This inspection took place on 5 January 2018 and was unannounced.
Elizabeth House 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.
Elizabeth House accommodates a maximum of 20 people who require personal care in one building across two floors. 18 older people lived at the home at the time of this comprehensive inspection and some people lived with dementia.
At the last inspection in October 2015, the service was rated 'Good'. At this inspection, the rating had not been sustained and service is rated as requires improvement.
The service is required to have 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 and associated Regulations about how the service is run. At the time of our visit the registered manager had been in post for six years.
The registered manager told us they had faced challenges in the previous year because members of the senior staff team had been absent from work. This meant that not all staff training had been delivered as planned and staff had limited opportunities for supervision. They had plans in place to demonstrate how they kept themselves up to date with best practice and demonstrated their compliance with regulation.
Some on-going training staff required to meet people's needs had not taken place and some training was not up to date. Plans were in place to make improvements to ensure staff had the knowledge they needed to deliver safe and effective care. Despite some staff not completing mental capacity training they demonstrated they understood the principles of the legislation to protect people's rights.
The registered manager demonstrated a good understanding of the MCA legislation. New staff had received effective support when they had started work at the home. The staff team also had some opportunities to complete additional qualifications, such as social care diplomas.
Individual meetings with staff to discuss their role, competency and to identify how to further develop their skills had not taken place in-line with the provider’s procedures. Plans were in place to make improvements.
It is a legal requirement for providers to display CQC ratings on their website. Prior to our visit we identified this had not happened. Also, some information on their website was incorrect. Following our visit we checked and found action had been taken to resolve this issue.
The registered manager had some knowledge of the Equality Act 2010 and explained how they needed to support people who may have diverse needs.
People told us they felt safe living at Elizabeth House. There were enough staff to keep people safe and respond to their needs in a timely way.
Procedures were in place to protect people from harm. Staff had received safeguarding adults training and knew to follow procedures to keep people safe. The provider's recruitment procedures minimised, as far as possible, the risks to people safety.
Staff were knowledgeable about the risks associated with people's care. Risk assessments were in place and detailed the support people needed to reduce and manage the risks. A system to monitor accidents and incident that happened in the home was in place.
There were processes to keep people safe in the event of an emergency such as a fire. Regular checks of the building and equipment took place to make sure they were safe to use.
People's needs were met by the design and decoration of the home. The home was clean and well maintained and care workers assured us they understood their responsibilities in relation to health and safety infection control.
People received their medicines as prescribed. Medicines were securely stored and staff were trained to administer them; their competence to do this safely was assessed regularly.
People provided positive feedback about the food and dining experiences. Staff had a good understanding of people's nutritional needs. People received effective care, support and treatment from health professionals.
People and their relatives told us the staff were kind and caring. Staff enjoyed working at the home and knew the people they cared for well. People were treated with dignity and respect and people were supported to be independent.
People were involved in the planning and review of their care. Care plans detailed people's individual preferences which supported staff to provide personalised care.
People chose to take part in a variety of social activities to occupy their time which they enjoyed. People knew how to make a complaint and felt comfortable doing so.
People and their relatives spoke positively about the registered manager and the leadership of the home. Staff felt supported by the management team.
There were systems in place to monitor and review the quality of the home. People and their family members were encouraged to put forward their suggestions and views about the service they received and the running of the home. Annual quality questionnaires were sent out to gather people's views on the service they received.
The registered manager had an understanding of which notifications they were required to send to us so we were able to monitor any changes or issues within the home.