We attempted to carry out an unannounced inspection on 12 February 2018. We were unable to enter the premises due to an outbreak of an infectious illness. We returned to carry out a comprehensive inspection on 14 March 2018 which was unannounced. This meant the provider; staff and people using the service did not know we would be visiting. We returned for a second day of inspection on 15 March 2018 which was announced.

Elizabeth House is a large, purpose built detached building set within its own grounds. It provides personal care for older people. It is registered to provide care to a maximum of 34 people. At the time of our inspection 31 people used the service.

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.

There was 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.

At the last inspection in June 2016 we rated the service 'Good.' At this inspection we found the evidence continued to support the rating of ‘Good’. There was no evidence or information from our inspection or on-going 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 followed policies and procedures to protect people from harm and abuse. Systems were in place to make sure lessons were learned when incidents took place. Risk assessments and guidance were in place to minimise the risk of harm to people. Safe recruitment procedures were in place and there were sufficient staff on duty. Medicines were administered safely and infection prevention and control was well managed.

Staff received the training they need to be able to carry out their roles and had regular supervision and annual appraisals.

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. However, further work was needed to ensure decision specific mental capacity assessments and best interest’s decisions were recorded when people lacked capacity to make their own decisions.

People told us they enjoyed their meals and had a choice of food. People’s weight was monitored so any issues could be addressed and food was nutritious. Health and social care professionals were involved in people’s care where needed.

People were supported by staff who knew them well. Care was delivered in way that responded to people's needs and preferences. Plans of care were drafted following assessment of people’s needs and these were reviewed regularly. Privacy, dignity and independence were consistently promoted. The policies and practices of the home helped to ensure that everyone was treated equally.

People had access to a wide range of activities and leisure opportunities and were encouraged to maintain personal relationships.

The environment and equipment had been regularly maintained. Emergency contingency plans were in place.

People were aware of how make a complaint. The management team completed regular audits and sought feedback to monitor and improve quality. Staff and people using the service were involved in decisions about how the service was run through regular meetings. The service worked closely with a range of health and social care professionals. Staff told us they felt supported by the management team and provider.

Further information is in the detailed findings below.

This inspection took place on 14 and 21 June 2016. Both days of inspection were unannounced which meant the registered provider and staff did not know that we would be attending.

Elizabeth House provides support and accommodation for up to 34 people living with a dementia and / or a physical disability. At the time of inspection there were 34 people using the service. The service was located in a residential area within its own grounds and located very close to local amenities.

The registered manager became registered with the Commission in December 2014. They had previously worked for the registered provider as a carer and had been supported to progress with them. 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.

Staff understood the procedures they needed to follow to raise a safeguarding alert. Staff had received up to date training and could provide examples of the different types of abuse which people at the service could be at risk from. All staff told us they felt confident in whistle blowing [telling someone]. When safeguarding incidents occurred, the service worked quickly to carry out an investigation and minimise the risk of harm to people.

Risk assessments for people and for the day to day running of the service were in place and had been regularly reviewed. This meant the registered provider had procedures in place to recognise the importance of risk management delivering care and support in a safe way to people.

Up to date health and safety certificates were in place to show the service was safe to deliver provide care and support to people. Regular maintenance was also carried out at the service. All staff participated in planned fire drills which were scenario based and included questions designed to test staff knowledge.

Robust recruitment procedures were in place. Potential candidates were invited to attend two taster days at the service to determine their suitability. Staff only started work once two checked references and a Disclosure and Barring Services (DBS) check had been obtained. This helped the registered provider to ensure people employed were of suitable character to work with vulnerable people.

People and staff told us there were enough staff on duty during the day and at night. The registered provider regularly monitored staffing levels and dependency tools were completed each month. This showed there were sufficient staff on duty to provide safe care and support to people.

People received their medicines when they needed them by appropriately trained staff. Topical cream records and ‘as and when required’ medicine protocols were in place.

All new staff participated in a robust induction process which included training and shadowing more experienced staff. Staff training, supervision and appraisals were up to date for all staff. This showed the registered provider supported staff to remain competent in their roles.

People were supported with their nutrition and hydration. Appropriate risk assessments and care plans were in place for people who were at risk of dehydration or malnutrition. The service referred people to dieticians when further support was needed.

The service was decorated to a high standard and had good quality furnishings in place. People’s rooms contained their personal belongings, furniture and photographs. People had access to a wide range of communal areas at the service and a dementia friendly garden had been put in place by the registered provider.

People and their relatives spoke highly about staff and the care provided at the service. Everyone told us they enjoyed living at the service. We could see staff knew people and their relatives well. People told us that care was given w

At our last inspection of Elizabeth House on 11 September 2013 we identified some concerns with the standard of record keeping. We carried out this follow up inspection to make sure that improvements had been made.

At this inspection we found that improvements had been made and records were now being completed more comprehensively. We found that care plans had been amended to include more person centred information, although it was acknowledged that there was further work to do. We saw that charts that detailed people's food/fluid and repositioning in bed has been appropriately completed. The recording of nformation that related to incidents of challenging behaviour had improved and care plans for diversional activities had been introduced. This helped to ensure that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We also spent time and observed how staff interacted with people who lived at Elizabeth House. We saw that people were treated kindly and we saw that staff provided gentle encouragement to people when mobilising.

A relative we spoke with said, “There is a really nice atmosphere. The staff are marvellous and he/she has settled really well.”

During the inspection we spent time observing the interactions with staff and people who used the service. We spoke with eight people who lived at Elizabeth House and six relatives. We also spoke with the deputy manager and a number of staff of different grades and roles.

All of the people we spoke with were very satisfied with the care they had received. Comments included, " “The girls always knock on my door before they come in. I always get asked if I am OK and am I alright. The staff is so kind and will do anything for me.” " The staff are so lovely, very kind and thoughtful; they do anything you ask of them." Relatives comments included, “Because mum is not really able to make a lot of decisions, I help her. I am kept fully informed about mum’s health and her care; I think the staff do an extremely difficult job with a great deal of commitment and care.”

We saw that staff were attentive and treated people with dignity and respect. Staff responded quickly when people called for help. We saw that staff communicated well with people and explanations of care were given.

We found that people lived in an environment that was homely, clean, well maintained and safe.

We saw that there were systems in place to monitor the quality of the service, however some of the analysis could be more detailed.

We found that people had their care needs assessed, however we found that records were not always detailed enough, appropriate or fully completed.

People's needs were assessed and their rights were respected by the staff. People told us they were able to make decisions about how they wanted to spend their time. We saw staff treating people with dignity and respect. People said “Staff knock on the door and I can choose when I get up and go to bed. I get some help with choosing my clothes and I can have a bath whenever I want.”

People said they were well cared for and said that they liked living at the home. People had support plans and risk assessments in place which helped staff to understand and meet people's needs. We observed staff helping people to maintain their independence and make choices for themselves.

The home had policies and procedures which helped to protect people. People told us that they felt safe and that their concerns would be listened to.

Staff had received sufficient training to enable them to meet the needs of people living at Elizabeth House. One person said “I like the staff, they are all nice."

People's views were being sought about the quality of the service provided. We saw that the management team acted upon any issues to make sure that people remained happy with the service they received.

During our visit to the home people told us they were offered choices about the care they receive and how this is done. They also said that staff were very good. People

living at the home made comments such as, "The staff look after me well."

We talked to people about the care they received and everyone we spoke to during our visit to the home expressed satisfaction about the care at Elizabeth House. People made comments such as "I feel I am pretty well looked after here." One person said "I would rather be here than not coping at home." We were told that the food is good and plentiful.

People that we spoke to during our visit, told us "I'm happy with the care" and "Staff are lovely."

We spoke to relatives and their comments included "I am pleased that my family member has settled and is happy with everything"; "The staff are brilliant, especially the manager" and "I have witnessed sensitive and professional handling of my family member."