About the service Queen Elizabeth Care Centre is a residential care home providing personal and nursing care. The service provides support to people aged 65 and over and some people were living with a learning disability. At the time of our inspection there were 66 people using the service. Queen Elizabeth Care Centre accommodates up to 74 people in one adapted building over three floors. One of the floors provides care to people living with dementia.
People’s experience of using this service and what we found
People were not consistently kept safe from the risk of harm. Risk assessments lacked detail or had not been included in care plans. There were inconsistencies with the medicine management at the home and there were not always enough staff to meet people’s needs. We found infection control concerns where people were not always being kept safe from the risk of infection.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff required a more robust training programme to be effective in their role.
People were not always supported with their emotional needs and we received mixed feedback about how they are supported with their independence.
There were minimal organised activities for people to engage with at the home. People told us they were bored and missed the engagement and inclusion activities offered. End of life care plans had been introduced to care plans.
Audits were either not being completed or ineffective in identifying the concerns we found at this inspection. We found the provider had not supported the new management team to be equipped to carry out their roles effectively.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability (LD) and/or autistic people.
The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The nominated individual, in the absence of a registered manager, was unaware that people living with LD were residing in the home.
Right support: Like all people living in the home, people living with dementia had very little in place to maximise their choice, control and independence. Due to staffing levels people were not supported to do daily tasks to encourage their independence.
Right care: The home was not offering people person-centred care. Care plans lacked person-centred detail and people were not taking part in activities in line with their hobbies and preferences. This meant people sat in communal areas or their bedrooms for extended periods of time without engagement.
Right culture: People did not feel included in the home. They were not engaged in activities and resident meetings had not been arranged for them to feel empowered by sharing suggestions or concerns.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 03 August 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.
At our last inspection we recommended that improvement was made to the management of medicines and person-centred assessments. At this inspection we found the provider had not acted on either of the recommendations to make improvements.
Why we inspected
The inspection was prompted in part due to concerns received about staffing levels, infection control, training and lack of activities or person-centred care. A decision was made for us to inspect and examine those risks.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to person-centred care, safe care and treatment, consent and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures:
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.