This inspection was undertaken on 24 September 2018 and 2 October 2018 and was announced.

Elizabeth Senior Care Ltd provides care and support to people living in their own homes in and around the area of Ellesmere Port. People were able to access the services of Elizabeth Senior Care Ltd directly. At the time of this inspection the service was supporting and caring for 25 people, enabling them to continue to live in their own homes.

There was a registered manager in place. 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 a 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 on 20 and 26 June 2017 we found that there were a number of improvements needed in relation to safe care and treatment, staffing and good governance. These were breaches of Regulation 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective Responsive and Well Led to at least good. The provider sent us an action plan that specified how would they would meet the requirements of the identified breaches. During this inspection we found all the required improvements had been made.

Improvements had been made to the medicines systems in place. Staff had all received up-to-date training and had their competency assessed. Medication administration records (MARs) were consistently completed and PRN ‘as required’ protocols were in place. People told us they received their medicines correctly and on time.

Improvements had been made to people’s individual care plans and risk assessments. An initial assessment was undertaken prior to a person receiving support from the service. People’s needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process. The assessment information was used to create risk assessments and person-centred care plans. These documents included clear guidance for staff to follow to ensure people’s preferred routines were followed and preferences met.

Improvements have been made to quality assurance systems. The registered provider undertook regular audits to identify areas for development and improvement at the service. Policies and procedures had been regularly reviewed and updated.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and to report on what we find. We saw the registered provider had made improvements since our last inspection. Policies and guidance were in place, the staff had received training and were able to demonstrate a basic understanding. Records showed that consent was sought in relation to care and treatment.

Staff recruitment systems were robust and this helped to ensure the only staff suitable to work with vulnerable people were employed. All staff had undertaken a thorough induction process that included undertaking shadow shifts prior to them lone working. Staff all undertook regular training for their role and refresher updates as required. There were enough staff employed to meet the needs of the people supported.

People had developed positive relationships with the staff that supported them. People told us they had regular staff that visited them. They told us staff treated them with kindness and were caring. People told us their privacy and dignity was respected and their independence promoted.

All staff received support and supervision through the management team. Observations were undertaken to monitor the quality of their work. Staff attended team ‘patch’ meetings and told us they felt well supported in their

This inspection took place between the 20 and 26 June 2017 and was announced.

The service was last inspected on the 23 and 24 July 2014. At that time, it met all legal requirements and was provided with an overall rating of 'Good'.

Elizabeth Senior Care Ltd provides care and support to people living in their own homes in and around the area of Ellesmere Port. People are able to access the services of Elizabeth Senior Care Ltd directly. At the time of this inspection the service was supporting and caring for 44 people, enabling them to continue to live in their own homes.

There was a registered manager in place. 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 registered manager was also the registered provider. For the purposes of this report, they will be referred to as the registered provider.

During this inspection, we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

Staff had a good understanding of the support people required. However, records showed that people's needs were not always robustly assessed and only basic information was available for staff. Risk assessments were not in place where there were identified risks such as moving and handling. This meant that staff less familiar with a person may not provide the right level of support. A daily record was kept for the purpose of recording care offered and delivered but this did not fully or accurately reflect what actually occurred.

Improvements were required to ensure the safety of medication administration: records and training were not adequate to promote safe and effective practice.

There were no formal quality assurance systems to review the safety and effectiveness of the service. Issues we found during our inspection relating to support planning, risk assessments, medication, training and documentation had not been identified or fully addressed. Policies and procedures had not been updated to reflect changes in legislation or best practice.

Staff understood the importance of seeking consent from people prior to delivering care. People who used the service and their relatives told us that support was always given in line with people's wishes. We have made a recommendation about accessing training and evidencing consideration of the Mental Capacity Act (2005) in care planning.

There were sufficient staff to support people. When new staff were appointed recruitment checks were carried out to make sure they were suitable to work with vulnerable people. The registered provider did not have a system in place to assure themselves of a person’s on-going suitability to work with vulnerable people.

Staff understood what was meant by abuse and they were aware of the process for reporting any concerns. Family members told us that they felt reassured by staff and that the service was safe. The information given to staff in regards to safeguarding adults required updating in line with changes to legislation and local authority guidance.

Where concerns about people’s health or wellbeing were noted, discussions were held with family members and people were referred to the appropriate services. Staff worked well with health and social care professionals to make sure people received the care and support they needed.

The registered provider ensured that, where possible, people had a consistent team of staff. This enabled people, relatives and staff to build up good working relationships and develop confidence in the service. Staff were caring and treated people with kindness and respect. People who used the ser

We found that people were able to express their views, so far as they were able to do so, and were involved in making decisions about their care and support. We spoke with five people who used the service and one relative. All of them told us they felt they were listened to and were able to take part in decisions about their care. Comments included; "The manager often comes round and explains everything to me", "The girls are smashing. We have a right laugh in the mornings" and "My Mum thinks they are brilliant. They are very respectful."

We contacted the Local Authority and examined our records before our inspection. We had no concerns about the care that was provided by the service.

We spoke with six members staff who told us they thought the service employed enough staff to meet the needs of the people who used the service. Discussions and examination of training records showed they were supported by the service to gain National Vocational Qualifications (NVQ) levels 2 and 3 in social care.

We saw that surveys were given to people who used the service and their relatives. All of the surveys we looked at showed that people were happy with the care provided.

The manager told us they had not had any recent complaints. We saw there were systems in place to deal with any complaints should they be made.

At our last visit to the service on 25th October 2012 we found that improvements were needed to record keeping to ensure people were protected from the risks of unsafe or inappropriate care and treatment. At this visit we found an improvement to these records had been made.

We spoke to two people who used the service and three relatives who told us that they were happy with the service provided. They said that the staff were polite, caring and helpful. They had been involved in drawing up their care plans which indicated the support they required.

The manager had sent surveys to the people who used the service on a six monthly basis to find out their views about how the service was operating. We looked at ten of these and found that all ten people were happy with the care and support they received.

Staff where aware of how to manage any safeguarding issues and records showed that staff had received training in this area.

We found there had been improvements to the recruitment of staff to ensure that staff had a check of any criminal records prior to employment to ensure they were suitable to work with vulnerable people.

Staff had received most of the training they needed to appropriately support the people who used the service. We identified that staff were in need of training in first aid as records showed that no staff had received this training.

We found that improvements where needed to records around care planning and reviews of care plans and around the support provided to staff.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014. 

There was a registered manager in post at the service.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and had the legal responsibility for meeting the requirements of the law, as does the provider.  This was an announced inspection in which we informed the service 48 hours prior to our arrival that a visit would be taking place.

Elizabeth Senior Care Ltd provides care and support to people living in their own homes in and around the area of Ellesmere Port.  People are able to access the services of Elizabeth Senior Care Ltd directly or via a referral from the local social services.  At the time of this inspection the service was supporting and caring for 44 people, enabling them to continue to live within their own homes within the community.

People who used the service, their relatives and carers spoken with had only positive comments to make about the service they received.  They told us that the staff were well trained, polite and reliable and that the service was well led.  The ethos of the service was planned and delivered around individual’s preferred choices and wishes.

Staff working within the service understood the needs of the people who used the service, their relatives and carers and support was provided in a respectful caring manner.  People told us that they were happy with the care and support delivered by the staff

The service was previously inspected on the 8 November 2013 and was found to be compliant in all of the five areas we looked at.