CQC report explained · a residential care home
What the CQC found at ST ELIZABETH
Rated Inadequate: inspectors found the home performing badly and the CQC has taken enforcement action.
What inspectors found, June 2021
Rated Good; inspectors found improved safe, kind and personalised care, with more work needed on end-of-life plans and some records.
This was an unannounced focused inspection on 29 April 2021. One inspector spoke with people, relatives, staff and other professionals. They observed care and a mealtime, and checked care, medicine, staffing, recruitment and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found improvements in risk assessments, medicines, infection control, staffing, activities, consent and quality checks.
The home had previously been rated Requires Improvement in May 2019 and had breached several regulations. At this inspection, inspectors said the provider was no longer in breach. They still found that end-of-life plans needed more detail, and that some care records and staff training needed further improvement.
Safer care systems
Risk assessments, medicines management and infection control had improved. Staff understood safeguarding and how to respond when things went wrong.
“The service had made improvements to risk assessment processes and management systems which meant people were protected from the risk of avoidable harm.” from the report
Kind and respectful staff
Inspectors saw staff respond to distress and support people with kindness, dignity and compassion. People and relatives spoke positively about the staff.
“Staff consistently acted with kindness and compassion towards people.” from the report
Personalised support
Care plans reflected people's personalities, preferences and support needs. Activities had become more individual and staff spent more one-to-one time with people.
“Activities had been adapted to be more reflective of people's individual needs and preferences.” from the report
Some records needed simplifying
minorSome care plans contained information that was out of date or spread across different sections. The home had identified this in its improvement plan.
“Some aspects of record keeping required further improvement, for example, to ensure care plans were simplified and clear.” from the report
Some training was overdue
needs fixingSome training was out of date because of pandemic restrictions. The manager had identified this and set actions to address it.
“Some training was out of date due to restrictions during the pandemic, however this had been identified on the service improvement plan with clear actions to address.” from the report
- 01How will you make sure my relative's end-of-life wishes are recorded in enough detail?
- 02What is the timetable for simplifying and updating care plans and other records?
- 03Which staff training is overdue, and when will it be completed?
- 04How will you protect my relative's privacy when staff discuss personal care or medicines?
- 05Has the new manager's application to register with the CQC been completed?
This was an unannounced focused inspection to check improvements after the previous inspection and included infection prevention and control under the Safe question. This explanation was written from the published report of 26 June 2021 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, May 2019
ST ELIZABETH was Rated Requires Improvement; inspectors found risks with medicines, staffing, consent, activities and quality checks, and issued a warning notice.
This was an unannounced inspection over two days in February 2019. Two inspectors visited the home, spoke with people, relatives, staff and professionals, and checked care records, medicines, training, complaints, incidents, audits and the building.
The home was not consistently safe or meeting people's needs. Inspectors found incomplete risk assessments, unsafe medicines practices, infection control problems and times when there were not enough staff. People's capacity to consent was not always assessed, and some restrictions had not been properly authorised.
All five areas were rated Requires Improvement. The provider breached five regulations. Inspectors also made recommendations about dementia-friendly buildings, current guidance and staff training. The provider updated one choking risk assessment and carried out further capacity assessments after the inspection.
Clean environment
The home and kitchen were clean and tidy, and people appeared clean and well cared for.
“The home, including the kitchen was clean and tidy. People appeared clean and well kempt.” from the report
Kindness from staff
Inspectors saw staff supporting people who were upset or anxious, and found that staff often knew people's preferences.
“Staff knew people well. They were gentle, polite and treated people with kindness.” from the report
Privacy and dignity
Staff generally protected people's privacy when entering rooms and discussing personal care.
“Staff knocked before entering rooms and spoke quietly and respectfully when discussing people or asking people about personal care.” from the report
Family relationships
The home had established relationships with families and involved them in day-to-day life and important decisions where appropriate.
“The service had good, long term relationships with people and their families.” from the report
Medicines and infection control
seriousMedicines records were unclear and included omissions. Staff did not always wash their hands or use gloves between people, increasing the risk of infection.
“Safe infection control procedures and medicines management procedures were not consistently applied or followed.” from the report
Staffing and supervision
seriousThere were times when no staff were present when people needed supervision, including during a falls risk and an incident involving agitation. Recruitment checks were also incomplete.
“There were not sufficient numbers of suitable staff deployed to keep people safe and meet their needs.” from the report
Activities and independence
needs fixingPeople did not have enough regular, meaningful activity. Poor signage and a lack of dementia-friendly adaptations made it harder for people to find toilets, bedrooms and other areas independently.
“People's needs were not being met as they did not have sufficient activity to meet their needs and preferences.” from the report
Quality monitoring
seriousAudits and checks were not strong enough to identify and correct unsafe or poor-quality care promptly. Records were sometimes incomplete or out of date.
“The lack of robust quality assurance measures meant poor quality and unsafe care might not be identified and addressed, putting people at risk.” from the report
- 01How do you now check that each person's risk assessment is complete, current and followed by staff, especially for choking and falls?
- 02What checks now make sure medicines are given as prescribed, records are accurate and staff are competent to administer them?
- 03How do you calculate safe staffing levels, and how do you ensure people are supervised when staff are working in different areas?
- 04Which residents have had capacity assessments and the correct authorisations for restrictions, including any covert medicines?
- 05What regular activities are now available for each person, and what changes have been made to signs and dementia-friendly adaptations?
This was an unannounced planned inspection of the overall service, including the care provided and the premises, and it assessed all five CQC questions. This explanation was written from the published report of 1 May 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 ST ELIZABETH
2 rated inspections over 2 years: the service has improved, from Requires improvement to Good.
- June 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2019Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2018
Registered with the Care Quality Commission on 28 March 2018.
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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