This inspection took place on 18 December 2017 and was unannounced. This meant the provider and staff did not know we would be visiting. A second day of inspection took place on 20 December 2017 and was announced.

Elwick Grange is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Elwick Grange provides personal care for up to 60 people. At the time of our inspection there were 58 people living at the home who received personal care, some of whom were living with a dementia.

A registered manager was in place at the time of our inspection. 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.

We last inspected this service on 5 October 2015 when it was rated ‘Good’ overall. At this inspection we found the service remained ‘Good.’

Staff received training to ensure they knew how to recognise and report potential abuse. Risks to people were identified and plans were in place to help manage and minimise risks. Medicines were managed in a safe way and checks were made to ensure staff were competent to administer people's medicines. There were enough staff to meet people's needs promptly. Staff followed good infection control practices.

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 were supported to have enough to eat and drink in line with their needs and preferences. Staff were provided with effective training, support and development opportunities to enable them to meet people's needs.

Staff supported people to do the things they enjoyed and also encouraged independence with daily living. Staff were caring and respectful to people who used the service. Staff knew what was important to people and how to support them accordingly.

People were supported to engage in activities meaningful to them. Detailed support plans were in place which were specific to the needs of individuals. Support plans contained information about how people wanted and needed to be supported. People’s care plans reflected their end of life preferences, where people felt able to discuss this. People knew how to make a complaint. Complaints had been dealt with in a timely manner and lessons had been learnt where appropriate.

The service had a registered manager. Staff told us there was a positive culture and they felt supported. Systems were in place to assess the quality of care people received. People's feedback was sought regularly and acted upon. Staff told us they could approach the management team at any time.

Further information is in the detailed findings below

The inspection took place on 5 October 2015 and was unannounced.

We last inspected the service in August 2013 and found the provider was meeting all the regulations we inspected that were in force at the time.

Elwick Grange is two storey purpose built care home for up to 60 people, some of who are living with dementia.

At the time of our 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.

Staff we spoke with were confident in their role in safeguarding people from potential abuse. Training had been delivered and staff were knowledgeable about the different types of abuse and the organisations procedure on safeguarding.

The registered manager had produced a laminated card for staff which summarised the key information and relevant contacts for safeguarding, mental capacity, whistleblowing and deprivation of liberty safeguards.

During the inspection we spent time observing the medicines round. We saw people were given the time and support they needed to take their medicines.

We reviewed the rotas and saw staffing levels were consistent. Staff personnel files showed clear recruitment procedures had been followed and all staff had the appropriate checks in place.

The provider had defined mandatory training and set clear timescales for refresher training. Additional training was also made available for staff on areas of interest.

Staff received supervision every two months, the annual appraisals were running behind and half of the staff had not received these, however they were only over due by a number of months.

We saw people were supported during meal times and wherever possible were encouraged to be independent.

Staff had a good understanding of the Mental Capacity Act 2005 and the procedure for Deprivation of Liberty Safeguards (DoLS). We saw that following a successful DoLS application a care plan was created to ensure the least restrictive option was always considered for the person.

People and their relatives told us they were happy with the care they received at Elwick Grange. People were involved in their day to day choices and were promoted to be independent.

There was a activities calendar available. People told us there were activities organised on a daily basis. Visiting relatives told us how the home made an effort to help people celebrate special occasions, such as birthdays.

All care documentation was electronic. We reviewed this and noted that everyone’s care plans and risk assessments were up to date and detailed to reflect each person’s individual needs.

People told us they knew how to complain and would be confident in raising any concerns. The staff told us they felt supported in their role and could talk to the registered manager about anything.

The registered manager and the management team conducted regular audits of the service the home provided. They had recently introduced a ‘resident of the day’ scheme which meant that each person living at the home had their care plans and preferences reviewed on a monthly basis.

We spoke with four people who used the service. They told us they were happy with the care they received, the staff were good and they had no complaints. One person said, “I couldn’t be in a better place.” We spoke with two relatives of a person who used the service. They told us, “The staff are lovely, they will do anything for you.”

We observed staff interacting well with people and saw there was a friendly and relaxed atmosphere between people living and working at the home. We found that people experienced care that met their individual needs.

We saw that people who used the service had a choice of food and drink. One person we spoke with told us, “I like the food, you get plenty and if you want something else you just have to ask.” We found that there was a choice of suitable and nutritious food and drink to meet the needs of people who used the service.

We found the premises that people, staff and visitors used were safe and suitable.

We found that the home had effective recruitment procedures in place and staff had received regular training and supervision sessions.

We found there was an effective complaints system in place at the home.

We visited the service to check the improvements put in place since our last inspection. During this visit we spoke with four people who used the service, and the relatives of two people. They told us that that they thought the service was good, and that they liked the staff. One relative told us, "I am happy with the care provided." They also said, "For the staff it's not just a job. It is a vocation. They all really care."

Some people had difficulty telling us if they were offered choices and respected, so we observed care practices. We saw that staff were respectful to people. They spoke to people and checked what people wanted them to do and helped orientate people in place and time. We observed staff explaining to people what they were going to do before giving care or assistance.

We found that Elwick Grange had made improvements to address the concerns raised at the last inspection. This included improvements to the assessment and care planning process, safeguarding processes and increased access to supervision and training for staff.

We spoke with three people and the relatives of another two people living at the home. One person told us "It's ok, as homes go. I keep my own room clean. I haven't been asked my views on the home. There are meetings for resident's and their families, but I haven't been to them." They also told us "I have my own hairdresser come to the home, from the salon I always used to go to. I won't trust anyone else with my hair."

Another person told us "The staff are very good. I like the activities here. I'm going to go and play bingo tomorrow." They also said, "I could have ended up somewhere much worse."

Another person told us "It's good in here. The staff are good; they're a good bunch of lads and lasses."