Queen Elizabeth House is a nursing home which provides care for up to twenty people with epilepsy, learning and/or physical disabilities. The home is a purpose built bungalow and consists of an eight bedded and 12 bedded unit. At the time of our inspection there were twenty people living at the service.

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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained good.

Relatives were happy with the care and support provided. They had positive relationships with staff and the registered manager. One relative raised concerns with us about some aspects of their family member's care. This was fed back to the provider who told us they were already aware of the complaint and had commenced an investigation.

Systems were in place to safeguard people. Risks to people were identified and managed. Safe medicines and infection control practices were promoted.

Staff were suitably recruited, inducted, trained and supported. The required staffing levels were maintained, although the registered manager recognised continuity of care was difficult to achieve through the high use of agency staff.

People had care plans in place which outlined their needs and support required. Their health and nutritional needs were identified and they had access to a range of health professionals. People were provided with support and equipment to promote their health, well-being and independence.

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.

Staff were kind and caring. Relatives described staff as "Wonderful, attentive, caring and knew how to support and communicate with their family members."

The provider had systems in place to audit and oversee the running of the service. Internal audits and some aspects of record keeping were incomplete. The registered manager addressed this immediately to bring about the required improvements.

The registered manager was experienced in their role. They were supportive and acted as a positive role model to staff. They were described as professional, knowledgeable, approachable, good listener and acted on issues raised.

Further information is in the detailed findings below.

This inspection took place on 27 and 28 January 2016. It was an unannounced visit to the service.

We previously inspected the service on 7 March 2014. The service was meeting the requirements of the regulations at that time.

Queen Elizabeth house is a nursing home which provides care for up to twenty people with epilepsy, learning and/or physical disabilities. The home is a purpose built bungalow and consists of an eight bedded and 12 bedded unit. At the time of our inspection there were seventeen people living in the home.

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.

We received positive feedback about the service. Comments from people and relatives included: “The care is fantastic here”, “Feel like the staff and people living here are family, we are very happy with the care provided and don’t want anything to change”, “Staff have the right attitude, intelligence and empathy to support our family member”.

People told us they felt safe. Relatives were confident people were safe. Staff were trained in safeguarding and policies and procedures were in place to support safe practice to safeguard people.

Accident/ incidents and risks to people were appropriately managed. People’s medicines were handled safely and daily checks were in place to pick up any discrepancies in medicine administration.

People had access to a wide range of healthcare professionals. Staff were responsive to changes in people’s health and well- being. They sought advice in a timely manner to prevent deterioration in people. People were provided with specialist equipment to promote their independence and keep them safe.

People had care plans in place which provided guidance for staff on how people were to be supported. Care plans were person centred, informative and kept under review. Staff had a good awareness of people’s needs and risks. They knew how they liked to be supported and support was in line with the guidance provided.

People felt cared for. Relatives were happy with the care provided. Staff were observed to be kind, caring, enabling and had a good relationship with the people they supported. People were supported to take part in activities. Activities were being developed to provide a more varied programme of activities for people.

Safe staffing levels were maintained and agency/ bank staff were used to cover gaps in the rota. Staff were inducted, trained and supported in their roles to ensure they worked to the vision and values of the service. Bespoke training was provided to provide staff with the knowledge and skills they needed to support individuals with more complex needs. Safe recruitment practices were promoted to ensure staff had the right skills and attributes for the role.

The home was clean, well maintained and kept in a safe condition. Equipment was cleaned and regularly serviced.

People, relatives and staff were all complimentary of the registered manager. They felt the home was well managed. They described the registered manager as “Accessible, approachable, outstanding, fantastic, helpful, friendly, kind, gifted and amazing”. The registered manager was a positive role model to the staff team. They had worked hard in developing the staff to work as a team, they were proactive in addressing issues and finding solutions, they had facilitated improvement in a person’s well -being, they had introduced innovative ideas in relation to training and inductions and remained committed to providing the best care for people.

The registered manager and provider audited the service to ensure it was safe, effective, caring, responsive and well-led. People and their relatives were given the opport

This visit was a follow up inspection to check if the home was now compliant. Following the last inspection, the provider had sent us an action plan detailing how they were going to address the concerns raised. During this inspection we found the action plan had been put in place.

We found people’s freedom of choice and their dignity was promoted and respected. We did not speak to people during this inspection. We saw people were given choices, for example some people chose to eat fish and chips and others had chicken kiev. We saw staff members were supportive towards people and support was delivered in a patient and unhurried manner. We saw staff positioned themselves sitting next to the person they were supporting. Once people had finished eating lunch they asked people what they wished to do and how staff could support them with this this. For example, one person wished to go to their room, another person had asked staff to help them into the lounge

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We reviewed a sample of care plans. For example, we saw in one person's eating and drinking plan it stated ‘Staff to observe me while I am eating due to risk of choking. I need a non-slip mat and a plate with an adapted rim. Staff to remind me to slow down my rate of eating and to chew my food well.’ During our observation we saw these protocols had been followed by staff. We found staff had followed the guidance and protocols written in the persons care plan.

We found people’s records were kept securely and could be located promptly when needed.

During out visit we were only able to speak with one person.This was because the people living in Queen Elizabeth House had complex needs and had limited communication, which meant we were unable to speak to more people. We also spoke to two relatives who were visiting on the day of inspection. The person we spoke with told us "I am happy here" and "The staff are nice and take care of me." The relatives we spoke with told us "(X) has moved here for the better....They have been absolutely marvellous to (X), the nursing here has been second to none" and "(X) medical needs are met here, (X) is well taken care of and has choices here."

We found people who used the service, where they were able, expressed their views and were involved in making decisions about their care and were offered choices in what they wished to eat and activities they wished to take part in, however, their dignity and their freedom of choice was not always respected and promoted.

We found people were cared for, or supported by, suitably qualified, skilled and experienced staff. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. The relatives we spoke with described the staff as "Very knowledgeable , skilled and competent in their jobs" and "The manager is very approachable, we have known her for 18 years and she is very good."

People's records were not kept safely and securely and this did not promote people's confidentiality.

People told us they were able to make choices, for example when to get up, go to bed, what activities to be involved in and a good choice of meals. They said they were happy with their care and felt safe living at the home. They knew who to talk to if they had any concerns. They said staff were available to support them when required.

A visitor commented that “they were delighted with the care” and that “the care provided was amazing”. They told us they were aware of how to raise a complaint and commented “that issues raised were addressed so that they do not become complaints”.

People told us they liked living at the home. They felt their privacy was respected.

They commented that they got good care and felt well looked after.

People told us they felt safe and would talk to staff if they had any concerns.

People commented that they thought the staff were nice.