This inspection was carried out on 11 October 2018 and was unannounced.

Elizabeth Road care home is a care home that supports five people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual arrangement. CQC regulate both the premises and the care provided and both were looked at during this inspection. The home is purpose-built and fitted with aids and adaptations to meet the needs of the people living there. The people supported were living with complex physical health needs and learning disabilities or autism.

The home had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include, choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The home has a registered manager. A registered manager is a person who is 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The last inspection, the service was rated good. At this inspection we found the service remained good. The service is rated good as it met all the requirements of the fundamental standards.

Relatives, staff and health and social care professionals all spoke positively about the staff team.

Recruitment systems at the home remained safe and sufficient staff were employed to meet the needs of people supported. All staff had completed an induction, as well as training to enable then to be effective in their role. Staff had undertaken additional training to meet the specific individual needs of the people supported. Staff received regular support and supervision for their role and told us they felt well supported.

The registered provider had safeguarding policies and procedures in place that staff were familiar with and felt confident to follow. Staff had all received training along with regular refresher updates. Staff are able to describe what abuse may look like and had all received training in this area. Staff believed any concerns they had would be promptly acted upon.

People had their needs assessed prior to moving into the home and this information was used to create individual care plans and risk assessments that included clear guidance for staff to meet people's needs. People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process.

Staff had developed positive working relationships with people who lived at the home. We observed positive interactions between staff and people living at the home throughout our inspection. Staff were caring and demonstrated kindness. A variety of activities were available for people to participate in.

Medicines were ordered, stored, administered and disposed of in accordance with best practice guidelines. The registered provider had medicines policies and procedures in place. Medicine administration records (MAR) were fully completed and regularly audited for accuracy.

People were supported by staff with their food and drink needs. When people have been identified as having specific dietary needs, staff had guidance available on how to support people. Speech and language therapists and dieticians were appropriately used to ensure people's individual needs were met.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and report on what we find. We saw that the registered provider had guidance available for staff in relation to the MCA. Staff had undertaken basic training and demonstrated an understanding of this. The registered provider had made appropriate applications for

The inspection took place on 18 and 19 January 2016 and was unannounced. At our previous inspection in June 2014 we found that the provider was meeting the regulations in relation to the outcomes we inspected.

Elizabeth Road is registered to provide accommodation with nursing and personal care to five adults. It is a purpose built care home which is fully accessible and fitted with aids and adaptations. Elizabeth Road is registered as a location under the registration of the provider Community Integrated Care. This is a registered charity which provides social care to people with a range of needs. The property is situated in a residential area of Huyton, Merseyside.

The home has 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 manager was available for part of the inspection and engaged positively with the inspection process. The manager was friendly and approachable; she operated an open door policy for people using the service, staff and visitors.

We found that care was provided by a long term staff group in an environment which was friendly and homely.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act were met.

The relationships we saw were caring, respectful and dignified and the atmosphere was one of calm and comfort. Everyone in the service looked relaxed and comfortable with each other and with all of the staff.

Staff members had developed good relationships with people living at the home and care plans clearly identified people’s needs, which ensured people received the care they wanted in the way they preferred.

Staff knew about the need to safeguard people and were provided with the right information they needed to do this. They knew what to do if they had a concern. There were sufficient staff to meet the needs of the people who lived in the home.

The home was well-decorated and maintained and adapted where required. People had their own bedrooms which they could personalise as they wished.

We considered our inspection finding to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found -

Is the service safe?

Systems were in place to assess any risks identified when planning people's care and support. We found that these systems were effective. We found that the risks to people who used the service had been assessed and that the risks were reviewed on a regular basis.

Is the service effective?

Relatives of people who used the service told us, “Treated with dignity” and “They understand when they are in pain.” We saw that people who used the service were enabled to access local community facilities on a regular basis.

Is the service caring?

People were supported by pleasant and respectful staff. Each person had a named nurse to co-ordinate their care and nursing needs. Relatives of people who used the service told us “They are very caring, always get the GP if needed” and “They care for them a lot.”

Is the service responsive?

A system of review was in place to enable care plans to be updated on a regular basis. We saw that systems were in place to monitor the service delivered and identify any areas of improvement required.

Is the service well-led?

The manager of the service demonstrated a good awareness of areas in which the service could be improved. The relative of one person who used the service told us the “Management is very good.”

We were not able to gain the views of people who used the service. However, we made observations about how people were being supported throughout the day, and we have used this and our discussions with relatives and staff, along with what we found when we checked records, to make our judgement.

We found that when people were not able to make decisions about their care then decisions were made in their best interests. This sometimes included a team of people coming together to make those decisions.

We judged that people had received the care, support and treatment they required to meet their needs. People were well supported with their personal and health care needs. People's needs were clearly reflected in their support plan and staff presented as having a good understanding of people's needs. We also spoke with a number of visiting relatives. They gave us good feedback about the service and they told us they felt the standard of care was good.

Medication was managed safely and people’s needs with medication were clearly recorded in their support plan.

New staff only started work after they had gone through appropriate pre- employment checks. These aimed to ensure people were supported by staff who had the appropriate skills and qualities they needed to carry out their roles.

Relatives told us they would be happy to approach the manager if they had any concerns or complaints about the service and they felt confident that the manager would address any concerns.

We met each of the people who were living at the home, but on this occasion we were not able to attain their views about the service. However, during our visit we spent time observing the support people received from staff and talking to staff. We also looked at information about people’s care and support and information on staff training. We used this to make judgements about what we thought were people’s experiences of care and support.

We spoke with a visiting relative during our visit. Following the visit we also spoke with a care manager who knew people in a professional capacity. Feedback from these stakeholders was generally positive and raised no areas for concern.

The people using the service were unable to communicate their wishes and feelings verbally. On the day of our visit we observed that they appeared relaxed and content in their home and with the staff supporting them.

We also spoke with two student learning disability nurses who had been at the care home for 7 weeks. They told us that:

“They look after them well here”

“They get them out as much as they can”

As part of this review of compliance we asked relatives to comment on the operation of the service. We also asked the adult social care team at Knowsley Council and Knowsley LINk*. LINk did not have any up to date information for this compliance review.

* LINks are networks of individuals and organisations that have an interest in improving health and social care services. They are independent of the council, NHS and other service providers. LINks aim to involve local people in the planning and delivery of services.