About the service:

Elizabeth House accommodates up to 20 people in one adapted building. It

provides residential care to people over the age of 65. During our visit 18 people lived at the home. The home is located in Solihull, West Midlands.

People's experience of using this service:

¿People were protected from avoidable harm and enough staff were on duty to meet people’s needs.

¿ Risk management plans contained clear instructions for staff to follow to keep people safe.

¿Staff were recruited safely and received on-going support and training to be effective in their roles.

¿The environment was clean, and staff followed good infection control practices.

¿Medicines were managed safely, and people were supported to access healthcare when needed.

¿People received information in a way they could understand and chose how to live their lives.

¿People's nutritional and hydration needs were met, and staff understood people's dietary needs.

¿Staff knew people well and were responsive to their needs. Care plans helped staff to provide personalised care.

¿People were supported to be independent. Their privacy was respected, and their dignity was maintained.

¿People's end of life wishes were documented to ensure their wishes would be respected at the end stage of their lives.

¿People enjoyed the variety of social activities and maintained positive links with their community.

¿ People and relatives spoke positively about the leadership of the service and staff felt supported.

¿Complaints were being managed in line with the provider's procedure.

¿ Systems to monitor the quality and safety of the service were effective.

¿Lessons were learnt when things had gone wrong. The provider shared learning across the organisation to drive continual improvement.

¿Feedback gathered from people and relatives was used to drive forward improvement.

At this inspection we found the evidence supported a rating of 'Good' in all areas. More information in 'Detailed Findings' below.

Rating at last inspection: At our last inspection in January 2018 we rated the service as 'Requires improvement' overall.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

This inspection took place on 5 January 2018 and was unannounced.

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.

Elizabeth House accommodates a maximum of 20 people who require personal care in one building across two floors. 18 older people lived at the home at the time of this comprehensive inspection and some people lived with dementia.

At the last inspection in October 2015, the service was rated 'Good'. At this inspection, the rating had not been sustained and service is rated as requires improvement.

The service is required to have 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 and associated Regulations about how the service is run. At the time of our visit the registered manager had been in post for six years.

The registered manager told us they had faced challenges in the previous year because members of the senior staff team had been absent from work. This meant that not all staff training had been delivered as planned and staff had limited opportunities for supervision. They had plans in place to demonstrate how they kept themselves up to date with best practice and demonstrated their compliance with regulation.

Some on-going training staff required to meet people's needs had not taken place and some training was not up to date. Plans were in place to make improvements to ensure staff had the knowledge they needed to deliver safe and effective care. Despite some staff not completing mental capacity training they demonstrated they understood the principles of the legislation to protect people's rights.

The registered manager demonstrated a good understanding of the MCA legislation. New staff had received effective support when they had started work at the home. The staff team also had some opportunities to complete additional qualifications, such as social care diplomas.

Individual meetings with staff to discuss their role, competency and to identify how to further develop their skills had not taken place in-line with the provider’s procedures. Plans were in place to make improvements.

It is a legal requirement for providers to display CQC ratings on their website. Prior to our visit we identified this had not happened. Also, some information on their website was incorrect. Following our visit we checked and found action had been taken to resolve this issue.

The registered manager had some knowledge of the Equality Act 2010 and explained how they needed to support people who may have diverse needs.

People told us they felt safe living at Elizabeth House. There were enough staff to keep people safe and respond to their needs in a timely way.

Procedures were in place to protect people from harm. Staff had received safeguarding adults training and knew to follow procedures to keep people safe. The provider's recruitment procedures minimised, as far as possible, the risks to people safety.

Staff were knowledgeable about the risks associated with people's care. Risk assessments were in place and detailed the support people needed to reduce and manage the risks. A system to monitor accidents and incident that happened in the home was in place.

There were processes to keep people safe in the event of an emergency such as a fire. Regular checks of the building and equipment took place to make sure they were safe to use.

People's needs were met by the design and decoration of the home. The home was clean and well maintained and care workers assured us they understood their responsibilities in relation to health and safety infection control.

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We carried out this inspection on 12 October 2015. The inspection was unannounced. .

The service is registered for up to 20 people and offers accommodation for people who require nursing or personal care. At the time of our inspection there were 18 people living at the service including one person staying there temporarily on respite care.

A requirement of the service’s registration is that they have 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. A registered manager was in post and had been for three years.

Support was provided that met people’s needs and there were enough staff to care for people safely. People’s health and social care needs were reviewed regularly. Staff referred to other health professionals when needed, so people were supported to maintain their health and wellbeing. Risk assessments were completed and plans minimised risks associated with people’s care.

People told us they felt safe living at the service. Staff knew how to safeguard people and what to do if they suspected abuse. People were protected from harm as medicines were stored securely and systems ensured people received their medicines as prescribed. Checks were carried out prior to staff starting work at the service to make sure they were of good character and ensure their suitability for employment.

Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs). No one at the service had a DoLs authorised.

Staff had training to do their jobs effectively in order to meet people’s care and support needs. Staff were encouraged to continue to develop their skills in health and social care. Staff told us they felt supported by the management team to carry out their roles effectively.

People’s nutritional needs were met and special dietary needs were catered for. People took part in some organised activities and told us there was enough for them to do.

People told us they liked living at the service and that staff were kind and caring. People were cared for as individuals with their preferences and choices supported. Staff treated people with dignity and respect when supporting them and encouraged people to be independent. Relatives were encouraged to be involved in supporting their family members.

People were positive about the management team and the running of the service. The registered manager was responsive to people’s feedback in developing the service, and making continued improvements. Systems and checks made sure the environment was safe and that people received the care and support they needed. People knew how to complain if they wished to, and these were addressed to people’s satisfaction.

We visited Elizabeth House to follow up concerns we found when we carried out an inspection on 01 April 2014. We completed this inspection to make sure the necessary changes had been made to make sure people received care from staff who were suitably qualified and trained. We spoke with the registered manager, a housekeeper, a team leader and one care staff. We also spoke with two people who lived at Elizabeth House. This information helped to ensure people received care and support from a service that was safe, effective, caring, responsive and well led.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

We inspected the service previously on 01 April 2014 and identified improvements were required. These included improvements to the training and supervision records because it was not always clear whether staff had received training and supervisions when required. We found the provider had made changes following our previous inspection and improvements had been made.

We saw training records had been completed that recorded what training each staff member had received and what further training was required.

We saw records showed staff supervision meetings were being completed and records confirmed what issues and topics had been discussed.

People told us they like the staff. One person said: "The staff are very nice here."

The registered manager had introduced a system that identified when staff supervisions were required. We checked staff records and found supervisions had been completed when required.

The registered manager had trained other senior staff members to complete supervisions to make sure staff supervision meetings where completed at the appropriate times.

The system that recorded staff training had been updated and improved. Training records showed which staff had received training and who required further training. This made sure people were not placed at risk of receiving care and support from staff who were not suitably trained to meet their individual needs.

We inspected Elizabeth House and spoke with the registered manager, a training manager, two care staff and a housekeeper about the support they gave to people who lived at the home. Speaking with these people helped answer our five questions. Is the service safe? Is the service effective? Is the service caring? Is the service responsive and is the service well led?

Below is a summary of what we found. This summary is based on our observations and evidence we found during the inspection. We were able to speak with four people and a friend of a person who lived at the home. The people we spoke with were able to tell us about their personal experiences of what it was like living at Elizabeth House.

Is the service safe?

People told us they felt safe living at the home. People told us the staff were kind and friendly towards them and provided the care and support they needed. People told us they felt safe because they were able to lock their own doors if they wanted to. People also told us they were involved in their day to day care decisions.

People’s records had been completed at the required intervals and people’s care records matched their individual care needs. We found people had appropriate risk assessments in place that made sure people were not placed at additional risk. We found people had appropriate risk assessments in place that made sure any risks were managed.

We found equipment was checked and serviced at the required intervals. We found the service completed regular housekeeping audits to make sure the quality of service people received was maintained.

Is the service effective?

People’s health and care needs were assessed and people had been involved in planning the care they received. We found care plans had been reviewed regularly and matched the care people required. We found care plans supported staff to deliver care and support to meet people’s needs.

People were involved in how their care was delivered. Staff asked people for their consent before any care or treatment was provided. People’s mobility and other needs were taken into account in relation to their environment. This enabled people to move around freely and safely and with the level of support that met their needs.

Visitors we spoke with confirmed they were able to see people in private and that they could visit their friends and relatives whenever they wanted.

We found staff did not always receive the required training to support people effectively. We found some staff had not completed the necessary training which had the potential to place people at risk of receiving inappropriate care or support. We also found the provider did not have an effective system in place that made sure staff had regular supervisions to discuss any concerns, performance or training needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff and making sure all staff are trained to the appropriate level.

Is the service caring?

Staff were attentive to people’s needs throughout our inspection. We saw staff interacted positively with people and staff gave people time to respond. We found staff showed patience when communicating with people who lived at Elizabeth House. People told us that staff respected their choices and staff helped them to promote their own independence as much as possible.

We found people’s preferences were supported. People were free to make their own choices about food, drinks, bedtimes, personal care, clothes they wanted to wear and where they wanted to spend their time in the home. People told us they did not have to wait long when they needed help or support. People told us the staff were very supportive and friendly.

Is the service responsive?

People received help and support from other health professionals when required, such as doctors, dentists and opticians. People were supported to participate in activities inside and outside of the service. People were engaged with the local community.

People told us that they were able to raise any concerns they had, although all the people we spoke with were satisfied with the service they received.

Is the service well led?

The service worked with other health professionals and services to make sure people received the appropriate levels of care they needed. We found the service had an effective quality assurance system in place and any identified actions had led to improvements in the service that people received. People told us they were able to speak with staff and managers and felt able to raise any issues or concerns they had.

We carried out a routine inspection at Elizabeth House Care Home on 31 October 2013. We looked how people were being cared for at each stage of their treatment and care and how this was recorded. We looked how the service supported people with their nutritional needs and how medication was managed by staff. We talked with people who used the service and staff.

We observed staff interacting with people with kindness. They demonstrated through one to one discussions with us that they knew the care needs of the people they were looking after.

We reviewed the care of four people with varying levels of need. We spent a period of time observing how people were being cared for. We saw people who were identified as being at risk did not always have appropriate risk assessments to support their needs.

We saw people’s nutritional needs were being met. Medication was stored and administered safely. There were enough staff to meet the needs of the people being cared for.

We saw records were stored appropriately, however some records were not up to date and did not contain accurate information.

We noted appropriate referrals were made to outside specialists on behalf of people who lived there.

We spoke to people who used the service. They told us they were happy with their care. One person stated, “I never have to wait long for one of the girls, and they always come with a smile on their face.”

We found the provider to be compliant in the areas of involvement and information; safeguarding and safety, staffing and supporting workers. We found the provider non-compliant in the areas of personalised care and quality management.

We spoke to staff, observed policies and processes, reviewed four sets of notes and spoke to six people using the service to gain further insight of the care provided.

Persons using the service were satisfied with the care provided. Many had lived at the home for a number of years and found the carers to be kind and respectful. One person said “the staff are wonderful”. Another said “they are all so kind”.

We found evidence of some quality management processes including complaints and housekeeping checks. However, the planned programme of audits had not been completed as planned and people that use the service had not been formally consulted on the care they receive.

There were systems in place for staff training and recruitment. Staff enjoyed working at the home and had attended the training planned for them. However, the annual appraisal and supervision programme for staff had not been completed and the policies in place required review.

We observed that staff were kind and considerate and that the people who live at the home liked living there. Everyone we spoke to said the food was excellent and that staff were always willing to help.

We spoke with seven people who live in the home. We observed the care that people received. People we spoke with were positive about their experiences of living in Elizabeth House and the care they received. We saw that people looked happy and relaxed in the home. Three people told us that they are “Very happy here."

People told us that they had an assessment before an agreement is reached to move in. To help people make an informed decision about moving into the home people are encouraged to visit and spend the day at Elizabeth House. Information is given to help people decide whether the home is the right place for them. One person told us "I haven’t been here long but it feels homely so far.” Another person said “I don’t have any concerns.”

People told us that they are treated with respect and staff are kind to them. A comment received included “They (Staff) always ask me how I want things done.”

People living in the home said that a choice of meals was always offered to them. People said that staff had asked them what foods they liked. People commented "the food is good” and “There is a good choice.”

People told us that they felt there was enough staff to help them with their day to day life. People commented that "Their (Staff) all lovely.” “The staff are friendly.” People living in the home told us that they can tell the care staff anything. When we asked who they would speak to if they were unhappy and needed to complain they told us they would speak to the manager. People were confident that their concerns would be listened to and acted upon.