This inspection took place on 10 and 11 January 2018 and was unannounced. It was carried out by one inspector.

Elmbridge Residential Home Limited 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. The home can accommodate 16 people in one adapted building. During this inspection 15 people lived there. The home specialised in the care of older people who lived with dementia or who had mental health needs.

The home provided people with accommodation which comprised of 14 single bedrooms and one shared bedroom. People had the use of communal toilets, a bathroom and a shower room, as well as a lounge, conservatory and dining room. A garden to the back of the home provided people with a safe space outside to enjoy. Limited car parking was provided but car parking was possible in the surrounding area. There was disabled access into the home. Inside a stair-lift supported access to the second floor.

A registered manager was 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.

At the last inspection on 2 and 6 February 2017 we rated the service Requires Improvement and asked the provider to take action to make improvements. These were to ensure people received their medicines as prescribed, that systems were in place to assess, monitor and improve the quality and safety of the service and to ensure accurate records were held with regard to people’s care and treatment. The provider was required to submit a monthly written report (to CQC) with the results of their quality monitoring and the improvements they had made to the service. We found the above necessary improvements had been made. Improvements to the key questions, is the service safe, effective, responsive and well-led? had also been made in order for the rating of these, as well as the service’s overall rating, to improve to Good. The rating for the key question, is the service caring? was previously rated a Good and has remained Good.

During this inspection we made two recommendations to further improve the provider’s good practice in relation to the managing of environmental risk and gaining additional professional support. There were arrangements to keep people safe. Risks were identified and action taken to reduce these. People were protected against potential abuse and staff worked with other agencies to safeguard people. There was zero tolerance of any form of discrimination. Staff were recruited safely and there were enough staff on duty to meet people’s physical and emotional needs. People received their medicines as prescribed and safely. The home was kept clean and arrangements were in place to prevent the spread of potential infections. The kitchen had been refitted and the home had been recently awarded the highest rating possible by the Food Standards Agency.

People’s needs were assessed and staff worked closely with other professionals to ensure people received the care they required. Staff had received training and people’s diverse needs were met safely and skilfully. Staff understood and adhered to the principles of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People had a choice in what they ate and their nutritional wellbeing was monitored. Some adaptations had been made to the home to support people’s independence and to help them receive safe care.

People’s care was planned with their i

We inspected Elmbridge House Residential Home on the 2 and 6 February 2017. Elmbridge House Residential Home is a residential home for up to 16 older people. Many of these people were living with dementia. 14 people were living at the home at the time of our inspection. This was an unannounced 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 last inspected in October 2015 and found that the provider was not meeting a number of the regulations. We found that people did not consistently receive safe care and treatment, because staff had not always administered their medicines as prescribed. Following our inspection the registered manager told us immediate actions would be taken to ensure people would receive their medicines as prescribed.

Whilst the registered manager had taken some action, including reducing the stock of people’s prescribed medicines and ensuring care staff had received further management of medicine training, people were still at risk of not receiving their medicines as prescribed. Care staff did not always keep an accurate record of when they had assisted people with their medicines. Care staff had signed to say they had administered some people’s medicines; however these medicines had not been given to the person.

The registered manager had implemented systems to monitor and improve the quality of service people received, however these systems were not always effective. The registered manager did not have formal systems to monitor the skills and competency of staff. Additionally there were not clear structured formal systems to seek the views of people’s relatives or visitors.

People and their relatives were generally positive about the home. People felt safe and looked after. People told us they enjoyed the food they received in the home and had access to food and drink. People told us there was not always something for them to do at Elmbridge Residential Home; however they enjoyed living at the home. People benefitted from positive caring relationships with care staff.

People’s care and risk assessments were often person centred and reflective of their needs. Care assessments give care staff and nurses clear information in relation to people’s needs. The risks associated with people’s care was not always clearly documented, however care staff knew how to meet people’s needs and protect them from risk.

Staff were deployed effectively to ensure people’s basic needs were met and kept safe. All staff felt they had received the training they needed meet people’s healthcare needs. Staff felt supported, by the registered manager.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulation 2009. You can see what actions we told the provider to take at the back of the full version of this report.

We inspected Elmbridge Residential Home on the 29 October 2015. Elmbridge provides residential care for older people over the age of 65; a number of the people living at the home were living with dementia. The home offers a service for up to 16 people. At the time of our visit 16 people were using the service. This was an unannounced inspection.

We last inspected in May 2014 and found the provider was meeting all of the requirements of the regulations at that time.

There was a registered manager in post on the day of our 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 did not always receive their medicines as prescribed. Care workers did not always keep an accurate record of when people had received their medicines. Where people needed their medicines covertly, care workers followed clear guidance to ensure their needs were met.

The registered manager had informal systems to monitor the quality of service people received. There was limited physical evidence to show checks the registered manager carried out had a positive impact on people using the service. We have made a recommendation about introducing a formal system to monitor the quality of service being provided.

People’s relatives spoke positively about the registered manager. They felt the registered manager was approachable, listened to them and asked for their views. Relatives felt involved in people’s care.

People were supported with activities, and enjoyed time spent with care workers and other people. People told us there were things for them to do in the home.

People were supported and cared for by kind, caring and compassionate care workers. Care workers knew the people they cared for and what was important to them. Care workers supported people to stay as independent as possible.

Care workers protected people from the risks associated with their care. Care workers had clear guidance to protect people from the risks of smoking and falling. Care workers had clear guidance of how to support people who were anxious or exhibited behaviours which challenge.

People’s needs were met by care workers who had access to training, effective supervision and professional development. There were enough staff deployed to meet people's needs.

People told us they felt safe in the home, care workers had a good understanding of safeguarding and the service took appropriate action to deal with any concerns or allegations of abuse.

People had access to appropriate food and drink and were supported to access external healthcare services. Care workers had good knowledge about consent and restrictions. People who were being deprived of their liberty were being cared for in the least restrictive way. However, where people had given consent around their care, this had not always been documented.

We found one breach 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 this report.

During this inspection we found that the areas which had shown a lack of cleanliness on 30 October 2013 had been cleaned. The lounge had been redecorated and a new and clean looking carpet was in place.

However, the arrangements which the provider had told us had been put in place to maintain a good standard of cleanliness and hygiene, in relation to the environment, had not been put in place. After inspecting areas of the care home we found evidence of inadequate cleaning arrangements. The arrangements for monitoring, identifying and then addressing these shortfalls were also not effective.

There were good arrangements in place for preventing the spread of infection.

We found, with the exception of one person they were unable to clearly tell us about their experiences. One person who used the service said "I am comfortable here, all the girls are good". The relatives of one person said "We are very happy with the home and the care being given".

Each person required a lot of support to ensure their preferences were identified and met. Staff had a good understanding of each person's ability and supported them to make simple choices on a daily basis. People's care was planned on an individual basis making sure their meeds were met. There was evidence to show that people's rights were upheld. Staff made sure people had access to specialist health care professionals when needed. People's medicines were managed well, although the arrangements for demonstrating that staffs' knowledge was updated needed improvement.

Risks to people were monitored and arrangements made to ensure these were managed. Close communication with members of the local mental health team took place if risks related to people's behaviour or mental wellbeing.

Some areas of the environment were not clean and there was a foreseeable risk that people would be exposed to infection. This was despite there being some good infection control systems in place. People were given guidance on how to raise a concern/complaint within the service or externally. Robust recruitment processes were adopted in order to protect people.

During this inspection we spoke to one member of staff and the manager. We also spoke to six people using the service and one visitor. Most of the people we spoke to were unable to give us their view of the service due to their mental frailness. One person said "I have a chat with the other men and we sometimes play dominos" and another said "the food is good here". The visitor told us that their relative appeared settled and relaxed.

We looked at the care records of three people and these demonstrated that people's needs were being assessed and their care was being planned. They showed that alterations were being made to people's care and treatment as required. There was evidence to show that the service worked alongside external professionals and agencies in order to meet people's health care needs. There were arrangements in place to safeguard people against potential abuse, to ensure their rights were upheld and to make sure they were not discriminated against. Potential and actual risks were being effectively identified and managed.

Staff were being trained and supported to perform their jobs safely and competently. We observed a couple of shortfalls in practice that indicated that staff may not always be applying their training in their practice.

There were systems in place to monitor the service and actions were being taken as a result of this monitoring, but the monitoring process and actions were not always being recorded.

Elmbridge Residential Home provides care to 16 older people with dementia or mental health issues. An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary, please read the full report. This is a summary of what we found.

Is the service safe?

People had been cared for in an environment that was safe. There were enough staff on duty to meet the needs of the people living at the home and the manager was always available in emergencies. Staff had received appropriate training and knew the needs of all the people who used the service very well.

Is the service effective?

We saw feedback from relatives of people who used the service. This feedback was very positive about the care their relatives received. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs. They knew each person who used the service very well.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and encouraged the people who used the service.

Is the service responsive?

People’s needs had been assessed. Records confirmed people’s preferences, interests, aspirations and diverse needs had been considered and acted on. Care had been provided to meet their needs. People had access to activities that were important to them.

Is the service well-led?

Staff had a good understanding of the home and the people who used the service. Relatives told us that they felt comfortable approaching any member of staff if there was any problems. The manager was present in the home on a regular basis and spoke to people who used the service and their relatives on a regular basis.