Elizabeth House Care Home Adults

At our last inspection on January 2017 we found five breaches of legal requirements. These were breaches of Regulation 12 because the management of medicines was not safe: Regulation 11 because the principles of the Mental Capacity Act 2005 had not been followed: Regulation 17 because there was a lack of effective governance processes and Regulation 18 because staff had not received regular supervision, appraisal or training to effectively undertake their role. We also found a breach of Regulation 18 of the Care Quality Commissions (Registration) Regulations 2009 because the registered persons had not always notified CQC of significant events that happened in the home. The provider was required to send us an action plan telling us what they would do to meet the requirements of the law. They sent this to us and we saw at this inspection improvements had been made.

Elizabeth House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Elizabeth House provides support for up to 20 people with mental health issues and/or learning disabilities. It consists of two large terraced houses knocked into one, situated in a quiet residential area of Portsmouth. The home has 18 bedrooms, two of which are for two people to share. The home has four floors. Offices and meeting rooms are on the lower ground floor; the kitchen, two lounges, the dining room, a smoking room and some bedrooms to the ground floor; and other bedrooms and bathrooms on the first and second floor. There was a stair lift on one short section of stairs between the first and second floor. On the day of inspection there were 18 people living at the home.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service complied with the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLs), and people were encouraged to make choices about their day to day life. However, we found that the recording of mental capacity assessments needed to be improved and we have made a recommendation about this.

People and staff told us they lived and worked in a safe service. All staff had undertaken training in safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and were able to describe what action they would take to protect people from harm.

Risks associated with people’s care were well known by staff, clearly documented in people’s care plans and well managed. Environmental risks were assessed, monitored and measures had been taken to reduce these. The home was clean and infection control procedures were in place.

The management of medicines had improved and was safe.

There were sufficient numbers of staff to meet people's needs and to keep them safe. The provider had effective recruitment procedures in place and carried out checks when they employed staff to help ensure people were safe. Training for staff had improved and staff had the necessary skills to care for people appropriately. Staff were well supported through induction, supervision and appraisal systems.

People told us they received care and support that was very good and was delivered in a way that met their needs and preferences. Staff treated people with dignity and respect and people were supported to be as independent as possible.

People had enough to eat and drink and were complimentary about the food on offer.

People were aware of how to raise a complaint and we saw that complaints had been investigated and resolved. Feedback was encouraged from people, staff and other health professionals and this was used to improve the service.

People and staff said the management of the service was very good. Quality assurance processes had improved and the safety and quality of the service was effectively monitored.

Elizabeth House is a care home for up to 20 people with mental health issues and/or learning disabilities. It consists of two large terraced houses knocked into one, situated in a quiet residential area of Portsmouth. The home has 18 bedrooms, two of which were originally for two people to share. The home has four floors. Offices and meeting rooms are on the lower ground floor; the kitchen, two lounges, the dining room, a smoking room and some bedrooms to the ground floor; and other bedrooms and bathrooms on the first and second floor. There was a stair lift on one short section of stairs between the first and second floor, but no other lift access in the building.

The registered manager told us people no longer wished to share rooms so the home accommodated a maximum of 18 people. One the first day of inspection there were 17 people living at the home, although one moved to a different care home later that day.

Elizabeth House was last inspected in May 2014. At that time it was found to be compliant in all areas examined. This was the first inspection to give the home an overall rating and for the different aspects of care.

The home had a registered manager; he was also one of the partners who acted as registered providers of the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We identified various issues with medicines administration and management. The registered manager, who was responsible for medicines at the home, had not been on medicines training for 20 years.

Most aspects of the building, utilities and equipment had been checked on a regular basis. However, the registered manager had not taken steps to reduce the risk of a Legionella outbreak at the home.

People and their relatives told us there were sufficient staff deployed to meet people’s needs. Our observations on inspection supported this view.

Accidents and incidents had been documented at the home, although records lacked detail about actions taken to prevent further occurrences. Care staff could describe how they supported people with behaviours that may challenge others, and we observed them doing so effectively. However, some people’s behavioural management care plans lacked detail.

People and their relatives told us they thought the home was clean. Whilst the décor of the home was tired in places, we found the home to be clean and odour-free.

Training records could not evidence staff had received the training they needed to meet people’s needs effectively. Whilst staff told us they felt supported, the registered manager had not provided staff with supervision or appraisal since 2015.

The home was compliant with Deprivation of Liberty Safeguards, but not with the Mental Capacity Act 2005 (MCA). This was because people’s ability to consent to care and treatment had not been assessed. Care staff knowledge of the MCA was poor.

People were happy with the food and drinks on offer at the home and told us they had a choice. Records showed people with specific nutritional needs were supported appropriately. People also had access to a range of healthcare professionals in order to help maintain their physical and mental health. The home tracked people’s appointments and supported them to attend them, when necessary.

Interactions we observed between staff and people during the inspection were all positive. All staff, including the management team, knew people well as individuals. People and their relatives told us staff were kind and caring, and promoted people’s independence.

Staff respected people’s privacy by knocking on their bedroom doors prior to entering. We saw staff promoted people’s dignity by supporting them with their personal care and grooming, if they needed it.

Records showed, and people confirmed, they were involved in the design of their care plans. Most people had chosen to sign their care plans and we saw they were reviewed with them on a regular basis.

People had access to advocacy services and had been referred to them when they needed independent support to make decisions.

Risk assessments and care plans were person-centred. Daily records plus bimonthly and annual reviews evidenced people were supported in accordance with them. The home had a transition process for prospective new admissions to the home.

People’s care plans were not based upon a recovery model of mental health. We recommended the registered provider investigate current evidence-based practice around this in order to maximise people’s mental health and independence.

People told us they had enough to do and most opted to pursue their own hobbies and interests. The home provided some activities and organised social events for people. We observed most people chose to go out during the day and returned to the home at mealtimes.

None of the people or relatives we spoke with had made a complaint about the home, but all said they would feel confident approaching a member of the management team to raise concerns if they needed to. Complaints received by the home had been investigated and responded to appropriately.

Feedback about the management team from people and their relatives was all positive. People, their relatives and staff completed biannual satisfaction surveys. Staff attended regular meetings and could share their views about the home.

The registered manager had failed to monitor most aspects of the service for safety and quality. This meant there was no analysis of accidents, incidents or complaints for trends, and issues with medicines administration and management had not been identified and addressed. Some incidents at the home had not been reported to CQC as statutory notifications.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014 and Care Quality Commission (Registration) Regulations 2009. You can see what action we have told the provider to take at the back of the full version of the report.

We also used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

People confirmed they received the support and care they needed.

The home ensured relevant health care professionals were contacted when appropriate.

People were cared for in an environment that was safe, clean and hygienic.

We looked at four staff files to make sure the system in place to recruit staff was safe and protected people from those who may not be suitable to work with them. We saw all files checked complied with legal requirements and this showed care had been taken in appointing these members of staff.

The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

The health and safety of people who lived in the home was being consistently promoted through regular health and safety audits and routine safety tests on all equipment and installations.

Is the service effective?

All people had an individual care plan which set out their care needs. We looked at four individual care plans which we found to be detailed and comprehensive and clearly identified people's needs.

There was evidence in the care records we looked at that demonstrated they had been reviewed and updated each month. This meant that information recorded reflected the current needs of each person.

People told us they were satisfied with the care and support they received. They said that staff gave them the help they needed with things like personal care and getting around. One person said "staff look after me well, they are marvellous".

One person told us "I like living here, if I did not like it, I would have moved out a long time ago".

Is the service caring?

People living at Elizabeth House Care Home were very positive about the staff and management.

We saw people were happy and relaxed during our visit and there were good relationships between the staff and people living at the home. We spoke with two members of care staff who had a good knowledge of the people they cared for. The staff we spoke with told us what would indicate to them a person's needs had changed, and what steps they would take to ensure their needs continued to be met.

People told us they had good relationships with the staff that were described as kind and caring.

Is the service responsive?

We saw that care plans were reviewed regularly by a member of the management team.

It was noted the health and safety of people who lived in the home was being consistently promoted through regular health and safety audits

We saw people were able to participate in a range of activities both in the home and in the local community.

Is the service well led?

There was a clear management structure with good lines of communication and accountability. Staff spoken with were clear about reporting arrangements.

The provider had an effective system to regularly assess and monitor the quality of service people received. We were told by the management team that they 'walked' the service daily which enabled them to be aware of any issues as they arose.

People told us they regularly complete surveys asking for the views on the home.

They confirmed that they talk to one of the management team if they need guidance for anything or have any concerns.

People we spoke with told us they were happy and that they were supported by staff to receive the care they needed. Comments included: 'I am quite happy' and, 'I have lived in other places and this is good.'

We spoke with two members of staff who both told us they liked working at Elizabeth House. One person said 'I like working with people and it's nice to give people the help and support they need'.