This inspection was carried out on 19 June 2018 and was unannounced. At their last inspection on 13 July 2017, they were found to not be meeting the standards. This was in relation to governance systems, the number of skilled and knowledgeable staff, care plans not being up to date and care needs not being met. Following the inspection, they sent us an action plan stating how they would address and resolve the issues. At this inspection, we found that they had made the required improvements and were now meeting the standards.

Elmside 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.

Elmside provides accommodation for up to 69 older people, some of whom live with dementia. The home is not registered to provide nursing care. At the time of the inspection there were 65 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. The registered manager was new in post following the last inspection.

People, relatives and staff felt the service was well run and there were systems in place to monitor the quality of the service and address any shortfalls. The management team worked with other agencies to improve and maintain standards.

People felt safe and were supported by staff who knew how to reduce risks, were trained and had regular supervision. Lessons learned were shared and any incidents were reviewed. Medicines were managed safely and there were effective infection control practices.

People were supported by sufficient staff who were recruited safely. However, staff felt at times they were short staffed.

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. The principles of the Mental Capacity Act 2005 were adhered to and people were supported to eat and drink enough and risks were monitored. There was regular access to health professionals and the design of the building suited people’s needs.

People were treated with dignity and respect. We found staff were kind and friendly. Confidentiality was promoted and people were involved in their care.

People’s care needs were met in a way they liked and care plans included the appropriate information to help ensure care was provided in a person centred and safe way. Where people were supported at the end of their lives, this was done with dignity and kindness. People enjoyed the activities provided and complaints were responded to and feedback was sought.

We carried out an unannounced inspection of this service on 13 July 2017.

The service provides accommodation and personal care for up to 66 adults, some of whom may be living with dementia.

The service did not have a registered manager. 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.

There were systems in place to safeguard people from harm and staff understood when and how to report any concerns they had. There were risk assessments in place that gave guidance to staff on how risks to people could be minimised, although these had not all been kept up to date. There were insufficient skilled staff to provide safe care to people and the service was relying heavily on agency staff. Poor management of the staffing rota meant that adequate numbers of staff were not always on shift. The provider had effective recruitment processes in place and were in the process of recruiting to vacant posts.

Staff had been trained to meet people’s individual needs. They understood their roles and responsibilities to seek people’s consent prior to care being provided. In recent months, staff had not received regular supervision to support them in their role, although some staff we spoke with told us that they had just had their first supervision meeting for a long time.

People were supported to have enough to eat and drink and to maintain a diet that was suited to their needs. They were also supported to access other health and social care services when required.

People’s needs had been assessed, and care plans took account of people’s individual needs, preferences, and choices. However, care plans had not always been kept up to date to ensure people’s care was relevant to their current needs.

There was a wide range of events and activities provided which was based on people’s interests and hobbies, and people were supported to maintain links with the local community.

The provider had a formal process for handling complaints and concerns but people, relatives and staff did not feel that the acting manager was approachable and did not have confidence that their views were used to make improvements to the service

There were systems in place to support the management of the home and to monitor the quality of the service, but these were not all used effectively.

We found there were breaches of regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report

We carried out an unannounced inspection on 11 August 2015.

The service provides accommodation and personal care for up to 66 adults, some of whom may be living with dementia. At the time of the inspection, 63 people were being supported by the service.

The service had a registered manager. 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.

There were systems in place to safeguard people from harm and staff understood when and how to report any concerns they had.There were risk assessments in place that gave guidance to staff on how risks to people could be minimised.

The provider had effective recruitment processes in place and there were sufficient, skilled staff to provide safe care to people.

Staff received supervision and support, and had been trained to meet people’s individual needs. They understood their roles and responsibilities to seek people’s consent prior to care being provided.

People were supported to have enough to eat and drink and to maintain a diet that was suited to their needs. They were also supported to access other health and social care services when required.

People’s needs had been assessed, and care plans took account of people’s individual needs, preferences, and choices. There was a wide range of events and activities provided which was based on people’s interests and hobbies and people were supported to maintain links with the local community.

The provider had a formal process for handling complaints and concerns.

The provider encouraged feedback from people and acted on the comments received to improve the quality of the service.There were effective systems in place to monitor the quality of the service.

We found that people who lived at Elmside were respected, had choices and were well cared for. One person told us, “I like living at Elmside. It is very good and there is a lot to do.” Relatives we talked with also spoke positively. One relative told us, “We are very happy with everything.”

Care plans were individual to people and up to date. We found that people and their relatives were involved in the care planning process. We also found people were supported to access a range of activities that promoted their well-being and independence.

Systems were in place that enabled staff to identify and support people at risk of poor nutrition. Mealtimes were social occasions and people were supported to access a choice of nutritious food and drink. Arrangements were in place to manage medicines safely and a new electronic system had recently been introduced.

We found that there were enough trained staff to meet people’s needs and the provider ensured their continuing professional development. Staff told us they enjoyed their work and felt supported.

We previously visited Elmside on 13 November 2012. On that occasion we found that people had not been given the opportunity to make informed decisions about resuscitation in the event of a medical emergency.

The provider wrote to us and told us that they had made the necessary improvements and had become complaint by 13 December 2012.

We visited the home on 24 January 2013 and found that these improvements had been made and that where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

When we visited Elmside on 13 November 2012 we saw that people could choose to receive their meals at a table in the coffee shop style dining area, in the lounge or in their rooms. One person said, "The food is very good, it's different every day."

The service employed a chaplain and church services were held on the premises to support people's spiritual needs.

Care was delivered in a way that was relevant to people as individuals and reflected current guidance. One person said, "Oh yes they spent quite a bit of time working out my care plan. I get everything I need." A relative said, “They understand the nature of dementia and care for my relative in a magnificent fashion ... I have not seen [my relative] happier in a long time.”

Care plans were person centred although some sections were not signed by the person using the service or their representative. We found that decisions about whether people would be resuscitated in the event of a medical emergency were not made in accordance with correct procedures and this needed to be reviewed urgently.

Staff were trained to recognise and respond to abuse and had access to local safeguarding procedures. People said they felt safe at the home.

People were cared for by staff that were motivated, trained for their role and supported by an effective supervision process.

Systems were in place to monitor the quality of service and respond to feedback or complaints from people living there or their representatives.

When we had a number of conversations with people who live in Elmside on the 04 August 2011, in various parts of the home and at different times, they told us that they were very much involved in the way that their care was delivered and that they were encouraged to maintain their independence.

We were told of residents’ meetings at which ‘you can raise anything’ and they told us that they felt their needs were being very well met overall. ‘Very satisfactory’ was one person’s comment whilst another agreed that they were ‘very well looked after’.

When we sat with a person living in Elmside who had just finished their breakfast, they confirmed that there was a choice for all meals and it was also ‘up to them’ if they took part in activities or not.

One person we talked with told us that they thought at times there were not enough care staff and that ‘you have to wait’; however they also said that the care staff were usually ‘very good and helpful’.

In all of our conversations of 04 August 2011 with people who live in Elmside we were told that the care staff were kind and thoughtful and whilst one person told us that ‘some are better than others’ they agreed that they were nonetheless well looked after.