This inspection took place on 13 and 14 November 2018. The first day was unannounced.

This was the first inspection of Elizabeth House since it was registered under new owners. At the last inspection in February 2016 we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as staff recruitment procedures were not sufficiently robust. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question ‘is the service safe’ to at least good.' At this inspection we found improvements had been made and the service was no longer in breach of this regulation.

Elizabeth 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. It is registered to provide care and support for up to 18 people. At the time of our inspection 16 people were living at Elizabeth House. The home has two floors, with bedrooms on both the ground and upper floor.

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.

The people who lived at Elizabeth House told us they felt safe. There were enough staff to meet the needs of the people who currently lived there, and appropriate precautions were taken to ensure that staff had the right character to work with vulnerable people. The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

The building was secure, clean and well maintained, and staff ensured any environment hazards were minimised. However, the layout of the building was unhelpful, as narrow corridors made manoeuvring wheelchairs difficult, and the service could not easily accommodate people with difficulty mobilising on the upstairs landing.

Care records were well kept and easy to follow. They gave a good indication of resident’s abilities and provided a good description of their likes and dislikes. Where risk had been identified, risk plans were in place to minimise the risk of harm occurring. Senior staff were trained to administer medicines and we saw people were assisted to take their prescribed medicines in a way they were comfortable with by staff who understood their needs.

People were supported by a stable staff team who knew the residents well. We saw that the staffing ratio reflected the needs of the people living at Elizabeth House. The people we spoke with believed the staff were competent and knowledgeable. We saw from training records that all new starters received a thorough induction and ongoing refresher training to maintain their competence.

Staff communicated well with each other and we saw that information was exchanged between staff informally throughout the working day, and a detailed handover meeting took place at the start and finish of every shift. This ensured that care staff were aware of any change in peoples’ needs and of any tasks which might need to be completed.

The registered manager and the care staff we spoke to, demonstrated a good understanding of capacity and consent. When people were being deprived of their liberty the correct processes had been followed to ensure that this was done within the current legislation.

People liked the food provided, and attention was paid to their dietary needs and preferences. However, the choice of main meals was limited. Lunchtime was not a sociable occasion and there was little conversation