Elgin Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The CQC regulates both the premises and care provided, and both were looked at during this inspection.

Elgin Rest Home is registered to provide accommodation with personal care for up to 17 older people, some of whom may be living with dementia related needs. There were 11 people living in the service when we inspected. The service is delivered over two floors from two houses that have been converted into one accommodation.

When we inspected the service in February 2017 the service was rated overall Requires Improvement. Following further information on an incident that had occurred in December 2016 we completed another focussed inspection specifically to look at Safe and Well Led. The rating of Safe remained Requires Improvement and Well Led was rated Inadequate.

We met with the provider and asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well Led to at least good. We found at this inspection the provider had taken the required action to improve the service.

The service had 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.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People’s needs were met by sufficient numbers of staff. People were cared for safely by staff that had been recruited and employed after appropriate checks had been completed. Medication practices were safe and dispensed by staff who had received training to do so. There were systems in place to minimise the risk of infection.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in safeguarding adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). 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 service support this practice.

People had sufficient amounts to eat and drink to ensure that their dietary and nutritional needs were met. The service worked well with other professionals to ensure that people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including a doctor, district nurse and speech and language therapist. The environment was appropriately designed and adapted to meet people’s needs.

Staff were well trained and attentive to people's needs. Staff were able to demonstrate they knew people well. Staff treated people with dignity and respect.

People were provided with the opportunity to participate in activities which interested them at the service. These activities were diverse to meet people’s social needs. People knew how to make a complaint should they need to. People were provided with the appropriate care and support at the end of their life.

The registered manager had a number of ways of gathering people’s views; they held regular meetings with people and their relatives and used questionnaires to gain feedback. The registered manager carried out quality monitoring to help ensure the service was running effectively and to make continual improvements.

We carried out a focussed inspection of this service on 10 and 17 May 2017.

When we last inspected the service on the 6 and 10 February 2017 a criminal investigation was taking place following the death of a person who had died shortly after being admitted to the service following their discharge from hospital; therefore we did not fully report the circumstances of the incident. However information shared with CQC about the incident indicated potential concerns regarding the service’s pre-admission/admission procedures, the management of medication, emergency procedures and ensuring staff were competent and skilled to effectively fulfil their role. This inspection examined those risks.

Elgin Rest Home is registered to provide accommodation with personal care for up to 17 older people, some of whom may be living with dementia. There were 16 people living at the service when we inspected.

The service had a registered manager who was also the registered provider of the service. 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.

Improvements were required to ensure robust pre-assessments were undertaken prior to people moving into the service to ensure people’s needs could be met safely by appropriately trained, skilled and competent staff.

Improvements were required to the management of medicines to ensure people received their medicines safely and as prescribed.

Improvements were required to ensure all incidents were thoroughly investigated and lessons learned to mitigate the risk of re-occurrence.

Quality assurance systems had failed to identify a number of concerns we found during our inspection placing people at risk of harm.

The inspection took place on the 6 and 10 February 2017 and was unannounced. We had previously inspected the service in February 2016 when we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to Regulation 12 Safe care and treatment, Regulation 17 Good governance and Regulation 19 Fit and proper persons employed. Following the inspection in February 2016 the registered provider wrote to us to tell us the action they would be taking to ensure they met all the relevant regulations. During this inspection we found improvements had been made and the registered provider was now meeting these regulations. At this inspection we found one breach of regulations in relation to Regulation 18 Staffing.

Elgin Rest Home is registered to provide accommodation with personal care for up to 17 older people, some of whom may be living with dementia related needs. There were 14 people living in the service when we inspected.

The service had 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.

Improvements were required to ensure staff were deployed effectively at all times to meet people’s needs. The service had systems in place to identify and manage risks to people and to maintain the safety of the service as a whole, however the provider needed to ensure their review and oversight of how staff are deployed and what this meant for people were more robust and ensured good quality care delivery at all times.

Staff were trained in how to protect people from abuse and harm and how to raise an alert if they had any concerns. Effective recruitment procedures ensured that only suitable staff were employed. People were supported by staff that had the skills and experience needed to provide effective care. Medication was dispensed by staff who had received training to do so.

Assessments of people’s capacity were carried out in line with the Mental Capacity Act 2005 (MCA). The registered manager and staff were aware of their responsibilities in relation to the MCA and the associated Deprivation of Liberty Safeguards (DoLS).

Staff knew people well and were kind and caring and treated people with respect and dignity. Generally people told us they were happy with the care and support they received. Staff encouraged people to maintain their independence as much as they were able to. Where required people were supported to access advocacy services.

People’s nutritional needs were assessed and met and people were supported to maintain a healthy and balanced diet. People were supported to access health and social care professionals and services when needed.

People had opportunities to participate in activities and a dedicated member of staff was responsible for the delivery of the activities programme. The registered provider had systems in place to deal with any concerns or complaints.

People living and working in the service had the opportunity to say how they felt about the home and the service it provided. Staff enjoyed working at the service and felt valued and supported by the registered manager. The registered manager was committed to continuous improvement and there were systems in place to regularly assess and monitor the quality of the service provided.

The inspection was completed on 15 February 2016, 18 February 2016 and 19 February 2016 and was unannounced.

Elgin Rest Home provides accommodation and support for up to 17 people who may need assistance with personal care and may have care needs associated with living with dementia, physical disability and sensory impairment. There were 16 people living at the service at the time of our inspection. The home does not provide nursing care.

A registered manager was 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 2008 and associated Regulations about how the service is run.

Although people told us they felt safe, we found that the systems and processes in place to help keep people who lived at the home safe required improvement. People were not always protected from the risks associated with the unsafe use and management of medicines. Safe procedures had not always been followed when recruiting staff and thorough checks had not been completed for staff prior to them commencing employment. Though staff told us that they felt supported by the registered manager, staff had not received regular formal supervision or appraisal.

The service did not adequately involve people in the development of the service. Quality assurance systems were not always effective and failed to demonstrate how the service was identifying areas for improvement and taking the appropriate actions.

People’s needs were not always met because there were times when staff were not deployed effectively to meet their needs.

Although the registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS), some staff were unable to demonstrate an understanding of the MCA and DoLS and how they would support people so not to place them at risk of being deprived of their liberty.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns.

Staff treated people with kindness and compassion and people’s privacy and dignity was respected. People told us they were happy with the care provided to them. We saw staff smiling and laughing with people and offering support. There was a good rapport between people and staff.

Care plans were regularly reviewed and provided staff with sufficient information about how to meet people’s individual needs and preferences. People’s healthcare needs were monitored and advice and guidance was sought from healthcare professionals when needed.

People were supported to eat and drink sufficient amounts to meet their nutritional needs. People were able to choose alternative meal options if they did not like the choices offered on the daily menus.

There was a range of activities for people to participate in.

The provider had a complaints policy in place. People told us they felt able to raise any complaints and were confident they would be listened to.

You can see what actions we told the provider to take at the back of the full version of the report.