The inspection took place on 30 July 2018 and was unannounced. The inspection continued on 31 July 2018 and was announced.

Elsadene 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. At the time of the previous inspection in February 2016 Elsadene was registered as a hospital. On 4 January 2018 Elsadene changed its registration to a care home. For that reason, Elsadene was inspected as a care home under the Adult Social Care assessment framework.

Elsadene is a large, detached property in Weymouth. The home is set out over three floors and provides long term accommodation and care for up to 13 adults living with enduring and complex mental health needs. At the time of our inspection 11 people were living at the home.

The service had 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.

People felt safe. They were supported by staff with a good understanding of how to safeguard them and how to raise concerns either internally or externally if they suspected harm or abuse. People’s individual risks were assessed and reviewed. People were encouraged to take positive risks with restrictions minimised as far as possible.

There were enough staff to meet people’s needs and respond flexibly to unforeseen changes. People received their medicines on time and as prescribed. The home was clean and free from malodours. Staff understood their responsibilities to prevent and control the risk of infection.

The home carried out regular accident, incident and near miss audits. This included a description of what had happened, the result of the investigation, and follow up action taken. Learning was shared with people and staff. This helped reduce the risk of things happening again.

People had their needs comprehensively assessed to support their move to the home. This included their care needs and how they preferred to live their lives. People were supported by staff who had received an induction and shadow shifts with more experienced staff. People were supported to eat a balanced and healthy diet. They were given choice of what to eat and drink and could eat as much or as little as they wanted. People spoke highly about the food.

People were supported to attend appointments to maintain their health and well-being. Where people’s health needs changed there was timely contact with relevant health and social care professionals.

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. Where people lacked capacity to make particular decisions they were supported by staff who were trained and worked in line with the principles of the Mental Capacity Act 2005.

Staff consistently demonstrated a kind and caring approach towards people. Interactions were warm, natural and positive. When people were feeling upset or worried staff supported them emotionally.

People’s privacy and dignity was supported at all times. They were given time and space to spend time alone relaxing or with friends and relatives. People were encouraged to maintain their independence.

People had thorough pre-assessments which had supported their move to the home. These included people’s needs, preferences, network of support, and their abilities. There was a wide range of activities available at the home. These supported and motivated people to maintain their interests and develop new skills.

People were supported to m

At the time of our visit there were 12 people living at Elsadene. We spoke with four people who used the service who all told us the care, treatment and support were very good. One person told us “this is the best place I have ever stayed, the staff are friendly and the food is good”. Another person said “this is my home now I never want to leave”.

We spoke with three members of staff who told us they “loved coming to work” and “it is a great team here and we all work towards the same thing, supporting people the best way we can”. We looked at staff training and supervision arrangements and found that staff were trained and supported well in their roles.

People’s records included comprehensive risk assessments and care plans which were regularly reviewed and updated.

People told us that they were happy at the home and their needs were being met. People told us that they felt that staff were approachable and would sort problems out for them.

People had consented to treatment. Where there was no consent the provider had ensured that people could appeal their treatment plan. The provider had made arrangements for the people to have independent professional support to assist them in the appeals process.

The home was clean and processes were in place to ensure that the home was maintained to a good standard.

The staff were well trained and supported to meet the needs of the people living at the home.

The provider had systems in place to monitor the service provided at Elsadene.

We spoke with four people who lived at Elsadene. The people who used the service informed us that they felt the staff were kind to them and supported them with their day to day needs. They said they were encouraged to express their views and make or participate in making decisions relating to their care and treatment.

One person told us that they got up when they liked and that there was always someone around to help. They told us they chose what to eat and what to do in the day.

The interactions between the staff and people who live at home were observed as very positive and compassionate. We observed that some staff took their meals with the people that live in the home spending time to sit and talk.

The home did not have effective systems to maintain a minimum standard of cleanliness.

We gave an overall rating for Elsadene Hospital of requires improvement because:

• The staff team did not have access to records completed by the responsible clinician to ensure patients' treatment records held in the hospital were accurate.

• Patients were not protected from fixed ligature points. Staff were not clear about the steps they need to take to reduce the risk of ligature points to patients.

• The hospital was not compliant with guidance on same sex accommodation. Patients' sleeping and bathroom areas in the hospital were not segregated to ensure males and females were accommodated on separate floors and did not share bathroom facilities. Female patients did not have access to a female lounge.

• There were not effective governance arrangement to monitor and review the way the functions under the Mental Health Act were exercised.

• The revised Mental Health Act Code of Practice was not fully implemented and staff, including the hospital managers, did not receive training to help them implement the revised Code. There was a lack of clarity around arrangements and not enough trained hospital managers to ensure functions under the Act were followed

• Patients did not have access to occupational therapy to ensure that all patients have access to a range of activities which promote and assist their move to independent living.

• Patients did not have the opportunity to complete advanced decisions.

• The governance measures around controlled drugs were not sufficient to ensure they were stored safely.

• Staff did not record the use of oral Lorazepam when given for agitation as rapid tranquilisation.

However :

• The hospital have working positively towards meeting the requirements from this report. They provide care and treatment for people who had many previous placements which, for a variety of reasons, have not been successful.

• Patients were involved in all aspects of their care and support.

• Staff made comprehensive assessments of patients on admission including a good assessment of people’s physical health needs.

• All staff contributed to incident reports on their paper based system and understood when to report an incident.

• Staff were kind and respectful to patients and recognised their individual needs.

• The manager and the deputy, who had worked together for many years, provided clear leadership.

• Staff morale was high and the team worked well together.