confidentiality.” from the report
- 01Have all new staff recruitment checks, identity details, employment histories and references now been completed before staff work with residents?
- 02How are bedroom movement alarms now agreed through recorded best interests decisions for people who cannot consent?
- 03What new audits or checks are used to identify problems with recruitment, consent, medicines and safety?
- 04How are as-required pain medicines and covert medicines now described in care plans?
- 05How will residents and relatives be given the complaints procedure?
This was an unannounced planned inspection covering all five CQC questions, including accommodation and the care provided. This explanation was written from the published report of 2 November 2019 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 Elizabethlodge
3 rated inspections over 5 years: the service has held its Good rating throughout.
- June 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- March 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 4 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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