What life is like for people using this service:

People continued to receive safe care. Staff have a good understanding of safeguarding procedures that should be followed to report harm and incidents of concern. Risk assessments are in place to manage potential risks within people’s lives, whilst also promoting their independence.

The staff recruitment procedures ensured that appropriate pre-employment checks are carried out to ensure only suitable staff worked at the service. Adequate staffing levels are in place.

Staff have training that provides them with the knowledge they need to perform their roles. The registered manager and senior carers support staff to put their training into practice.

Staff obtain people's consent before they provide care and support. Bed rails are used only if people consent to them being used to prevent them falling from their beds. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

There are procedures in place for evacuating non- able-bodied people who are in imminent danger. These are risk assessed and judged to be safe. However, the service did not have purpose made evacuation sheets that are recommended for use when evacuating non-able-bodied people. After we discussed this with registered manager they ordered evacuation sheets and arranged for staff to be trained in using the equipment.

Infection control procedures are in place but not all staff are familiar with these. People’s rooms and communal areas are clean. However, we saw two people using wheelchairs that were stained with dried food. Not all staff were clear who was responsible for cleaning people’s wheelchairs or what the appropriate cleaning method was. After we discussed this with the registered manager added the cleaning of wheelchairs to cleaning schedules and cleaning audits.

Staff treat people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Care plans reflected people’s likes and dislikes, and staff spoke with people in a friendly manner, addressing them by their preferred name. Our observations during inspection were of positive and friendly interactions between staff and people.

People or their relatives are involved in the planning of care and contribute to decisions about how they are supported. People and their relatives are involved in reviewing their care and making any necessary changes if they want.

A process is in place which ensures people can raise any complaints or concerns. Concerns are acted upon promptly and any necessary changes were made to care plans and communicated to staff.

The service continued to be well managed. The provider has systems in place to monitor the quality of the service. Actions are taken and improvements were made when required.

Rating at last inspection: Good (report published 24 March 2016).

About the service: Elmbank Care Home is a care home that was providing personal care to 24 older people at the time of the inspection.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

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

This inspection took place on 24 March 2016 and was unannounced.

Accommodation for up to 35 people is provided in the home on three floors. The service is designed to meet the needs of older people. There were 27 people using the service at the time of our inspection.

There was a registered manager who was available during the inspection. 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.

People felt safe in the home and staff knew how to identify potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. The premises were managed to keep people safe. Sufficient staff were on duty to meet people’s needs and they were recruited through safe recruitment practices. Safe medicines and infection control practices were followed though some floors and equipment needed better cleaning.

People were not always appropriately supported to receive sufficient to eat and drink. Staff received appropriate induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005. External professionals were involved in people’s care as appropriate. Some adaptations had been made to the design of the home to support people living with dementia.

Staff were caring and treated people with dignity and respect. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident raising any concerns with the registered manager and that they would take action. There were systems in place to monitor and improve the quality of the service provided. The provider was meeting their regulatory responsibilities.

We saw that relatives of people using the service had been asked to review their care and provide information about their relatives.

We spoke with people who use the service who told us, “I’m happy living here. I’ve settled in well.” We saw that care plans and risk assessments had been reviewed on a regular basis.

Relatives of people using the service told us, “My relative feels safe.” We saw that most staff had attended safeguarding training when we looked at the staff training programme.

Staff we spoke with told us, “Equipment is well maintained and it’s always available.” During our inspection we saw that people using the service sat in chairs with additional cushions as required.

We looked at three staff files which contained evidence of the interview process, proofs of identification and references.

Relatives of people using the service told us, “We raised an issue about our relative’s room needing to be cleaned and it was cleaned, it’s been ok since. We raised the issue verbally and we were satisfied with the result.” We looked at the complaints register and saw that complaints received had been dealt with appropriately and in a timely manner.

People living at the service were involved in decisions about their care. One person said: “The staff discuss things with me and involve me.” All people we spoke with told us that the staff were very respectful and spoke with them in a dignified manner. One person told us: “The staff treat me with respect and that is very important to me, they always knock on my door before they come in.” Another person told us that staff had supported them to go to the pub the previous day for a meal.

People told us that the service was good. One person told us: “The staff are very good, they are friendly and warm, they just care about you.” Another person told us that they did not like the amount of noise in the lounge. They told us that staff had asked them if they would like to sit in the quiet lounge but they refused. We received positive comments about the quality of the food, one person said: “The food is good we get plenty of drinks throughout the day as well.”

We spoke with people living at the service about how safe and supported they felt. All of the people told us that they were safe and staff protected them. One person told us: “I feel safe here. I have not found anyone to be uncaring.” One person we spoke with told us: Staff clean my bedroom regularly and I have not found anything to be dirty.” We were also told that staff appropriately supported people to take their medication. One person told us: “Staff seem trained to do their job, they are very sensible and helpful.”

We carried out this responsive inspection because we had concerns that this service had not been visited since 2008. During our visit to the service we spoke with a number of residents who told us that they were satisfied with the care and support they received from staff. One resident told us: “I like it here the staff are very kind and good to us.” Another resident told us that: “I choose what I want to wear every day the staff always ask me.”

Residents told us that the quality of food was good. One resident we spoke with told us: “The quality of the food is good, we get a choice, and I get to have my breakfast in bed whenever I want to.”

The provider had some ways in which residents and relatives could give feedback about the services they receive. One resident we spoke with told us: “I have completed a questionnaire about the how I am looked after and the quality of food, I think they listen to our suggestions.”