We inspected this home on 7 November 2017. At our last inspection we found the provider was meeting the regulations and we rated the home as ‘Good’. Saint Elkas is a care home. People in care homes receive accommodation and 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.

The care home is registered to accommodate nine people in one adapted building, on the day of our inspection nine people were using the service. It is a large house set in extensive gardens, with a small self-contained annex at the rear of the property. The home’s ground floor accommodation comprises of a lounge, dining and games room, kitchen, small office and medicine room. The upstairs accommodation contains the bedrooms and bathroom facilities. The home provides support to people with mental health needs.

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 told us they enjoyed living at the home. They felt safe and protected from harm by staff who had the skills and training to support them. There was sufficient staff and there was a flexible arrangement to support appointment or events. Staff had received training in medicine management and provided safe administration. People were supported to learn to administer their own medicine as part of developing their independence skills.

Risk assessments had been completed and people supported with their risks. Guides were provided and measures taken to reduce the risks. Staff had received training for their role. There was a choice of meals which were decided on a weekly basis at a community meeting in the home. People’s diets and preferences had been considered. Referrals had been made to health care professionals to support peoples ongoing health needs or their wellbeing. 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.

People felt they had developed positive relationships with staff who provided a kind and caring environment. They were supported to be independent and their choices were respected. People had been involved in the development of their care and any reviews. Their cultural needs had been considered and wishes in relation to religion. Activities, interests and hobbies were available and encouraged to support people to be stimulated and to support their health recovery. People’s care was inclusive and considered people’s last wishes.

Staff were supported by the manager and the home had good links with the provider. The registered manager completed a range of audits which reflected the needs of the home and people receiving the care. Community development had been established and new initiatives taken on board to support the safety of people using the service.

We saw that the previous rating was displayed in the reception of the home as required. The manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.

The inspection took place on 29 September 2015 and it was unannounced.

Saint Elkas Care Home provides care and support for people with mental health needs. The home is registered to accommodate up to eight people. At the time of our inspection eight people were living there.

There was a registered manager in place. 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 told us they felt safe and were protected from the risk of abuse or avoidable harm. There were sufficient numbers of staff employed to meet people’s needs on a day to day basis.

Staff were knowledgeable about the people who used the service and were aware of their roles and responsibilities. They had the skills, knowledge, experience and training required to support the people who lived in the home. Care staff provided appropriate support to encourage people to be independent and supported them when they felt anxious. Activities outside of the home were promoted. The service was very effective in promoting people’s independence and confidence.

Care and support was delivered to people in a way that met their individual needs. People were encouraged to make choices about their daily living. While being supported with their dietary needs they were also encouraged to make their own choices about meals.

Records for staff recruitment were in place and staff had been recruited in an appropriate way.

The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) 2008 were known and understood by staff, although at the time of our inspection no-one lacked capacity to make their own decisions. Staff asked for people’s consent and acted in accordance with their wishes.

Medicines were managed in a safe and appropriate way.

Relatives were encouraged and made welcome in the home. We saw that the registered manager had a high profile in the service and people felt they could approach them with any concerns. There was an effective quality assurance system in place which acted on people’s views about the quality of their care and monitored the service being provided.

Saint Elkas is a care home for up to eight people. It can provide care and support to people who have enduring mental health needs. Eight people were residing at St Elkas on the day of our inspection, they were from middle to older age.

The service had a registered manager in post. There were clear management structures offering support and leadership. The home had a positive, empowering culture.

People told us they were happy living at the home and they felt the staff understood their care and support needs.

People were involved in decisions about their care and support. Staff made appropriate referrals to other professionals and community services.

Staff understood people’s care and support needs. They were kind and thoughtful towards them, and treated them with respect.

The staff had received training and understood the needs of people living at Saint Elkas. There were sufficient staff to meet the needs of people at all times.

We looked at how medication was administered, recorded, stored and managed. We found systems were in place but improvements could be made in relation to the recording and storing of medication.

People spoke positively about the range of activities in the home and community, they were tailored to individual needs and preferences.

The home was clean, hygienic and well maintained.

We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards.

Records showed that CQC had been notified, as required by law, of most of the incidents in the home that could affect the health, safety and welfare of people. We found that one safeguarding notification had not been completed. The provider ensured all staff knew about this and we saw improvements to systems were put in place on the day of our inspection. Because the provider had not provided the notification they had breached one area of the Health and Social Care Regulations. The action we have asked the provider to take can be found at the back of the full report.

At the time of our visit there were seven people receiving care at Saint Elkas. During our visit we spoke with four people who were receiving care, the manager and two staff members.

People told us they could make drinks or snacks at any time they chose to. Most people told us they enjoyed the meals provided. People told us the staff were “very good”, “everything is fine”, and “Staff are around when you need them”.

There were suitable arrangements in place to ensure that people were consulted and involved in making decisions about their care.

We found that care was planned and delivered to meet people's needs. We saw people's care needs were documented well and care plans were updated if there were any changes. This ensured staff had access sufficient information about to care for people.

People were protected from the risk of malnutrition and dehydration. People were offered a choice of menu and they were asked about their dietary preferences. There were suitable systems in place to monitor people’s weights and nutritional intake. Where concerns about people’s weights were identified referrals had been made to healthcare professionals.

Medicines were suitably stored and handled. There were arrangements in place to support people to self-medicate where this was considered appropriate.

There were systems in place to ensure staff were supported and received training.

There were suitable systems in place to handle complaints. People told us they would speak to staff if they had any concerns but had not felt the need to. People were offered opportunities to discuss any worries at regular residents meetings.

There were seven people living in the home at the time of this review. We spoke with three people to gain their views of the service. One person told us “the staff are lovely, I get on well with them”, another person told us “I couldn’t wish for better”.

People appeared at ease with the staff and there were lots of chat and positive interactions observed. People were able to make their own drinks and meals when they wished at breakfast and lunch. At the main meal of the day at teatime people and staff ate together.

People and told us they were involved in making decisions about their care.

The care plans were signed by people to show their involvement and agreement.

Staff were suitably trained and had access to information about medicines. We spoke with three people who told us that staff always gave them medicines at regular times. Where appropriate there were systems in place to support people to self medicate. We observed some poor practice during our visit and found that staff were not always following safe administration practices.

There were robust recruitment procedures in place. This ensured that staff were suited to work with vulnerable adults.

The provider had systems in place to monitor the quality of the service and involve staff and people in the running of the home.