Elm House provides nursing care for up to 32 people in a residential area of Southport, well located for local amenities and public transport. All bedrooms have ensuite facilities and are situated over four floors. There is a passenger lift providing access to floors. The house has a large garden to the rear of the home with seating areas.

Elm 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.

At the last inspection of 19 June 2017 the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good:

The service met all relevant fundamental standards.

At the time of our inspection 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.

We looked at the care plans for four people receiving support at the service. Care documents were individualised so staff had the information they needed to provide care and support to people in accordance with their needs and wishes. People living at the home and relatives told us they were involved with their plan of care and this was reviewed with them when needed.

Staff were clear about the need to support people’s rights and needs regarding equality and diversity. Care records contained important information about people’s sexuality, ethnicity, gender and other protected characteristics.

People were supported by staff to maintain their health and wellbeing through access to external health and social care professionals and specialist services. This along with partnership working with external organisations helped to achieve effective safe outcomes for people. External professionals were complimentary regarding the service provision.

We talked with staff about people’s care needs and they demonstrated good knowledge and understanding of the care and support people needed to ensure their safety and wellbeing.

We saw good communication between staff and people they were supporting. It was evident that staff knew people well and had the skills and approach needed to ensure people received the care they needed.

People told us that staff had a kind, warm and sensitive approach and this we observed during the inspection.

People had been consulted regarding the social activities they wanted at the home. We saw a wide programme of social activities which were held each week and people also went out for day trips to local venues. There was a relaxed friendly atmosphere in the home with visitors popping in at different times of the day.

People told us they enjoyed the meals, especially the home baking. People’s dietary needs were assessed and managed with reference to individual need, preference and choice.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest.

Staff were aware of safeguarding procedures. Staff told us about reporting procedures including referral to relevant local authorities in accordance with agreed guidelines.

The registered manager had made referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it

Elm House provides nursing care for up to 30 people in a residential area of Southport.

We carried out an unannounced comprehensive inspection of this service on 4 January 2017.We found a breach of regulation regarding consent to care and treatment for people living at Elm House. When people were unable to consent, the principles of the Mental Capacity Act 2005 (MCA) were not always followed, in that assessments of the person’s mental capacity was not made based on individual decisions.

We also made a recommendation under the ‘Well led’ section of the report to further develop a more comprehensive series of management audits to monitor the service.

Following the inspection in January 2017 we gave the service a quality rating of ‘Requires improvement’.

After the comprehensive inspection, the registered provider wrote to us to tell us what they would do to meet legal requirements in relation to the breach; the provider told us they would be compliant with the regulation by 16 May 2017.

We undertook a focused inspection on 16 June 2017 to check that they had they now met legal requirements. This report only covers our findings in relation to these specific areas / breaches of regulation. They cover two questions we normally asked of services; whether they are ‘Effective’ and 'Well led'. The questions ‘was the service ‘Safe’, Caring’ and ‘Responsive’ were not assessed at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Elm House Nursing Home' on our website at www.cqc.org.uk.

At this inspection we found improvements had been made with respect to gaining people’s consent and adherence to the MCA 2005; the previous breach of regulation had been met.

We found there was a clearer understanding of the principles of the MCA 2005 and how this should be applied with people living in the home. We saw examples where people’s capacity had been assessed with regard to key decisions they were making and where they lacked capacity, decisions had been made in people’s best interest.

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.

We found action had been taken to improve the management and governance of the home by developing a program of on-going audits to monitor and maintain good standards.

We were satisfied that the improvements in overall governance evidenced an on-going consistency to meet standards in the home and we have raised the quality rating for Elm House from ‘Requires improvement’ to ‘Good’.

Elm House provides nursing care for up to 30 people in a residential area of Southport, well located for local amenities and public transport. All bedrooms have en-suite facilities and are situated over four floors. There is a passenger lift providing access to all floors. The house has a large garden to the rear of the home with seating area.

This was an unannounced inspection which took place on 4 and 5 January 2017. The service was last inspected in September 2015 and at that time was found to be in breach of two of the regulations under the Health and Social Care Act 2008 (HSCA). The breach of regulations was due to concerns with the level of hygiene in the home and adherence to infection control, as well as some environmental safety issues such as, poor monitoring of hot water temperatures which placed people at risk of scalds.

The service had been rated as ‘Requires improvement’.

The provider set us an action plan which told us the issues raised in the report had been addressed.

The service had 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 HSCA and associated regulations about how the service is run.

At this inspection we found many developments to the service following the appointment of the registered manager ten months ago. Both previous breaches of regulations had been met. Effective arrangements were now in place for checking the environment to ensure it was safe. For example, health and safety audits were completed where obvious hazards were identified. We found the environment safe and well maintained. This had improved since our last inspection. We also found the monitoring of cleanliness and infection control in the home had also improved.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 [MCA] were not always followed, in that assessments of the person’s mental capacity was not made based on individual decisions. We had some discussion how this could be further improved by evidencing assessment around individual key decisions; this would meet best practice and follow the principles of the MCA. We told the provider to take action.

The registered manager was able to evidence a series of quality assurance processes and audits carried out internally. These had been effective in developing and maintaining existing standards in the home and were based on getting feedback from the people living there. However, during the inspection we found areas that need addressing and further development; the existing auditing processes had not been sufficiently developed to encompass these areas.

We recommended that further progress is made to develop a fully comprehensive series of management audits and these are routinely scheduled.

We saw written care plans were formulated and subject to ongoing review. We saw that people were generally involved in the care planning and reviews were held.

We made a recommendation that people’s clinical care plans contain relevant detail in line with best clinical practice.

The registered manager had made appropriate referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found the applications were continuing to be monitored by the registered manager.

We reviewed the way people’s medication was managed. We saw there were systems in place to monitor medication so that people received their medicines safely.

There were enough staff on duty to help ensur

The inspection took place on 29th September 2015 and was unannounced.

Elm House provides nursing care for up to 30 people in a residential area of Southport, well located for local amenities and public transport. All bedrooms have ensuite facilities and are situated over four floors. There is a passenger lift providing access to all floors. The house has a large garden to the rear of the home with seating areas. There were 24 people living in the home on the day of the inspection.

A registered manager was 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.

Some aspects of the environment at Elm House were not safe. We found doors to three store rooms were wedged open, one with a wheelchair. Both sluice doors were open and contained chemicals. Several of the store rooms and corridors had ceiling lights that did not work. The cupboard containing the main electricity meter was situated at waist height on a wall and not locked. Some bedrooms did not have thermostatic mixing valves to moderate the temperature of hot water to prevent scalding. Monthly emergency light testing was not carried out as recommended.

Some aspects of the environment were not very clean. Equipment was dirty and there was no planned cleaning of hoists, commodes or beds. The other areas in the home including the kitchen, people’s bedrooms, dining room and lounge area were clean and were included in daily and monthly cleaning schedules. Cleaning schedules we looked at detailed the tasks to be undertaken on each floor of the home.

Staff understood how to recognise abuse and how to report concerns or allegations.

There were enough staff on duty at all times to ensure people were supported safely.

We saw the necessary recruitment checks had been undertaken so that staff employed were suitable to work with vulnerable people.

Staff said they were well supported through induction and the home’s training programme. They said the manager provided good day to day support when required.

People told us they received enough to eat and drink, and they chose their meals each day. They were encouraged to eat foods which met their dietary requirements.

People’s physical and mental health needs were monitored and recorded. Staff recognised when additional support was required and people were supported to access a range of health care services.

People told us they had choices with regard to daily living activities and they could choose what to do each day.

They told us staff treated them with respect. Staff we spoke with showed they had a very good understanding of the people they were supporting and were able to meet their needs.

Staff attitude to people was polite and respectful using people’s names and people who lived in the home responded well to staff. We saw that staff interacted well with people in order to ensure their received the support and care they required.

We saw that staff demonstrated kind and compassionate support. They encouraged and supported people to be independent.

People told us that their privacy and dignity was always respected. We observed the door to a bedroom at the front of the house was left open, which did not afford any privacy to the occupant.

We saw that people’s care plans and risk assessments were regularly reviewed. People had their needs assessed and staff understood what people’s care needs were. Referrals to other services such as the dietician or occupational therapist or GP visits were made in order to ensure people received the most appropriate care.

People living at Elm House told us they were involved in the decisions about their care and support, and in choosing what they wanted to do each day.

The home had a complaints policy and processes were in place to record and complaints received to ensure issues were addressed within the timescales given in the policy.

The registered manager provided effective leadership in the home.

There were systems in place to get feedback from people so that the service could be developed with respect to their needs.

We received positive feedback from health and social care professionals who told us the home worked well with them and liaised to support people’s on-going health and social care.

The service had a quality assurance system in place with various checks completed to demonstrate good practice within the home. We found that the systems to monitor the quality and safety were not always effective. Recommendations from an external audit had not been acted upon to ensure improvements were made to protect people’s welfare and safety when using hot water.

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

We used a number of different methods to help us understand the experiences of some of the people living at Elm House. This was because some of the people who lived at the home had complex needs, which meant they were not all able to verbally tell us about their experiences.

We carried out some short observations between staff and the people who lived in the home. We observed some examples where staff supported people well, such as assisting people to sit comfortably and using appropriate communication with people. We spoke with one person who lived in the home, who told us "The staff are very kind."

We looked at six people's care records. We found they contained relevant and current information about the person's needs.

On checking medication management we found people received their medicines as prescribed. We found records regarding medication were accurate.

We spoke with four people who told us about their experience of living at the home.

People living at the home expressed their views and were involved in making decisions about their care and treatment. One relative told us "I am always kept informed about my mother's health"

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We spoke with a person who told us how staff had supported them with what they needed.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We saw people who lived at the house were very relaxed and confident around staff. This showed people felt safe in the home. The people we spoke with were very relaxed around staff and said they were listened to so that any concerns could be addressed. One person told us, "I would speak to the manager if there was any problem.”

People we spoke with told us they were supported well at Elm House and staff were always available to assist and help as needed.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. All of the people we met with were living in accommodation that suited their needs. They told us they enjoyed living in the home and were able to talk about any changes they wanted with the staff.