Elizabeth Homes is a residential care home for up to 30 older people including those with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is set out over two floors with communal areas and access to a large secure garden area.

The inspection took place on 19 and 24 April 2018 and was unannounced.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and 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 service has not changed since our last inspection.

Staff had received appropriate training to ensure people were protected from avoidable harm and abuse. Systems and processes were maintained to record, evaluate and action any outcomes where safeguarding concerns had been raised.

Assessments of risks associated with people’s care and support and for their environment had been completed. Support plans provided information for staff and other health professionals to ensure people received safe care and support without undue restrictions in place.

The provider maintained safe staffing levels to meet people’s needs. Staff recruitment included pre-employment checks that helped to ensure only suitable employees were recruited to work in the home.

Systems and processes ensured safe management of medicines and infection control.

People received appropriate care and support to meet their individual needs, because staff were supported to have the skills, knowledge and supervision they needed to carry out their roles.

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 supported this practice.

The provider was committed to providing people with a positive caring partnership with staff who were clear about the importance of paying attention to people’s wellbeing, privacy, dignity and independence.

The provider equipped staff with the skills and knowledge to appreciate and respond to the principles of equality and diversity. The provider ensured everybody received care and support that reflected their wishes and preferences and this information was recorded.

People continued to be involved in shaping their care and support. Records were evaluated for their effectiveness and amended to ensure they were up-to-date and reflective of the person’s current needs. Support plans continued to be person-centred.

Staff supported people to live as they choose and to enjoy a variety of meaningful activities.

Systems and processes were in place to support people should they need to raise a complaint.

People, their relatives, staff and other health professionals were consulted and their views and feedback used to help shape the service and maintain high standards of care and support.

The quality assurance system remained effective. Oversight by the registered manager ensured outcomes were evaluated for their effectiveness with timely action implemented where improvements were required.

Further information is in the detailed findings below.

We spoke with five people who used the service during our inspection. They were all satisfied with their care and said they were “Comfortable”, “Well looked after” and “Really pleased with the staff and the way they look after me.” We looked at the care files, risk assessments and associated care records for people who used the service. These had been updated and improved since our last visit in July 2013.

We saw improvements had been made to the cleanliness of the general environment and the living areas within the service. The provider had invested time and money into supplying new furniture, furnishings and floor coverings for a number of areas within the home and developed new cleaning schedules to sustain the improvements. People said “The home is looking lovely now and everywhere looks clean and fresh.”

The provider had recruited additional domestic and care staff since our last inspection in July 2013. Staff told us “We have more time to do our own jobs now.”

We found systems to monitor and evaluate the quality of the care were in place and being used appropriately. People told us they knew who to talk to if they had any concerns and were confident that the acting manager would deal with them quickly.

We were informed by the provider in June 2013 that the registered manager for the service had ‘stepped down’ from their post. During this inspection we met the new manager who had only been in post for two days prior to this inspection.

Our observations of the service showed us that the staff were very kind and caring and all the people who spoke with us were very happy with their care. One person said “The staff are very good, they listen to what we say”, another person said “The staff look after us well, they do their best to answer the call bells quickly and nothing is too much trouble.” However, we found that the quality of the care people received varied.

People said they were happy with their rooms and the communal areas. However, we had a number of concerns about infection prevention and control, the environment and fire safety practices within the service. These have been discussed within the report.

We looked at staffing levels as part of our visit and we found there were insufficient numbers of suitably qualified, skilled and experienced staff. Two people told us “The care staff are very good, friendly and supportive but they are always rushing around and do not have time to sit with people and chat.”

We found that improvements were needed to the quality assurance system to ensure people’s health, safety and care was monitored effectively and that appropriate action could be taken where necessary to make changes in the service.

When we visited the service in October 2012 people who used the service were satisfied with the care they received and their homely environment. We chatted briefly with people during this visit but their comments to us did not relate to the outcome we were inspecting.

We found that the provider and staff had acted on the information in the report from October 2012 and made positive changes to medication practices, staff training, staff supervisions and record keeping within the service.

People we spoke with during our visit were very satisfied with the care and activities within the service. They told us “There are varied activities in the afternoons and I get visits from my family” and “I cannot fault the place at all, the care is very good and the staff are lovely.”

People who used the service were satisfied with the care they received and said that they did not have to wait too long for staff when they needed assistance. Individuals told us “Staff are friendly, helpful and supportive.”

People we spoke with were confident about using the complaints system in place and satisfied that staff or the manager would take action to solve their problems.

Our observations of the service showed that staff spoke with and interacted with people who used the service in a patient and pleasant manner.

We found that medication recording and administration within the service did not always follow the policies and procedures of the service and presented some risk to people who used the service. Report writing in the care records was poor and did not always reflect the changes in care and treatment that people received. We also found that staff did not receive sufficient support and monitoring of their working practice through regular supervisions.

People told us they enjoyed living at the home. One person spoke highly of the activities available and another was pleased that the home supported his choice of remaining in his room most of the time.

The inspection of Elizabeth Homes took place on 19 and 23 November 2015 and was unannounced. At the last inspection on 18 October 2013 the service was found to have met all regulations assessed.

Elizabeth Homes is a residential care home that provides accommodation and support to a maximum of 30 older people, some of whom may be living with dementia. The service is situated on the main road and close to local shops in the centre of Howden, East Yorkshire. There is good access to local bus and rail transport networks and there is limited on-site parking with a pay and display car park immediately opposite the service.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager in post that had been registered for 18 months. 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.

We found that the service was safe in respect of systems to manage safeguarding issues, upholding people’s human rights, assessing risky situations, the maintenance of the premises, fire precautions, staffing numbers on duty, recruitment practices, management of medicines and infection control practices.

People were provided with effective care because staff were inducted, trained and skilled in their roles and staff received consistent management support. People were protected by the use of appropriate legislation should their capacity be in question. People received sufficient nutrition to keep them healthy and the design of the premises were suitable to meet people’s needs.

We found that people were cared for by staff that were responsive to their needs. Staff had a positive and caring approach, acknowledged diversity and exercised equality. They ensured people’s wellbeing, upheld people’s privacy and dignity and encouraged people to be independent whenever possible. This meant that the service was responsive.

People experienced a service of care that was well led because the culture of the service was positive, open and responsive.  People benefitted from a system of quality monitoring and assurance, to which they could contribute their views, be listened to and have a say in how the service was run.  This meant they were able to affect improvements in the service delivery.