Elizabeth House is a care home that provides 24-hour residential care for up to 30 people. At the time of our inspection there were 22 people living at the home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is situated approximately one mile from the centre of Oldham. It is a large detached building that provides accommodation over two floors. It has a garden at the front and an enclosed yard to the rear of the property.

This was an unannounced inspection which took place on 07 and 08 August 2018. We last inspected the service in November 2015. At that inspection we rated the service ‘Good’ overall. At this inspection we identified one breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was in relation to the maintenance of the premises. We have made a recommendation about staffing levels.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The home was clean and new lounge chairs had recently been purchased. However, the main corridor carpet was badly stained and malodourous and there were areas throughout the home where maintenance was required. Although the provider was aware of the poor condition of the carpet and had scheduled for it and other carpets to be replaced, there were other parts of the building where general maintenance was required. Action had not been taken to resolve these issues.

There were effective infection control and prevention measures within the service. Checks and servicing of equipment, such as for the gas, electricity, passenger lift and fire-fighting equipment were up-to-date.

People's needs were responded to promptly during our inspection. However, several people told us they felt more staff were needed, particularly during the night, when only two staff members worked the shift. The registered manager told us they were in the process of recruiting new staff to increase the number of care staff on duty and in particular, at night.

There were systems in place to help safeguard people from abuse. Recruitment checks had been carried out to ensure staff were suitable to work in a care setting with vulnerable people.

New staff were provided with an induction programme. All staff had undergone training to ensure they had the knowledge and skills to support people safely. Staff received regular supervision. This gave them the opportunity to raise any concerns, identify their training needs and receive feedback about the standard of their work.

People were supported to make choices, such as what they would like to eat and wear and what they would like to do. This showed the service was working within the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

Staff worked with health and social care professionals to ensure people were supported to maintain good health. People were provided with a choice of good quality, home-cooked meals.

The service had a process for handling complaints and concerns. There had not been any recent complaints.

People’s care records were detailed and person-centred. They provided staff with sufficient information to guide them on how people would like to be supported. Staff helped people to take part in activities of their choice.

The service had a registered manager who was new to this role. She showed enthusiasm and commitment to the service.

There were some systems in place to monitor the quality of the care provided. However, the audits had not iden

Our inspection team was made up of an inspector who addressed our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

People we spoke with told us they felt happy and safe. Relatives told us that they felt confident with the care and support delivered by staff in the home. One person told us that they could go home feeling happy and confident that their relative was being very well cared for.

During our visit we saw good examples of care practice and noted that staff took time to follow guidance in care plans so that they provided care and treatment in a safe and effective manner.

From records we looked at we saw that people who lacked capacity were fully protected when decisions were necessary regarding their health and personal care needs.

Records seen provided evidence that staff had received appropriate training so that they had the skills and knowledge to provide care and support in a safe way.

Is the service effective?

All relatives we spoke with told us that they were very happy with the quality and standard of care provided by staff. They told us that the manager and staff team were very open and responsive and addressed any issues they raised in a friendly, professional and timely manner. Relatives told us that they felt very involved in the care planning process and that they were kept up to date and informed regarding any changes in care needs.

Is the service caring?

All the people we spoke with during this visit expressed satisfaction about the care and support provided to people. Comments included : "The staff here are very caring, nothing is too much trouble for them".

Care plans were in place and these provided staff with detailed information on how to provide care and support to people in a safe and appropriate way. When we observed staff, we saw that they followed the instructions in the care plans. During our discussions with staff it was evident that they had a good knowledge and understanding of individual care needs. During the day we saw staff engaging in meaningful conversations with people and supporting people to join in activities.

Is the service responsive?

We saw that people’s needs were assessed before moving into the home to ensure that their needs could be met by the skill level of staff employed by the service. We saw that care plans were detailed and there was evidence that they were regularly reviewed. When any changes were identified the care plan was updated. We saw several examples where appropriate referrals had been made to healthcare professionals for additional assessments and guidance in respect of care and treatment.

Is the service well led?

The service had a registered manager in post and a number of senior staff. All the staff and relatives we spoke with spoke highly of the manager and her open and transparent approach in managing the home. People told us they felt confident in raising any issues of concern with the manager and that she was always visible and made herself available. There were robust auditing and monitoring systems in place and there was evidence that people using the service were regularly consulted on how the service was run.

We spoke with four people during our inspection to Elizabeth House. All stated that they were happy living at the home.

One person told us "I'm very pleased the way everything is. I like it here" and another said "It's a pleasure to be here". Comments about care included "I think I'm well cared for" and "The care is very good". One person commented that they would not change anything about the home.

Two people had completed satisfaction questionnaires supplied by the home during August 2012. They both said they were given the opportunity to be involved in their care planning, and they could talk to staff about any concerns they had. Two relatives had also completed survey forms, and comments included "We feel [our relative] is well looked after". Relatives said they were comfortable approaching staff to voice any concerns they had.

This inspection was carried out over two days on the 9 and 12 November 2015. Our visit on 9 November 2015 was unannounced.

We last inspected Elizabeth House in May 2014. At that inspection we found that the service was meeting all the regulations we assessed.

Elizabeth House is a large detached property overlooking a park approximately one mile from Oldham town centre. The home is registered to provide care and support for up to 30 people who require residential care only.

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 about how the service is run.

People who used the service told us that Elizabeth House was a safe place to live and that they were supported by sufficient numbers of staff to appropriately meet their needs.

Staff we spoke with expressed a good understanding of safeguarding matters and training records indicated that staff had received training in this subject.

Medicines were safely administered by staff that had received appropriate training.

Suitable arrangements were in place for the prevention and control of infection within the home.

Staff we spoke with confirmed they had received appropriate induction training when they started working at the home. They also told us they had access to, and received regular and appropriate training.

Regular visiting health and social care professionals told us they were confident that people using the service received a good standard of care and support.

Equipment, such as hoists and aids and adaptations were available in the home to promote people’s safety, independence and comfort.

People we spoke with were happy with the quality and choice of food provided. Where people’s nutrition and hydration required monitoring, staff completed food and fluid intake charts and we saw evidence of completed charts.

Positive efforts had been taken to make parts of the home ‘dementia friendly’. A ‘memory room’ had been created which was decorated and furnished in such a way to stimulate the memory of people to bygone days.

Care records viewed contained enough information to guide staff on the care and support to be provided to individual people. The information contained details about the person’s personal care needs, likes and dislikes, preferred daily routines, medication and nutritional needs.

Care plans viewed also included and identified risks to people’s health and wellbeing including nutrition, falls and the prevention of pressure sore development. The risk assessments gave staff guidance to manage the identified risks.

We saw that activities were provided in accordance with what people enjoyed participating in.

The complaints procedure was displayed in a prominent place within the home and a copy was also placed in each person’s bedroom. We saw that complaints made by people using the service had been appropriately and effectively dealt with.

People using the service and their relatives and representatives had opportunities to influence the development of the service by participating in meetings and by completing surveys about the quality and standards of care and support being provided.

Systems were in place to demonstrate that regular checks had been undertaken on all aspects of the management of the service. These checks included, monitoring risk assessments of the premises and equipment being used, monthly medication audit, monthly care plan audits, monitoring pressure relieving equipment, cleaning schedules, nurse call system, fire alarm system, health and safety checks and action taken to address any concerns identified during such audit checks.

Members of staff we spoke with told us that the management team were very approachable and supportive.