The inspection took place on 02 February 2017 and was unannounced.

Elmhurst provides accommodation for up to 61 people with residential and dementia needs. It does not provide nursing care. At the time of this inspection there were 55 people accommodated at Elmhurst.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

When we last inspected the service on 26 April 2016 we found that improvements were required in relation to the arrangements for activities and engagement in the home and how concerns raised with the management team were responded to. At this inspection we found that the necessary improvements had been made.

People felt safe living at Elmhurst. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued. People received support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

People and their relatives complimented the staff team for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements in place to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was a cheerful, open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

The inspection took place on 26 April 2016 and was unannounced.

Elmhurst provides accommodation for up to 61 people with residential and dementia needs. It does not provide nursing care. At the time of this inspection there were 55 people accommodated at Elmhurst.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

However, the registered manager was on sick leave at the time of this inspection and a registered manager from another Quantum Care service was providing interim support at Elmhurst.

When we last inspected the service on 19 December 2013 we found the service was meeting the required standards we inspected at that time.

People and their relatives told us that they felt people were safe living at Elmhurst. Staff and the management team were knowledgeable about safeguarding matters. Risks to people`s mobility and general safety had been identified and risk assessments had been developed detailing the measures to be employed to mitigate these risks. Our observations during the inspection confirmed that staffing levels in the home were appropriate to meet people’s needs. Staff members did not start to work at the home until satisfactory employment checks had been completed. There were suitable arrangements for the safe storage and disposal of people’s medicines.

People were supported to make meaningful meal choices and people were assisted to eat in a calm and unhurried manner. People received care and support from a staff team who were supervised and had the knowledge and skills necessary to provide safe and effective care. Staff asked people for their consent before they delivered all aspects of care. People’s health needs were well catered for.

People were complimentary about the care and kindness demonstrated by the staff team. Staff were knowledgeable about individual’s needs and preferences and people were involved in the planning of their care where they were able. Visitors were encouraged at any time of the day and people’s privacy was promoted. We observed sensitive and kind interactions between staff members and the people who used the service.

The arrangements for activities and stimulation in the home were reduced at the time of this inspection due to a member of the activity staff team being temporarily seconded into another role. The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. However, some relatives were not satisfied that concerns that had been previously raised with the management team had been listened to.

People who used the service, their relatives and staff members did not always find the registered manager to be approachable and supportive. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

Our inspection of 18 September 2013 found that people were not always cared for in a clean and hygienic environment. The manager provided us with information to show how they would achieve compliance with this standard.

During our inspection on 09 December 2013 we found that improvements had been made. We saw that the broken bathroom tiles had been replaced and three of the four kitchenettes had been refurbished.

We looked at three mechanical hoists that were used by staff to move people safely. We found that two of the three were clean however we noted that one was soiled with food detritus.

People told us they received care and support that had been discussed with them and that they had agreed to. One person said, “They listen to me and do what I ask them to do to keep me comfortable.” A relative told us, “They always involve us in any decisions about [relative’s] care.”

Relatives told us they were satisfied with the care and support provided for people living in Elmhurst. One person said, “I chose the place and it has come up to my expectations, they are taking good care of [relative].” Another person praised the staff and management team for the way they were always made welcome whenever they visited the home.

Health care professionals said they were satisfied with the care provided for people. They told us that staff were responsive to instruction and requested guidance and advice if they had any concerns.

We found that the provider was not maintaining the appropriate standards of cleanliness and hygiene at Elmhurst.

The provider had a recruitment procedure in place which ensured that new staff did not start work until the required checks had been carried out.

A complaints procedure was in place, which explained to people how they could complain should they have the need to.

People told us they enjoyed the food provided for them at Elmhurst; they said the new Chef Manager was very good. One person said, "The food is now very pleasant here, the Chef makes marvellous soup."

People told us they enjoyed some group tasting sessions that took place at the home. These were developed to encourage people to try new foods. People said these were really enjoyable and they had encouraged them to, "Try something new and I liked it!"

We looked at a sample of records relating to people who were at risk from poor nutrition and hydration. We found that the standard of recording had improved since our previous visit of August 2012. This meant that staff were monitoring people’s intake of food and fluid to promote their health and welfare.

People living in Elmhurst and relatives with whom we spoke praised the staff team for the care and attention people received. A person using the service told us, “Soon after I arrived here I had a sickness turn and they couldn’t have looked after me better.”

Families with whom we spoke told us they were confident that the service cared for people safely. One person said, "We can't fault the treatment that our [relative] has received. Come to think of it, we can't fault the treatment we have received either."

People living in Elmhurst told us of entertainment opportunities provided for them at the home. For example people spoke of coffee mornings, film club and a party during the Queen's Jubilee celebrations. A person said, "Films, coffee mornings, I go to whatever is on if it interests me."

We asked ten people living in the home what they thought about the food provision. Eight of the ten people said they thought the food was good. One person said, "I have no complaints at all, on the whole the food is good" and another person told us, "It is really quite good considering they have to cater for so many of us."

People living in the home and visitors with whom we spoke told us people were safe living there. A person using the service told us, “I feel very safe here, definitely, this is my home now.”

Visitors to the home and the people living there with whom we spoke all praised the staff team for the kind and gentle care and attention they delivered. One person said, "The staff are very good with [relative] and I can't fault the managers either."