Last year I discussed St Elizabeth’s for the first time, on Twitter. I’d heard of it over the years, heard some positive things about the school and about people’s epilepsy being brought under control, often for the first time in their lives, but I’ve also heard quite a bit that was less positive. A real mixed bag.

Depending on where you look St Elizabeth‘s is variously described as a school, a children’s centre, a supported living provider, a nursing home, a care home. A recent Ofsted visit described it as:

The school is part of St Elizabeth’s Centre, a large charitable organisation. The centre occupies a very large campus and includes the school, a convent, a children’s home, adult residential provision, a college for adults with learning disabilities and a health care centre.

Truth is it’s campus provision, the old school type that is meant to be long gone in 21st century care and support in the UK. It’s far from gone. We’re talking of a campus within “60 acres of beautiful countryside”, about as far away from ordinary lives in a local community as can be imagined. Not many people live on 60 acres these days.

When you visit the St Elizabeth’s website you’re met with a confusing array of information, there’s an arial photograph of the site, a banner with six drop down menus with more information, hyperlinked photographs further down the page, but the prime space, at the top right of the page has three large headings: Book a Visit, Contact Us, Donate.

You are never far from a request for money anywhere on the site.

It costs over £20 million a year to provide full educational, medical, therapeutic, leisure and home-care support for our children and young people.

We receive a degree of funding from Local Authorities to finance the essential costs of care, accommodation and education for individual service-users.

However, to ensure we can keep our services as up-to-date and our facilities of the highest quality as possible, we rely on the support of generous individuals, local groups, companies and trusts. Every year, we need to raise over £750,000.

St Elizabeth’s is looking for your support – you can help to ensure that those we care for can live safe and happy lives.

It’s quite the turn of phrase to refer to 174 government contracts and 6 government grants totalling almost £25million in 2020-2021 (as per the Charity Commission website) as ‘a degree of funding’.

So, at the very least you’d expect people to live safe and happy lives.

You can read the Oftsed reports for the school here, for the residential college for young people aged 19-24 here, and for the Children’s Home here, the CQC reports for the Health Agency here, for the supported living as provided by the Domiciliary Care Agency here, and for the Care Home with Nursing here.

It’s the latter I’ll focus on in this blog post. They were first rated inadequate by CQC in March 2022 following an inspection in November 2021:

It is this report, following the November 2021 inspection that has been updated and published today. The following quotes come from that report. The strap line on the St Elizabeth’s website is ‘Positive living and learning for people with epilepsy and other complex needs‘ let’s have a look shall we. What did CQC find?

CQC describe ‘the home’ as:

St Elizabeth’s Care Home with Nursing provides both nursing and personal care to up to 110 people in 11 bungalows and three single occupancy flats, within a campus style community. The service specialises in offering care and support to people with epilepsy, associated neurological disorders, a learning disability and other complex medical conditions. At the time of the inspection there were 86 people living at the home.

So first up it’s not a home. At best it could be referred to as a virtual home I suppose, but it’s a service covering a campus style ‘community’.

People were at risk of not having their needs met in a timely manner. The provider acknowledged that there were not enough staff available to meet people’s needs. They told us they were having to prioritise personal care and safety over supporting people to go out or learn new skills.

Imagine living this. In the middle of 60 acres, away from family and friends and your local community, reliant on staff for care and support, to be able to live a life, and there are insufficient staff. What does that look and feel like? At the very least you’d be clean and safe right.

The majority of risks in relation to people’s health, safety and well-being had been identified and assessed. However, these assessments did not always enable people to be in control of taking calculated risks. Furthermore, records indicated that risk assessments were not always followed by staff, for example, in relation to repositioning, choking or dehydration risks.

Here’s the thing, everyone at St Elizabeth’s has epilepsy. And some of the people there have physical disabilities or a learning disability. Given this comment about risk assessments, clearly some people are at risk of choking, yet those risk assessments aren’t being followed by all staff.

But at least people would live in beautiful buildings in their beautiful 60 acres of land right?

We identified a number of issues relating to the environment and repairs required. This included cracked tiles and flooring in bathrooms, exposed hot water pipes and a light fitting hanging from the ceiling in one of the bungalows. Staff told us they had reported these concerns but there was a long waiting list for repairs. Immediate risks were reported to the management team on the day of inspection and interim measures taken to ensure people’s safety.

At this point you might not even be surprised by what follows, but not all staff understood the law or how to provide people with choice and control over their lives in line with it:

People were not always 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. Not all staff we spoke with were aware of the principles of the Mental Capacity Act and these principles were not consistently embedded in their practice. This meant there were restrictive practices in place, such as locked doors. There was no evidence that the provider had considered if this was the least restrictive action to take.

All those providing support to autistic people or people with a learning disability are meant to provide support in line with Right Support, right care, right culture, statutory guidance issued back in October 2020, which in turn builds on the Reach Standards from Paradigm, first published in 2014. This should not be news to anyone in social care.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Staff did not always consider people’s individual needs nor promote choice and control.

The language used in care plans and by staff did not always promote a respectful, personalised approach and this had not been identified by the management team.

For example, care plans referred to people “absconding” from their own homes. A staff member also told us, “This is where people come to die”, in reference to the bungalow they were working in.

Just no words for that one.

People’s independence was not promoted. For example, in meeting minutes for one bungalow, it stated, “Cooking in the bungalow by residents still needs to be organised as it is time consuming and as staff are busy, it would be as time allows and needs to be planned in advance.” This suggested that the development of people’s independent living skills was not embedded in the day to day operations of the service.

There is such a gulf between what is claimed in their advertising and what is delivered on the ground. And an absence of basic manners and dignity.

We found that people were not always treated with dignity and respect. For example, staff did not knock on doors when entering people’s rooms and we were shown into rooms where people were in bed or being supported with personal care.

Care and support plans did not always focus on positive outcomes to improve people’s quality of life. There was limited evidence that staff supported people to identify aspirations for the future. Where wishes were identified they were not always personalised or meaningful to the individual.

No future. No meaningful life in the present. What a place to find oneself in.

Due to living within a campus style community, in a rural location, people were dependent on staff to leave the site safely.

However, people did not have control over when they could leave, and staff confirmed it would be difficult for them to facilitate any spontaneous trips out, with this situation exacerbated by staffing difficulties and the COVID-19 pandemic.

Daily records indicated that people had a limited choice of things to take part in during the day, and infrequent opportunities to leave the St Elizabeth campus.

No spontaneity, no leaving, warehoused in 60 acres.

The management team had not identified issues we found regarding the culture of the service. They had produced a service improvement plan; however, this did not include actions around how they intended to embed the principles of Right support, right care, right culture at the location.

Hmmm. Performative scrutiny, be seen to be responding, without actually doing it well enough to transform and improve people’s lives.

The provider did not clearly distinguish between the responsibilities of the staff employed by the care home and those employed by the on-site health agency. St Elizabeth’s Care Home with Nursing is registered to provide both personal and nursing care. However, all nursing care was provided by the on-site health agency. This arrangement meant that records were sometimes disjointed or missing.

For example, health records held at the bungalows were not always up to date. We were told this information was managed by the on-site health agency. This meant important information was not accessible to the staff supporting people on a daily basis.

Much of the response to the media about St Elizabeth’s is tied to the ‘staffing crisis’ in social care. Rarely do people step back and ask about the day to day staff experience of working for such employers.

Why would anyone want to work in this environment? If you wish to do a good job, yet you’re working in a system where people are provided unsafe care, in unsafe environments, with unsafe record keeping systems. It’s an accident waiting to happen.

The provider’s systems for understanding what was happening within the home were not effective, they had failed to operate effective monitoring of the quality of care. We identified gaps in care plans, risk assessments and daily records. These had not been identified by the provider.

Continuous learning was not promoted within the service, with lessons learned following incidents and safeguarding concerns not shared with all staff.

Management sleeping on the job, whilst being incredibly well paid to be anything but. Another snippet from the Charity Commission website, what are all these highly paid staff doing if not securing positive, safe and aspirational lives for people? Keep in mind that the Prime Minister (however incompetent) was only paid £75k salary, to run the country, but the CEO of St Elizabeth’s is on almost double that, whilst presiding over unsafe care and support and non-lives for people.

This report followed a visit in November 2021.

CQC returned to visit St Elizabeth’s in June 2022, report published in August last year. They still found it to be wholly inadequate in every domain inspected.

The summary paragraph on enforcement and recommendations stated:

We have identified breaches in relation to keeping people safe, not having enough staff which impacted peoples day to day life, systems surrounding peoples medicines were not managed well, people were supported by staff who did not promote kind and compassionate care which resulted in safeguarding issues, the environment was not fit for purpose and required work to ensure it was a nice environment to live in, people were not always supported with the least restrictive option and the management oversight did not always identify where improvements were needed and did not action this in a timely manner at this inspection.

Sounds like nothing has changed really. Except this report also included this statement:

The management team had completed a post incident review to identify lessons learnt following a death, we found that these lessons learnt had not be completed. This meant that improvements could not be implemented to ensure staff were providing safe care.

Such blatant apathy.

Inspectors also found:

People had risk assessments where they had a risk of choking, however we observed a staff member not adhering to the risk assessment which put the person at risk. The risk assessment indicated the person needed staff to sit with them whilst eating due to the risk of choking, however, staff did not sit with the person during their meal.

and

People’s risk assessments were not always person centred. For example, the epilepsy nurse stated that the SUDEP risk assessments for people living with epilepsy were a uniform document and not person specific. This document was key to ensuring staff were aware of how to reduce the risk of SUDEP.

and

We observed people who require emergency intervention medicines leave their home without taking this with them. The staff described that they would carry around a walkie talkie, in the event the person may need the emergency intervention they would alert the nurses, who would then run to the home pick up the emergency medicine and meet the person. In some cases, a person needed their emergency medicines within five minutes of a seizure. We asked the nursing staff if this process could be achieved in this time, in which they said this may be difficult.

and

People were not protected from the spread of infection. The service did not have effective infection, prevention and control measure to keep people safe. We observed staff not following government guidance when using personal protective equipment (PPE). We found staff either not wearing masks or not wearing them correctly. This put people at risk of cross infection.

The report is littered with further examples of poor or non-care and support.

CQC state that social care providers would usually only be allowed to be in special measures, providing inadequate services, for 12 months. The first inspection which found inadequate care was conducted in November 2021, so it’s well over 12 months now, although there was a 4 month delay between the inspection and the report being published, so maybe the clock starts in March, in which case they have two more months.

The update to the November 2021 report includes a page of enforcement action taken by CQC.

Four notices of decisions issued.

I’ve contacted CQC asking for confirmation of what the decision was. I’ll let you know what they say.