This inspection took place on the 11 and 12 May 2017 and the first day was unannounced.

Beth Ezra is a residential care home that provides accommodation and personal care support for up to 18 older adults. People living at the home had a range of needs and some people were living with dementia. There were 18 people using the service at the time of our inspection.

At the last inspection in 2015, the service was rated Good. At this inspection we found the service remained Good. The service demonstrated they continued to meet the regulations and fundamental standards.

People continued to feel safe and well cared for at Beth Ezra. Relatives shared similar confidence in the service. Assessments were undertaken to identify risks that may be involved when meeting people's needs. Staff were aware of people's individual risks and knew what to do to keep people safe. They understood their responsibilities to report any concerns they had about people’s care and welfare and how to protect people from abuse.

The environment remained well maintained and comfortably furnished. People had the equipment they needed to meet their assessed needs. Health and safety checks were carried out to make sure the premises and equipment was safe.

Medicines were managed safely and people had their medicines at the times they needed them. People were supported to maintain good health and attend routine health care appointments. The service involved other professionals when this met an identified need. For example, when people became unwell or required additional services.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and staff took prompt action when people were at risk of poor nutrition or dehydration.

The service remained responsive to people's individual needs. People were involved in their care planning, and staff respected their choices and promoted their independence. Care plans were updated to reflect any changes and ensure continuity of their care and support.

Activities were varied and arranged according to people’s needs and interests. The home employed an activity coordinator who supported people to take part in activities either individually or in groups.

People experienced positive, caring relationships with the staff and this extended to relatives and other visitors. Staff treated people with respect and kindness and maintained people’s privacy and dignity.

The provider continued to follow safe recruitment practices and people felt there were enough staff to support their needs. Staff received an induction and ongoing training to support people with their care needs and develop their knowledge and skills.

People's care records recognised their rights and were person centred. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice.

The registered manager continued to provide effective leadership. People and their relatives were comfortable to raise any issues and felt they were listened to. Staff felt supported and had regular opportunities to discuss and review their development and performance.

The provider had good oversight of the quality of the service. People were involved in reviewing and providing feedback on the care and support they received. Where improvements were needed or lessons learnt, action was taken.

This inspection took place on 10 February 2015 and was unannounced. At our last inspection in October 2013 the provider met the regulations we inspected.

Beth Ezra is a residential care home that provides accommodation and personal care support for up to 18 older adults. People living at the home have a range of needs and some people are living with dementia. 18 people were using the service at the time of our inspection.

A new manager was in post at the time of our inspection and was in the process of completing their registration. They successfully registered with us shortly after our 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 2008 and associated Regulations about how the service is run.

People using the service and their representatives told us they felt safe and well cared for at Beth Ezra. Staff were trained in safeguarding adults and the service had policies and procedures in place to ensure that the service responded appropriately to allegations or suspicions of abuse. The manager and staff team understood their role and responsibilities to protect people from harm. Risks were assessed and appropriate action was taken to reduce or eliminate the risk.

People’s rights were protected because the provider acted in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff understood people’s rights to make choices about their care and support and their responsibilities where people lacked capacity to consent or make decisions.

The provider’s recruitment procedures helped ensure that people were protected from unsafe care. There were enough staff on duty day and night to make sure people’s needs were met in a safe and timely way. Most of the staff had worked at the home for several years which meant that people experienced consistent care.

People lived in a safely maintained service and the quality of the environment was regularly checked. Medicines were managed safely and people had their medicines at the times they needed them.

People were able to take part in activities of their choice and were supported to maintain relationships with family and friends who were important to them. People spoke positively about the quality of the food and choices available and were provided with homemade, freshly cooked meals each day.

There were positive and caring relationships between staff and people who lived in the home and this extended to relatives and other visitors. Staff treated people who used the service and their guests with respect and courtesy. Staff maintained people’s privacy and dignity at all times and interacted with individuals in a caring and professional manner.

Care plans contained information about the health and social care support people needed and they were involved in making decisions about their care. Arrangements were made for them to see their GP and other healthcare professionals as and when they needed to do so. Where people's needs changed, the provider responded and reviewed the care provided.

Staff told us that they had the training and information they needed to care for people and that the manager was always available to offer guidance and support.

People who lived in the home and their relatives said they felt involved in the way the home was run and were encouraged to express their views and opinions about the services provided.

The provider carried out regular audits to monitor the quality and health and safety of the service and to plan improvements. Where improvements were needed, action was taken.

There was an open and inclusive atmosphere in the service and the manager led by example. Staff had a good understanding of the ethos of the home and told us they were clear about their roles and responsibilities.

We spoke to five out of the eighteen people who lived at Beth Ezra and one relative when we visited the service. The people we spoke with told us they were very happy living at Beth Ezra. One person using the service said, "Only one word to describe the home it begins with E for excellent." A visiting relative told us, "This is home from home.”

During our visit we saw staff treating people who use the service with dignity and respect. We observed staff always knocked on the door to occupied rooms. We also observed that when people using the service were not available to ask consent staff did not enter their rooms.

People using the service said that they felt able to raise any concerns or anxieties should they have any. One person we spoke to said, "I have been invited to complain if necessary, you don't feel intimidated.”

The provider had effective systems in place to ensure that people who used the service had their medicines at the times they needed them, and in a safe way. There were clear processes in place for the appropriate safe management of medicines.

We saw people who use the service eating lunch in the dining area, one person using the service told us, "food is very good; inclined to be rich, but good food.”

We spoke with seven out of the eighteen people who lived at Beth Ezra and three of their relatives and/or friends when we visited. They told us they were very happy with the quality of the care provided at the home. People also told us all the staff that worked there were always kind and supportive. Typical comments we received from stakeholders we met, included “Beth Ezra is a very good home…I can’t fault any of the staff that work here or the care given to my father”, “If you need to live in a care home you might as will live in the best... I would give Beth Ezra ten out of ten” and “the staff are all marvellous…I’m glad I decided to move in”.

During our visit we saw staff treated people who used the service and their guests with respect and courtesy. People received effective and safe care from suitably skilled staff who understood their individual needs, abilities and preferences.

The provider also had effective systems in place to routinely assess and monitor the quality of the care and support people received.

The feedback we received from the people who use this service was extremely positive about their experiences of living at Beth Ezra. Typical comments people we met made, included: “This place is very well run and the best thing about it is that I am amongst friends here”, “I have not got anything to complain about…the overall standard of the care and the attitude of staff is spot on”, “Pleased I decided to move in”, and “Basically, I am very happy living here…I do not think there’s anything they could do better”.

It was evident from all the comments we received from the people who live at Beth Ezra that they felt staff listened to them and that they could influence how their home was run. People told us: “We are given lots of information about the homes rules and how we can help run it”, “Staff listen to us here and always take us seriously”, and “I can have my meals in my bedroom if I want, but I prefer to eat with everyone else in the dinning room”. Another person we spoke with told us they believed the service was good at: “Letting people get on with their lives”.

There are good arrangements for ensuring that people who use the service live a

fulfilling lifestyle, in accordance with their wishes. Structured activities are provided

daily (including the daily Bible Reading at 4.00pm) and there are opportunities

and space for people to relax and spend time with their family and/or

friends.

The feedback we received from people who use the service was very complimentary about the quality and choice of the meals provided at Beth Ezra. Typical comments made, included: “The food is generally very good here”, “You always get a choice at mealtimes…the staff did ask me today what I wanted for my lunch, although I cannot recall what it was”, and “I do not like the cabbage here, but most meals are fine…no real complaints about the food”.

Arrangements for handling complaints and allegations of abuse are good. People are also protected by the safe handling of medication. People told us they felt safe living at Beth Ezra and able to talk to staff if they were unhappy or dissatisfied with anything. Typical feedback we received from people, included: “I feel completely safe living here”, “I never lock my bedroom door…no need”, “I would tell my key-worker or the manager if I was unhappy…They listen to me”, and “I would definitely tell the staff if I was not happy about something, and I am pretty sure they would take me seriously”.

The home is comfortable, very clean, and well maintained. The grounds of the

home offer an expansive and pleasant space to enjoy and relax.

Typical comments made by the people who live at Beth Ezra, included: “I have got everything I need in my bedroom”, “They let me bring some of my own furniture and hang up some of my paintings”, and “My room is fine…plenty of space and a good view of the garden”.

Staff members are supplied in adequate numbers, and there is good staff

training provided. Furthermore, all the people we met told us staff always treated them well and respected their privacy and dignity. Typical comments we received, included: “Staff are all very kind, cheerful and friendly here”, “The staff treat us well…most of them are Christadelphians, which I think helps”, “Staff always knock on my bedroom door before coming in…they are all very careful to do that”, “There’s always enough staff about”, and “Best thing about the place is the staff”.

Beth Ezra is extremely well run by a very competent and experienced registered manager. The care home also has excellent quality assurance systems in place, some of which are independently run by a ‘Quality Assurance Group’ that takes into account the views of all those using the service. Regular visits by members of the Board of Trustees is also a further mechanism to ensure best practice.