About the service: Elmfield House is residential care home that was providing personal care to 17 people aged 65 and over at the time of the inspection. People living at the service were living with physical and mental health conditions and some were living with dementia.

People’s experience of using this service:

People told us they lived in a safe and comfortable home. People and relatives said the environment was homely and this matched our observations. People were involved in the running of the home and decisions about their care.

Care was planned around people’s needs and backgrounds with plans in place to manage risk and promote their wellbeing. Staff worked well with healthcare professionals and medicines were managed safely. People gave positive feedback on the food that was prepared for them as well as the activities and events at the service.

People were supported by staff who had training and felt supported in their roles. We heard positive feedback on the leadership of the service from people, relatives and staff. People said staff were caring and knew what was important to them. Systems were in place to learn from incidents or complaints and the provider regularly sought to involve people, relatives and stakeholders in the service.

Rating at last inspection: Our last comprehensive inspection was in June 2016 where we rated the service ‘Good’ overall with ‘Requires Improvement in Well-led due to a breach of the legal requirements in relation to having a registered manager in post. We then carried out a focused inspection in May 2017 where we found a registered manager was in post and we rated the service as ‘Good’ in Well-led.

Why we inspected: This was a planned comprehensive inspection.

This inspection was carried out on 3 May 2017.

Elmfield House is registered to provide accommodation with personal care for up to 18 people. At the time of our inspection there were 18 people living at the service, some of whom were living with dementia.

At the last inspection in July 2016, the service was rated Good, however, we found the service was in breach of Regulation 5 of the Registration Regulations 2009 (Schedule 1) Registered manager condition. The service did not have a registered manager for the provision of the regulated activity at the location. During this inspection we found the provider has met this Regulation.

The registered manager had registered with the Care Quality Commission (CQC) for the regulated activity undertaken at the location.

Staff and the provider undertook quality assurance audits to ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were attended to by staff.

People, relatives and associated professionals had been asked for their views about the care provided and how the home was run. Regular resident and relatives and staff meetings took place.

Records of accidents and incidents were maintained at the service and the registered manager undertook monthly audits to identify any trends and took action as required to maintain the safety of people.

Further information is in the detailed findings below.

This inspection took place on 28 June and 8 July 2016. The first day of the inspection was unannounced. The second day of the inspection was announced, as we wanted to ensure the manager and provider were present.

Elmfield House is registered to provide accommodation with personal care for up to 18 people. At the time of our inspection there were 18 people living at the service, some of whom were living with dementia.

At the time of our visit there was no registered manager in post. There had not been a registered manager in post at the service since October 2014. 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 and their relatives told us they felt the service was safe. People told us that staff were very kind and they had not experienced any issues to their safety whilst living at the service. Staff had received training in relation to safeguarding and they were able to describe the types of abuse and the processes to be followed when reporting suspected or actual abuse.

Staff had received training, regular supervisions and annual appraisals that helped them to perform their duties. New staff received a full induction to the service which included training.

There were enough staff to ensure that people’s assessed needs could be met.

Where there were restrictions in place, staff had followed the legal requirements to make sure this was done in the person’s best interests. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way.

People and relatives were positive about the care provided and their consent was sought.

People’s care and health needs were assessed and they were able to access all healthcare professionals as and when they required.

People’s nutritional needs had been assessed and people were supported to eat and drink as and when required. The menus provided a choice of meals and people were able to choose a meal that was different to the menu choices.

Documentation that enabled staff to support people and to record the care they had received was up to date and regularly reviewed. People and/or their relatives had signed their care plans to signify their involvement in their care. People’s preferences, likes and dislikes were recorded and staff were knowledgeable about the care needs of people.

Staff showed kindness and compassion and people’s privacy and dignity were upheld. People were able to spend time on their own in their bedrooms and their personal care needs were attended to in private. People we spoke to consistently said that they liked the service.

People were able to take part in meaningful activities that helped to prevent them from becoming isolated.

People and relatives told us they thought the service was well run and they were able to have open discussions with staff. People told us they were able to raise concerns and make complaints if they needed to.

Staff were knowledgeable about the values and visions of the service and worked in line with these. Staff were also aware of the whistle-blowing procedures and would not hesitate to report bad practice.

Quality assurance processes were in place to help drive improvement at the service.

At our last inspection in July 2014 we found the provider was in breach of the Health and Social Care Act 2008 that related to staff recruitment. At this inspection we found the provider had taken action to comply with the relevant regulation.

During this inspection 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 th

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 pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This inspection was unannounced. The last inspection was undertaken on the 28 August 2013, no concerns had been identified.  Elmfield House is located in Bisley, near Woking, and provides accommodation for up to 15 older people who require nursing or personal care. On the day of our inspection there were 15 people living at the service.  People were independent with their needs and able to access all communal parts of the home.  They each had their own bedrooms that were furnished with their own personal belongings, TV and comfortable seats.  The accommodation was provided over two floors that was accessible by two sets of stairs and two stair lifts. 

On the day of our inspection visit there was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. This inspection was unannounced. 

During this inspection we found that the provider had not always recruited staff safely. We also noted there was not a written recruitment policy that would provide guidance on the procedures to be followed. We noted that two recruitment files did not include all the information that would ensure staff were suitable to work at the home. This meant people could be put at risk as appropriate checks had not been completed.

On the day of our inspection visit we observed staff interacting with people who used the service in a polite and calm manner. Staff and people who used the service had a good relationship with one another and the staff team knew people’s needs and preferences. People who used the service thought very highly of the staff.  We saw that they enjoyed a good rapport with staff.

People told us that they were happy living at the home and they felt safe and well looked after by staff.  They told us that staff were always available and helped them when they needed help. 

There was a very relaxed, pleasant and happy atmosphere at the home with people doing as they wanted to. People had their relative’s visit them and they were able to meet with them in private if they wanted to. Visitors were welcomed by staff at the service.

Staff were supportive of people who lived at the service. They had received training in relation to keeping people safe from abuse and how and who to report abuse to. We saw certificates that evidenced eleven staff had achieved the National Vocation Qualifications (NVQ) level two and above and another two staff had commenced this training. This training helped staff in their roles as carers.

People made choices about what they wanted do, where they wanted to go and the meals they wished to eat. They had care plans in place that ensured staff would attend to their care, treatment and support needs.  All people were able to have appointments with health care professionals such as GPs as and when they required them.   People were happy with the amount, variety and choice of food that was provided by the service. They told us that they made choices every day about what they wanted to do and eat and staff respected the choices they made. 

People and their relatives were very complimentary about the staff at the service and how staff attended to their care needs. They told us that staff were very polite and caring and they always had conversations with them. They stated that their views were sought, listened to and acted on through daily conversations, resident meetings and completion of surveys requested by the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

On the day of our visit there were twelve people residing in the home. We were met by the registerd manager and also met briefly with one of directors.

We found that people were being given every opportuntiy to consent to their care, both in terms of their care plans, and on a day to day basis. We also found that people’s right to refuse care was respected.

We found that people’s care was being properly managed and that everyone had a robust care plan in place that was regularly reviewed and updated. We also found that people who used the service and their relatives were very happy with service. One relative said: ‘I wouldn’t mind booking myself in’.

We found that staff were properly trained in safeguarding people from abuse, and were prepared to report any instances of abuse even if this involved close colleagues.

We found that there were appropriate staffing levels in the service and that care staff were qualified to fulfil their roles.

We found that the provider asked for regular feedback from people and relatives on the quality of the service, and had systems in place to conduct regular audits and assessments of the whole service.

During our visit on 30th April 2012, we were told that people who lived at Elmfield House were referred to as residents.

Residents we spoke with told us that they were happy at Elmfield House, that they were well supported, and that their needs were met.

We were told by the residents who spoke with us that they felt safe. One resident told us “I am happy and it feels very much like home”. Another told us, “I am treated with dignity and respect and I have no complaints”.

Residents commented on the staff, saying that the staff were very good. One resident said to us that “The staff give me lots of attention”.