We inspected Eliot House on 13 November 2018. The inspection was unannounced. Eliot House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 29 older people; some of whom have nursing care needs and some of whom experience memory loss.

On the day of our inspection 27 people were living in the home.

At our last inspection on 2 March 2016 we rated the home as ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’ overall. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the home has not changed since our last inspection.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. There were sufficient staff to meet people’s needs and safe staff recruitment procedures were in place and used. People received their prescribed medicines safely.

People continued to receive an effective service. The principles of the Mental Capacity Act 2005 (MCA) were followed. The policies and systems in the home supported this practice. Staff had the knowledge and skills to provide safe and appropriate care for people. People were cared for by staff who were well supported by the manager. People were supported to maintain their nutrition and staff monitored and responded promptly to people’s health conditions.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them.

People continued to receive a responsive service. Their needs were reflected in care plans and staff followed the guidance in the care plans. People were offered opportunities to pursue their interests and hobbies, and join in with social activities.

The home continued to be well led. There was an open and person-centred culture in which people and staff were encouraged to share their views and opinions. Systems were in place to monitor and improve the quality of the service provided.

This inspection took place on 2 March 2016 and was unannounced. Eliot House provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 29 people who require personal and nursing care. At the time of our inspection there were 26 people living at 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 2008 and associated regulations.

On the day of our inspection staff interacted well with people and people were cared for safely. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as a the district nurse and GP and were supported to eat enough to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered.

Staff received training to help them to provide appropriate support to people. The provider had a training plan in place and staff had received regular supervision. We saw that staff obtained people’s consent before providing care to them. People had access to activities and leisure pursuits.

Staff felt able to raise concerns and issues with management. Relatives were clear about the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. Audits were in place for areas such as falls and infection control. Accidents and incidents were recorded.

Due to the complex needs of the people using the service we used a number of different methods to help us understand their experiences when we undertook our inspection.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with three people who used the service and a relative and asked them for their views. We also spoke with four care staff, a qualified nurse and the registered manager. We looked at some of the records held in the service including the care files for three people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found where people were able to they gave consent to their care and treatment and people received care and support that met their needs. A person told us, “I am treated really well. I appreciate everything they (staff) do for me. A relative told us, “On a good day my relative can tell staff what they want and how they want to be supported. Staff know just how to help them so even on a bad day, my relative gets supported the way they like.”

We found people who used the service were protected from abuse. A person told us, “They keep me safe here. They keep an eye on you. I see them watching to make sure others are safe.”

We found the staff team were supported through training. A staff member said, “The training is very good and I get a lot out of it.”

We found the provider had systems in place to deal with comments and complaints. A person told us, “If I have got any complaints I tell the manager. They then deal with it. I am happy how they deal with things. I never feel bad for saying something.”

Due to the complex needs of the people using the service we used a number of different methods to help us understand their experiences when we undertook our visit.

We looked at information and records provided by the manager. These included care plan records. We observed staff providing support when people needed care, during meal times and when people were undertaking individual or group activities. We also spoke to a local priest who was visiting the service.

We observed that people received care in the way described in daily records and their care plans. We saw that staff provided sensitive support using special equipment when people needed help with moving safely, during meal times and when people were undertaking individual or group activities.

We also observed how people enjoyed the food that the home provided and the social activities that the home had organised. We saw there was a range of things for people to take part in as well as opportunities for them to go out into the community with support from staff and their relatives when they had chosen to.

The people we spoke with said they were happy with the care and support they received and felt the home was a safe place to live. They told us staff were respectful, supportive and kind and people had confidence in their abilities. There comments included things like, “I like it here, the staff are all friendly and kind”, “they are very caring” and “the staff are very good and very pleasant”.

We saw staff delivering care and supporting people in a kind and sensitive way, respecting their wishes and preferences.

The people we spoke with commented positively about the home and the care provided. They said they felt comfortable raising any concerns they might have with the manager and no one raised any areas of concern with us.

People told us that generally they were happy with the way the home operated. One relative said, “There is nothing extra I would like to see except maybe a few more occasional tables for when people have a drink or meal in the lounges”. When we asked what was good about the home one person said it was a nice building, had a happy environment, and was very comfortable. They also said “I get on well with the residents and staff”.