This inspection took place on 23 and 24 October 2018. It was an announced visit to the service.

Lady Elizabeth House provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented from a housing association and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service. Nineteen people were being supported by this service at the time of our inspection. People varied in age from younger adults to older persons and had a range of personal care needs and levels of independence. Each person had their own self-contained flat. There was a communal lounge and dining room people could use and an on-site day service run by the provider. Some people received personal care from other agencies as well as staff at Lady Elizabeth House.

We previously inspected the service in August 2017. The service was rated ‘requires improvement’ at that time. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘effective’ and ‘well-led’ to at least ‘good’. On this occasion, we found improvements had been made to people’s care. These included notification to us of incidents of abuse, assessment of people’s mental capacity and recording when medicines for occasional use had been offered to people. A deputy manager position had been introduced at the service and feedback showed this arrangement was working well.

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.

We received positive feedback about people’s care. Comments included “Without any sort of a lie I can say the care is actually excellent,” “The carers are exceptional” and “They are very friendly to (us). They laugh and joke and look really happy.”

Staff received the support they needed to meet people’s needs, through supervision, training and a structured induction. Appraisals also took place to assess staff performance. Thorough recruitment procedures were used.

Each person had a care plan which outlined the support they required. These had been kept up to date and were accompanied by risk assessments, to minimise the likelihood of injury or harm. Staff supported people with their medicines and nutritional needs, where this was part of their care package.

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.

Quality of care was monitored by the provider through visits to the service, audits and surveys. People were asked for their views in tenants’ meetings and during quality reviews. Complaints were responded to and actions were taken to make improvements, where necessary. The service worked well with other agencies and departments to make sure people received effective and continuous care. This included the housing association and other care providers.

This inspection took place on 22 and 23 June 2017. It was an announced visit to the service.

We previously inspected the service on 10 and 11 May 2016. The service was not meeting all the requirements of the regulations at that time. We asked the provider to make improvements to maintaining records of complaints. Recommendations were also made for the service to assess people’s needs before they received a service, making care plans more person-centred and adding a photograph to staff personnel files. On this occasion we found appropriate action had been taken to address these matters.

Lady Elizabeth House provides support to older people and younger adults living in extra care housing. Eighteen people were being supported at the time of out visit.

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.

We received positive feedback about the service. Relatives were complimentary of the standards of care and support given to people and to themselves. One relative told us “We couldn’t have picked a better place.” They added “They look after us too.” Another relative said “I’m very happy with everything here.” One person who lived at the service spoke about one of their care workers and described them as “Very kind and caring.” Another person said “I love them all.”

A community professional told us “Staff have a very good understanding of the needs of the residents and as a result are able to meet their needs well.”

Improvement had been made to assessing people’s needs before they received a service. Care plans were more person-centred and focused on the needs and wishes of the person rather than being task based. These had been kept up to date to reflect changes in people’s needs.

We found there were sufficient staff to meet people’s needs. They were recruited using robust procedures to make sure people were supported by staff with the right skills and attributes. Staff told us there was good teamwork at the service and they enjoyed coming in to work. They said they received the support they needed to meet people’s needs. Staff received support through induction, supervision and staff meetings. However, we found appraisals had not been carried out for staff in 2016 and some training requirements needed to be addressed.

People were supported to be as independent as possible. Their medicines were handled safely. We have made a recommendation about recording of when medicines prescribed for occasional use have been offered to people. This is in order to demonstrate staff consistently ask people if they need these medicines and to explain gaps in the records.

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. However, we have made a recommendation about mental capacity assessments to make sure people who may lack capacity, such as those with dementia, can make decisions about their care and support.

The provider checked the quality of care at the service through visits and audits. Most of the records we looked at were well maintained and those we asked to see were located promptly.

We found a breach of the Care Quality Commission (Registration) Regulations 2009, as the service had not informed us of all notifiable events. This meant we could not see at the time the events occurred that appropriate action was being taken to safeguard people’s welfare.

You can see what action we told the provider to take at the back of the full version of this report.

This inspection took place on 10 and 11 May 2016. It was an announced visit to the service.

We previously inspected the service on 29 August 2013. The service was meeting the requirements of the regulations at that time.

Lady Elizabeth House provides support to older people and younger adults living in extra care housing. Nineteen people were being supported at the time of out visit.

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.

We received positive feedback about the service. Comments from people included “You can’t fault them,” “They’re like family,” They’re 100%, brilliant” and “They’re wonderful people, they can’t do enough for you.”

There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. Risk was managed well at the service so that people could be as independent as possible. People’s medicines were handled safely and given to them in accordance with their prescriptions.

We found there were sufficient staff to meet people’s needs. They were recruited using robust procedures to make sure people were supported by staff with the right skills and attributes. We have recommended photographs are added to staff recruitment files to complete required records.

Staff received appropriate support through a structured induction, supervision and training. Staff told us they felt supported and the registered manager was approachable and had an open door policy.

Care plans were in place for each person. We have made a recommendation for the service to develop these so they are more person-centred, rather than focussing on tasks to be completed.

The registered manager told us there had been some complaints. Records could not be found for each one to show what the concerns were and how they were handled.

We found the service relied upon pre-admission assessments completed by the local authority. It did not undertake its own needs assessments. We have made a recommendation for the service to follow good practice in assessing the needs of people before it provides care to them.

Quality of care was monitored by the registered manager and the provider. The registered manager told us about important events (notifications) so we could see what action had been taken to protect people from harm.

We found a breach of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to receiving and acting on complaints. You can see what action we told the provider to take at the back of the full version of this report.

We saw assessments of people's needs covered various domains of personal care, including medical history, social requirements and cultural needs. There was also information about people's mobility, nutrition, and accommodation which enabled the care workers to provide a personalised service.

We spoke with the registered manager about the recruitment and selection process for choosing new staff. The manager explained job applicants completed an application form, attended an interview and submitted required documentation prior to their employment commencement. Four care workers we spoke with confirmed they had participated in this process prior to starting work at the location.

We saw there were a number of ways that people who use the service were able to provide feedback. These included through an annual provider survey, through regular residents and relatives meetings and via informal feedback to care workers and the registered manager.

Where different services were involved in delivering care or treatment the provider took appropriate action to co-ordinate a response to the person raising the complaint. Care workers and the registered manager were able to tell us about outside organisations people could contact to if they were not satisfied with the response of the provider.

People told us that someone from the service had visited and assessed their needs before they received a package of care and support. They confirmed that they were treated with respect and their dignity was maintained. People said they were satisfied with the standard of care provided and staff understood their needs. They told us that the staff treated them as individuals and respected their views and choices. They said they were consulted about any changes to their care and support and were able to make decisions and contribute to the care planning process. One person told us that their care manager helped them choose the service which met their needs and said ''I am very lucky...they meet my needs well.'' Another said ''all in all I am very happy, they encourage me to do as much as possibe...they've been really supportive and I would definitely reccommend to others.''