We carried out an unannounced comprehensive inspection at Elizabeth Court Rest Home in June 2016 where we found four breaches of Regulation. As a result we undertook a further unannounced inspection on 21 and 24 July 2017 to follow up on whether the required actions had been taken. We found all areas of concern had been addressed and the provider was no longer in breach of Regulation.

Elizabeth Court Rest Home service provides accommodation, care and support for up to 24 people. People were at risks of falls and living with long term healthcare needs such as diabetes and dementia type illnesses. On the day of our inspection there were 24 people living at the service.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

People appeared happy and relaxed with staff. There were sufficient staff to support them. When staff were recruited, their employment history was checked, references obtained and comprehensive induction completed. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place. Appropriate training was provided to ensure staff were confident to meet people’s support needs.

It was evident staff and the registered manager had spent considerable time with people, getting to know them, gaining an understanding of their personal history and building rapport with them. People were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

People’s needs had been assessed and detailed care plans developed. Care plans contained risk assessments for a wide range of daily living needs. For example, nutrition, falls, and skin pressure areas. People consistently received the care they required, and staff members were clear on people’s individual needs. Care was provided with kindness and compassion. Staff members were responsive to people’s changing needs. People’s health and wellbeing was carefully monitored and senior staff regularly liaised with healthcare professionals for advice and guidance.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

Where people lacked the mental capacity to make specific decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA). Where appropriate ‘best interests’ meetings had been instigated and outcomes recorded.

People were provided with opportunities to take part in activities ‘in-house’ and to access the local and wider community. People were supported to take an active role in decision making regarding their own daily routines and the general flow of their home.

Staff had a clear understanding of the vision and philosophy of the home and they spoke positively about their work and the management. The provider had established systems to registered manager undertook regular quality assurance reviews to monitor the standard of the service and drive improvement.

We inspected Elizabeth Court Rest Home on and 7 and 8 June 2016. This was an unannounced inspection. The service provides accommodation, care and support for up to 24 people. People were at risks of falls and living with long term healthcare needs such as diabetes. On the day of our inspection there were 24 people living at the service. The age range of people living at is 50 – 98.

We last inspected Elizabeth Court Rest Home on 14 May 2014 where we found it to be meeting all the legal requirements within the areas we inspected.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

Although people told us they felt safe living at the service we found the provider had not taken adequate steps to ensure people’s safety in relation to the number of care staff working, medicines and risks related to a person using specialist equipment. We found kitchen staff had not consistently followed basic food hygiene principles in relation to the storage of food.

Staff had a clear understanding of safeguarding and were able to identify different types of abuse; however the registered manager had failed in their responsibility to inform the local authority where there had been allegations of abuse.

Meal times were poorly organised which resulted in an inconsistent dining experience for some people. People with higher support needs at meal times did not always receive the assistance they required. However people were provided with a choice of healthy food and drink and people’s feedback on food was positive.

Staff received training and had an understanding of the Mental Capacity Act 2005 and were seen to act in accordance with its principles; however care documentation did not clearly identify how people who lacked capacity for specific decision had been supported to reach a decision that was in their best interests.

People’s dignity and confidentiality was not consistently protected by the provider in regard to meal times and people’s care documentation being left in communal areas.

The provider had not taken steps to ensure there was always clear guidance available for staff to enable them to support people living with more complex health needs such as diabetes.

The provider had systems in place to monitor and drive improvements in the quality of the service; however we found shortfalls with areas of quality assurance which meant the provider did not have consistent oversight of the service.

Appropriate checks had been undertaken when new staff were recruited to ensure they were safe to work within the care sector.

Care staff were responsive to people’s changing needs. People’s health and wellbeing was monitored and the provider regularly liaised with healthcare professionals for advice and guidance.

People told us staff were kind and we observed positive interactions between people and staff. Staff had a clear understanding of their roles and spoke enthusiastically about working at the service and positively about senior staff.

The provider had a complaints policy; this was displayed in a communal area. People and their relatives told us they knew how to complain.

We found breaches in Regulations. You can see what action we told the provider to take at the back of the full version of this report.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were in place and staff understood how to safeguard the people they supported. One person who used the service told us “This is my home, the staff are so nice and caring”.

Systems were in place to make sure that both managers and staff learnt from events such as accidents and incidents and responded to complaints and concerns.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Policies and procedures were in place to make sure that unsafe practices were identified and the people were protected.

Is the service effective?

People we spoke with told us they were happy with the care they received and felt their needs had been met. From our observations and also speaking with the staff it was clear that staff understood people’s care and support needs and they knew them well. One person told us “I have everything I could wish for, staff are so supportive”.

Staff had received training and ongoing development to meet the needs of the people living at the home.

Is the service caring?

Staff were attentive and kind to the people who needed support. Staff told us they encouraged people to maintain their independence.

People’s preferences, interests and diverse needs had been recorded in the care plans we viewed.

People who used the service had been offered a quality assurance survey to complete. Where shortfalls or concerns were raised they had been addressed and discussed with the person.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Information had been recorded on detailed care and support plans. People told us they regularly discuss their needs with their support worker.

People knew how to make a complaint if they were unhappy. The complaint’s policy was displayed on a notice board to remind people.

People who lived at the home completed a range of activities. One person we spoke with told us “I like gardening and spending time with the pets. We have fish, rabbits and chickens”.

Is the service well-led?

The service worked with other agencies and services to make sure people received care in a joined up way.

A quality assurance system was in place and records we viewed showed regular audits on the service and that any shortfalls had been addressed by the manager. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems that were in place. This helped to ensure that people received a good quality service at all times.

We spoke with five people during our inspection. One person told us, “It’s so comfortable here.” Another person said, “I’m very happy.” We also spoke with visitors who told us, "Excellent place, they really know how to care for people," and "I am always made to feel welcome."

We observed four people and reviewed the records of their care to help us understand their experiences. We saw that staff were attentive and reassuring when supporting people and delivering care.

We saw that there were processes in place to ensure that people’s consent was sought and respected. We saw that people were offered choices and their preferences acted upon.

We observed the administration of medicines and found that safe practices were in place.

We saw that people were protected by effective recruitment and selection processes. There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work There were training programmes in place and staff felt supported to meet people’s needs.

There was an effective complaints system in place which showed that the home improved its practice based on the feedback received.

People told us what it was like to live at Elizabeth Court and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective) and a practising professional.

During the day we spoke with nine of the 22 people present. People said that staff were caring and helpful.

Everyone spoken with said that they had sufficient food and that drinks were available throughout the day. They said that if they didn’t want what was on the menu an alternative would be provided.

One person said that they “love working in the garden and looking after the animals”. Another said that they like to ”help around the house with odd jobs”.

People said that there were sufficient staff to meet their needs. One person said there were ”ample staff all the time”. Everyone spoken with said they were happy with the response time to call bells. One person said that staff ”come straight away” and another that they “come pretty quickly”.

People said that they were able to raise concerns with the provider if they had any worries.