ST ELIZABETH

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed a total of 2 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was good. Our rating for this key question has deteriorated to requires improvement. We found the provider was failing to meet their legal requirements and were in breach of 3 legal regulations. We identified significant concerns in respect of people’s care records, this included people’s hydration records, lack of robust records to manage specific health conditions and we were not assured the provider met their requirement to provide person-centred care. The provider failed to demonstrate how they considered best practice guidance where people were living with dementia and the use of nationally recognised tools used to ensure people’s needs were identified and managed were ineffective. The provider had ineffective systems and processes to ensure they met their legal requirements where people lacked capacity to make decisions, and leaders of the service failed to demonstrate they had sufficient knowledge and understanding of their legal requirements.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We received feedback from people that meal choices were limited. People told us they were able to make choices at breakfast, but there were no options provided for the main meal of the day. A relative commented, “[Loved one] is always satisfied with the meals but at the moment he is not eating very much. I don’t think they have a great choice.”.

Staff we spoke with told us that they felt information was missing from people’s care plans such as information around people’s diabetic needs and end-of-life care.

The provider failed to ensure that records in relation to people’s nutritional needs were always completed, up to date or accurate. Where people required monitoring of their fluid intake, we found significant shortfalls in hydration records for people. For example, we reviewed records for 16 people between 26 July 2024 and 9 August 2024 where they had 0mls of fluid recorded and no evidence of what action had been taken. The provider used a range of best practice tools to support them to identify risks to people, however tools were not used effectively or completed to ensure accurate information was used to support people’s assessment. For example, the provider used a Malnutrition Universal Screening Tool (MUST) to support them to identify risk of malnutrition to people, however this was not being completed correctly and we were not assured people requiring additional nutritional support had been appropriately identified. Guidance in people’s care plan around managing their diabetes did not contain sufficient information to enable staff to effectively monitor their condition. This included a lack of detail around how levels should be monitored, when and target ranges for safe management of diabetes. The provider did not demonstrate they had considered all relevant best practice guidance for dementia friendly care environments. For example, we found the home lacked appropriate consideration of orientation for people, including ensuring all people's room doors had their names or signage was accessible. There were no tools in place to support people to make choices around their meals such as visual plates or photos. There was a lack of detail and guidance for staff about people diagnosis, such as dementia. There was a lack of detail around how their dementia affected them and how to support them if their condition deteriorates.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We received mixed feedback from people when asked if staff ask for consent before delivering care and support. This included: "Sometimes they do.", "Yes, I suppose they do." and "No.".

From discussions with leaders, it was clear there was insufficient knowledge of the legal requirements and a lack of understanding of their roles and responsibilities under the code of practice to appropriately assess people's capacity where this was required. The leaders acknowledged this was an area that needed to improve.

The provider failed to ensure the correct procedure was followed in relation to the Mental Capacity Act 2005 (MCA). We found multiple examples where people's capacity had not been considered where relevant to do so, and where acts were being carried out in people's best interest. Specific decisions for people included accommodation, consent to care, medicines, welfare checks and where they were prescribed a modified diet. Where people had capacity to consent to their care and treatment, the provider could not demonstrate that they consistently sought consent to deliver peoples care in line with their requirements. We were not assured the provider consistently met their legal requirements where people were deprived of their liberty. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Where the provider made applications for people to have a DoLs authorisation by the supervisory body, there was no evidence that the provider had acted in accordance with the MCA and undertaken an assessment of capacity or provided support to enable people to make their own decisions. We reviewed training records for staff and found there were shortfalls in Mental capacity and consent training.