Elizabeth Court is a care home that is registered to provide accommodation and personal care for up to 59 older people. 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. The home is set out over three floors with easy access between floors via a lift. There are five separate living areas each with their own dining room and communal lounges.

This unannounced inspection took place on 25 July 2018. At the time of our inspection 39 people were living in the home.

There was a registered manager 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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection.

We last inspected this service in August 2017 where we carried out a focused inspection to check action had been taken in response to some enforcement action we had taken following our inspection in March 2017. In March 2017 we identified breaches of Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to person-centred care, medicines and risk assessments, good governance and staff deployment. We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 as the registered manager had failed to notify us of significant events that had taken place in the service.

At our focused inspection in August 2017 we found the service had started to improve, however we felt those improvements needed to be embedded into the service. A new manager had just started at the service at that time and they subsequently registered with CQC. We used this inspection to check improvements had been sustained and continued progress had been made. We found the registered manager had made significant improvements to the service and as such our concerns in relation to medicines management, staff deployment, risk assessments, activities, record keeping, good governance and notifications had been addressed.

Information for people was provided in a way they would understand and where there were restrictions in place staff followed the principals of the Mental Capacity Act 2005 (MCA). We did identify however that some documentation was a bit muddled in that some people had best interests decisions despite having capacity make decisions and have made a recommendation to the registered provider in this respect. People’s care plans were detailed and where a person’s needs changed staff responded to this. However, we did find some further work was needed to ensure people’s end of life wishes were recorded. We have made a recommendation to the registered provider in this respect.

People’s medicines were handled in a safe way by staff and people received the medicines they required. We saw staff attending to people’s needs on the day in a prompt way which demonstrated a sufficient number of staff were deployed at the service.

People were cared for by staff who were kind, caring, attentive and showed respect towards them. People could have privacy when they wished it and they were given the opportunity to contribute to their care decisions.

People were cared for by a consistent staff team who felt supported by the registered manager. Staff had access to the training and supervision they required in order to carry out their role. It was clear the culture within the service was good as staff worked well together. Staff met on a regular basis to discuss all aspects of the service.

Staff ensured people had access to health care professionals when they needed it as well as to a range of nutritious foo

Elizabeth Court is a purpose built home providing care and accommodation for a maximum of 59 old people, some of whom are living with dementia. There were 48 people living in the home on the day of this inspection.

The inspection took place on 9 August 2017 and was unannounced.

The home did not have a registered manager. 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. Since our last inspection, the manager who was present on the day had left the service and a new manager had been recruited. The new manager would be commencing with their application to CQC to become registered manager.

We carried out a comprehensive inspection of this service on 2 March 2017 where we found five breaches of legal requirements. One breach relating to good governance within the home was a continued breach and as such we issued a warning notice to the registered provider. We gave the registered provider until 30 June 2017 to become compliant in the areas covered in our warning notice. This included deployment of staff, maintaining contemporaneous records, acting on shortfalls identified in quality assurance audits and responding to feedback received from people living in the home.

Following that inspection, the provider’s regional and district manager’s provided us with monthly action plans to inform us of their progress against the areas we identified. We undertook this focussed inspection to check that they had followed their plan and to confirm that they now met the legal requirements. This inspection found that the registered provider had partially met the requirements of the warning notice. We spoke with the district manager and manager at the end of the inspection in relation to our findings. We informed them we will be carrying out another comprehensive inspection sooner than scheduled to check that they have fully addressed all areas.

This report only covers our findings in relation to the leadership of the service. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Elizabeth Court on our website at www.cqc.org.uk.

The management and staffing team at Elizabeth Court had been working hard to improve the standard of record keeping across the service. However we found there was still a lack of contemporaneous record keeping for people. Some of this was down to the time team leaders had available to them to review and update the care plans. Deployment of staff within the home was better managed and staff told us they felt things had improved with regard to the support they received from team leaders and senior staff.

There were much improved systems in place to regularly audit and improve the service delivered. Where shortfalls had been identified we saw that action had been taken.

People were able to give their feedback and where people made suggestions in regard to the service, we heard from them that they had been listened to. Activities had improved slightly in that an external outing had taken place and a further two had been organised, however more focus was needed to help ensure people had access to activities that interested them.

Elizabeth Court provides residential care for up to 59 people who are elderly, frail or are living with dementia. At the time of our inspection there were 49 people living in the home.

This was an unannounced inspection which took place on 2 March 2017.

The home was without a registered manager. 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. There was a new manager in post who had started the process of applying to register with CQC.

We carried out an inspection to Elizabeth Court in March 2015 where we found breaches in relation to staff not following the requirements of the mental capacity act and a lack of contemporaneous records held about people. Following that inspection the provider sent us an action plan on how they planned to address our concerns. We carried out this inspection to check that the provider had taken the appropriate action. We found improvements had been made, however we identified concerns in other areas during this inspection.

There was a lack of appropriately deployed staff to meet people’s needs and staff did not feel valued or supported. People were not provided with enough activities to keep them stimulated and there was a lack of opportunity for people to go on outings. People’s individual preferences in the way they wished to be cared for were not always recognised by staff and people may not receive responsive care because information relating to their needs was not always included in their care plan.

Staff did not follow safe medicines practices and where people were at risk of harm these risks had not always been addressed or recognised by staff. Regular audits of the service were carried out to review the quality of the service provided. However, not all actions identified were addressed.

The manager and provider had not always notified CQC of important events, such as safeguarding notifications. Accidents and incidents were not monitored to identify trends relating to people.

A complaints policy was in place and people knew how to make a complaint. Residents and relatives told us they were involved in the running of the home through residents and relatives meetings. However we noted recurrent issues raised by residents/relatives which had not all been resolved.

People were cared for by staff that were attentive and showed kindness and empathy towards them. People’s dietary needs were respected by staff and should they have a change in their health needs, staff engaged advice and input from appropriate healthcare professionals. People were supported to maintain relationships with people who were important to them.

Staff understood the requirements of the Mental Capacity Act 2005. Staff ensured people were supported to make their own decisions and these were respected by staff. Training was provided to staff and staff received supervision and staff appraisals.

Staff understood how to safeguard people and knew what steps they should take if they suspected abuse. Prior to starting work at the home recruitment checks were completed to help ensure only suitable staff were employed. There was a contingency plan in the event of an emergency and evacuation plans had been written for each person to help support them safely in the event of an emergency.

During the inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. We also made two recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.

Elizabeth Court is a purpose built care facility that provides accommodation and personal care for up to 60 people. It is set over three floors and divided into five units. Each unit has its own dining area, small kitchen and lounge. The home supports older people, most of whom may be living with dementia or other conditions, such as Parkinson’s, as well as people who require daily support. On the day of our inspection 41 people were living in the home.

This inspection took place on 17 March 2015 and was unannounced.

The home is run by a registered manager, who was present on the day of the inspection. 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 and associated Regulations about how the service is run.

Where restrictions were in place, staff had not always followed legal requirements to make sure this was done in the person’s best interest. The registered manager had submitted some Deprivation of Liberty Safeguards (DoLS) applications to comply with their responsibilities, but they had yet to complete this piece of work. Processes in relation to the Mental Capacity Act (MCA) 2005 required improvement by staff .

We recognised the registered manager had undertaken a lot of work since they had started in the home. However, we found some areas required further work to enable us to say the home was consistently well-led. For example, we found care plans contained information to guide staff on how someone wished to be cared for. However, they did not always contain up to date information about people in relation to their care which meant staff may not be following the latest guidance .

People told us they felt safe and staff had access to written information about risks to people and how to manage these.

People were supported to take risks within a supportive environment and staff had carried out appropriate checks to make sure any risks of harm in the environment were identified and managed. For example, if people wished to smoke this had been assessed and protective equipment and procedures were in place to help keep people safe. Staff understood the need to use the correct type of sling for a person who required to be moved by a hoist in order to keep them free from harm.

Medicines were managed effectively and staff followed correct and appropriate procedures in relation to medicines. Medicines were stored in a safe way.

Staff knew how to recognise the signs of abuse and had received training in safeguarding adults. There was a copy of the Surrey multi-agency safeguarding procedures available to staff in the office and telephone numbers for people and staff on a noticeboard in the lobby.

Care was provided to people by staff who were competent to carry out their role effectively. The provider had taken steps to help ensure they employed staff appropriate for the role. Staff received regular training and supervision, although the registered manager told us staff appraisals were not up to date and this was a piece of on-going work.

We found enough staff on duty on the day of our inspection and did not see anyone waiting to be supported. We had feedback from some people and relatives that staffing levels had not always been consistent. The registered manager had worked hard to ensure they provided enough staff to enable people to receive care and support when they needed it.

It was evident staff had developed good relationships with people and knew them well. Staff were able to tell us individual information about people which told us they spoke with them and showed an interest in their past. Staff treated people with kindness and compassion and people were shown respect and allowed their privacy.

People were involved in their care and support and were encouraged by staff to do things for themselves, for example doing some washing up. People were provided with a choice of meals and facilities were available for people or staff to make drinks or snacks throughout the day.

Staff ensured people were referred to healthcare professionals to keep them healthy or when their health needs changed.

People were enabled to maintain their independence and take part in activities to reduce the risk of social isolation. During the day we heard staff speak to people in a kind, caring and encouraging manner. Staff took the time to work at people’s own pace and they never hurried or rushed people.

Complaint procedures were accessible to people and details were displayed on the noticeboard. We read the registered manager had responded to the complaints they had received.

Staff involved relatives in the running of the home by holding regular family meetings where everyone could express their views.

The registered manager was involved in the day to day running of the home and had a good understanding of the aims and objectives of the service. This was supported by our observations and staff comments. Staff said the registered manager checked they knew of and were following best practice.

We saw evidence of quality assurance checks carried out by the provider and staff to help ensure the environment was a safe place for people to live.

During the inspection we found some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We carried out an inspection at Elizabeth Court to look at the care and treatment that people who used the service received.

At the time of our inspection the service provided care and support to 52 people. As part of our inspection we spoke with four people who used the service, ten staff and six relatives. We also looked at people’s care plans and other associated paperwork.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

We found that people were being cared for in a clean, well maintained environment. We saw that, where appropriate, extra security had been installed to ensure the safety of the residents, for example a key pad entry system to the stairs.

When we looked at a sample of care plans we found that risk assessments were in place to provide information to staff to help minimise any identified risks. One person who used the service that we spoke with told us, “They don’t like you to go out on your own in case you fall.” A relative told us “I do not have any worries she’s going to be harmed.”

We saw that the recruitment practice was safe and thorough to ensure that only staff suitable to work with vulnerable people were employed by the service. One member of staff who had recently started work at Elizabeth Court told us the interview process had included, “A lot of questions about dementia.”

Is the service effective?

People, or their relatives, were involved in writing the plan of their care and support. We saw that people's care plans had been regularly reviewed which ensured they remained up to date in order to reflect their needs.

One relative we spoke with said, “They (staff) adapt to the needs of a person.”

At our last inspection we found that there were not always enough staff on duty to meet people’s needs. At this inspection we found that the provider had increased the staffing hours. Whilst this had improved people’s experience in terms of their care, people and relatives that we spoke with said that staff rarely had time to stop and talk with them.

Is the service caring?

We saw that people were supported by kind and attentive staff. Staff were seen to interact with people well.

One person who used the service that we spoke with told us, “”People are all very nice.” One relative told us, “Very satisfied with caring and safety aspects.” And another said, “It’s good to know she’s in the right place.”

Is the service responsive?

We saw that where people’s needs had changed, or their health deteriorated, staff responded by involving an appropriate health care professional.

Is the service well-led?

We heard from one person who used the service that if it had not been for the quick response of staff they would have become very unwell.

The provider had systems in place for monitoring the quality of the service. Relatives had the opportunity to meet on a regular basis to discuss any concerns they had or make suggestions on how to improve the service.

People who lived in Elizabeth Court told us that they enjoyed living there. They felt that they were well cared for and that they were treated kindly.

People told us that they were provided with sufficient information that helped them make a choice about moving into the home.

A relative of a person who used the service told us that they had looked at our last report on the web site to help them in their choice of home for their relative.

We were told that people are listened to in making choices regarding their care and treatment and that relatives are often consulted in the care planning process.

We had good comments and feedback regarding the standard of catering. People said that they enjoyed their food and that the meals were delicious and well prepared. A person who used the service told us "I am a fussy eater but the chef always manages to prepare something that I like".

Staff told us that they enjoyed working in the home but felt that the staffing levels should be improved to enable them to spend more time with people who required more time.

Staff had a good understanding of people's assessed needs and felt that they had the training required to enable them to undertake their roles.

People were aware of the complaints procedure and felt they would not be discriminated against for making a complaint.

We had been conducting a themed inspection at the service in respect of dignity and nutrition when we became aware of the need to inspect the service about medicines as well.

We spoke with people who lived in the home but their feedback did not relate directly to this standard. We relied on our observations and our discussions with the manager and staff to form our judgement on this occasion.

People told us that they liked living in the home. They told us that they are consulted about what activities they take part in and how they spend their time. We saw people making Christmas decorations in one activity group and in another group people were walking a dog that was visiting the home.

People were very positive in their feedback of the home. They said that staff looked after them well and that some were better than others.

Some people told us that they were kept informed about their care and treatment.

Some people told us that they liked this time of the year with the carol services and Christmas festivities.

They told us that the food was good and that there was always something available that they liked.

People told us that staff treated them with respect and that their privacy and dignity was maintained.