Elizabeth House is a purpose built care home and is registered to provide accommodation and personal care for up 60 older people some of whom live with dementia. At the time of our inspection 57 people were living at the home.

The home had a registered manager 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 2008 and associated Regulations about how the service is run.

The inspection took place on 26 October and 01 November 2017. This inspection was in response to concerns we received from the local authority regarding unsafe care practises and a lack of managerial oversight in the home. This inspection focused on the Alexandra Unit which provides care to people living with dementia, as feedback suggested this was the area of the home where the concerns were identified by the local authority..

The inspector arrived on the morning of 26 October 2017 to inspect the service unannounced. On 01 November 2017 we met with the provider to seek assurances due to the nature of the concerns identified at this inspection. We have also referred our findings to the local authority commissioning and safeguarding team.

At our previous inspection on 09 February 2016 we found that people's medicines were not always managed safely, however, we rated the service overall good and asked the provider to make improvements in this area. At this inspection we found that improvements had been made in relation to management of medicines, however we found that the service was not meeting the standards in relation to providing safe care and effective management and governance.

People told us they felt safe, however we found that people who required positioning to maintain their skin integrity did not receive this as required. Risks to people’s safety and welfare were not consistently identified and responded to. Where people were at risk of harm, or had experienced harm these incidents were not consistently reported to local safeguarding authorities or investigated by management. People’s medicines were managed well and they received their medicines as the prescriber intended.

People did not consistently receive care that was well led and robustly monitored. People’s personal care records were not regularly reviewed, completed or updated when required. Audits of people’s care records were not effectively reviewed to ensure actions were completed, and notifiable incidents were not consistently reported to CQC when required. Staff felt that the manager was not visible around the home and we found that leadership in the home was not sufficiently proactive to keep people safe. Notification that were required to be submitted to CQC regarding significant events had not been made.

This inspection was carried out on 9 February 2016 and was unannounced.

Elizabeth House Residential Care Home provides accommodation and personal care for up to 54 older people, some of whom live with dementia. There were 48 people living at the service on the day of our inspection.

At their last inspection on 20 January 2014, they were found to be meeting the standards we inspected. At this inspection we found that they had continued to meet the standards. However, we found that there were some areas that required improvement. These were in relation to the management of medicines and ensuring that people felt involved in planning their care.

People’s medicines were not always managed safely. We found that there were issues with some of the quantities and records relating to medicines. Also, although care plans included person centred information that indicated people had been involved in the process, people did not recall being consulted.

There was an interim manager in post who had applied for their registration with the commission while they were recruiting for a permanent manager. 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.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was working in accordance with MCA and appropriate DoLS applications were pending.

People received care that met their needs and care plans were written in a way to provide staff with appropriate guidance to provide safe care. People were protected from the risk of abuse as staff had a good understanding of recognising and reporting concerns. Risks to people’s health and welfare were assessed and reviewed as regularly.

Staff received appropriate training and supervision. They felt supported by the management team and provider. Staff underwent a robust recruitment process and there was sufficient staff to meet people’s needs. People, relatives and staff were positive about the management of the home and there were systems in place to assess the quality of the service.

People were supported to eat and drink enough to maintain their health and had regular access to health care professionals. There were activities provided, however, the activity organiser had recently left which had meant there was a recent drop in activities. This was being addressed. People were asked for their feedback through surveys and meetings. We saw complaints were responded to appropriately.

We saw that people had their needs assessed and planned for. We observed, and people told us, that care was delivered in accordance with their plans and their wishes. Staff were patient and communicated well with people. All of the interactions we observed were respectful and promoted the person's dignity. People who had complex needs had their care reviewed regularly and they, along with a relative if appropriate, were involved in this review.

We used comments cards to help gain the views of people who used the service and their relatives. We had five responses from relatives, all of which were very positive and the care their family member received.

The service worked well with other providers. We saw from records that the staff regularly contacted medical professionals and the social work team to enable them to provide the appropriate support to people.

There were systems in place which ensured the quality of dementia care was being delivered to good standard. Thought had been given to the lay out of the premises and staff had received sufficient training and support for their role.

People who lived at Elizabeth House told us that they felt safe and that they could talk to the manager if they had any concerns. We talked to visitors who confirmed that their relatives had an assessment of needs prior to moving in and that the quality of care was good. One relative told us that ' staff are so kind and helpful'. A person who lived at the home told us that staff were 'the kindest people on earth, we get looked after brilliantly here'. We saw evidence that people were consulted about their care and that their decisions to refuse support were respected. We heard that care plans and risk assessments were reviewed regularly to meet the changing needs of people. This was verified by our examination of records. We heard that the home had a particular interest in palliative and end of life care and saw that a comprehensive, person centred system had been put in place. We heard that staff were supported well and given good opportunities to develop their skills. Staff confirmed that their manager supported them well and encouraged them to develop their skills. We saw evidence that the complaints procedure was made available to everyone, and that complaints were investigated and followed up appropriately.

The people we spoke with when we visited the service on 17 November 2011, described positive experiences of living at Elizabeth House Residential Care Home.

People told us the service was well managed. One person told us they were very content living here and would give it 'full marks'. Another person said it was 'beautifully run'.

Individuals said they liked Elizabeth House because it was friendly and they felt reassured, 'there was always someone there for you'. One person told us their quality of life had improved since moving in because they were not anxious or worried any more. 'I can pull my call bell and someone will be there in a matter of minutes'.

People confirmed they were offered choices in their daily lives and had good relationships with staff who they said were 'kind' and treated them with dignity.

All the people we had conversations with were positive about the range and choice of meals they are served. One person described, waking early on the morning of our visit, and on hearing they had got up staff brought a tray of tea and biscuits to their bedroom.

People told us about various activities and events they look forward to or had taken part in. These included a variety of trips out during the summer. One person mentioned that the notice boards around the building provide information about what is being planned and news of what is happening within the service.

People told us they liked their bedrooms and had been able to add their own furnishings and personal items. Important pictures and photographs had been hung on the walls.

Individuals commented on the cleanliness of the service and described it as being 'spotless'.