Eliza House

Eliza House is a residential care home providing personal care to up to 26 people. The service provides support to older people, including people living with dementia. At the time of our inspection there were 24 people using the service.

The service accommodates people in 1 adapted building across 2 floors, accessible by a lift. Residents had access to ensuite toilet facilities and shared bathrooms. The service comprises communal lounges, a dining area and 2 courtyards.

People’s experience of using this service and what we found

For the most part, people received their medicines safely and as prescribed. However, we found shortfalls in the management of medicines for 3 people.

While there were enough staff to meet people’s needs, there were times when staff felt under pressure and did not have enough time to interact with people appropriately. The provider carried out checks to make sure staff were recruited safely.

Staff were trained in safeguarding and knew how to protect people from abuse. Risks to people were assessed and safely managed. Staff adhered to infection control measures to keep people safe from risks of infections.

People received person-centred care by a team of staff who knew theirs needs and preferences well. Staff supported and encouraged people to take part in various activities to keep them socially engaged. People and their relatives knew how to make their concerns known to the management.

Managers worked with people, their relatives, professionals and staff to provide a good service. Managers completed regular audits to monitor and improve the quality of service. During the inspection, we observed renovation works being carried out in the service to improve its overall state and appearance.

People spoke positively of the staff team and were pleased with the care and support they received.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 18 May 2022).

Why we inspected

We received concerns in relation to staffing and recruitment, activities for people, and the suitability of the physical environment of the service. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good based on the findings of this inspection. However, we have found evidence that the provider needs to make some improvements. Please see the safe section of this full report.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Eliza House on our website at www.cqc.org.uk.

Recommendations

We made recommendations about managing people’s medicines and staffing.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Eliza House is a residential care home providing accommodation and personal care to up to 26 people aged 65 and over some of whom were living with dementia. At the time of the inspection the service was at full occupancy. Eliza House accommodates and provides care and support to people in one adapted building.

People’s experience of using this service and what we found

People appeared to be comfortable and well supported at Eliza House. Relatives told us that they were assured that their family member was safe and received good, person centred care. Safeguarding processes were in place to help protect people from the risk of abuse.

Risks associated with people's care had been assessed and guidance was in place for staff to follow to keep people safe. People were protected from the risks associated with the spread of infection. The service was clean and well maintained.

There were enough staff deployed to meet people's needs and ensure their safety. Appropriate recruitment procedures ensured prospective staff were suitable to work in the home.

Medicines were managed and administered safely.

Staff received the required training and support and applied learning effectively in line with best practice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were seen to eat and drink well and were supported to maintain a healthy and balanced diet. People were supported to maintain healthy lives and had access to health and social care professionals where required.

Staff were caring and kind and relatives confirmed this. We observed staff responding to people's needs with dignity and respect.

There were quality monitoring systems and processes in place to identify how the service was performing and where improvements were required. The provider and registered manager had sustained improvements that had been made following previous inspections and were keen to continue working towards ensuring people continued to receive good quality person centred care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 September 2020).

At this inspection we found improvements had been made and recommendations that had been made had been acted upon.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 22 October 2019. Breaches of legal requirements, regulation 12; safe care and treatment and regulation 17; good governance. were found. The key question of well-led was rated inadequate and a warning notice was issued in relation to regulation 17; good governance. The provider completed an action plan after this inspection to show what they would do and by when to improve.

A follow up unannounced, focused inspection took place on 12 August 2020 and covered the key questions of safe, responsive and well-led. We undertook this inspection to check that the provider had met the requirements of the warning notice that had been issued. We also wanted to check that the provider had followed their action plan and to confirm that they were meeting legal requirements.

We undertook this focused inspection to again check that the provider had continued to follow their action plan and to confirm they now met all legal requirements. This report covers our findings in relation to the Key Questions Safe, Effective, Caring and Well-led which contained recommendations from previous inspections relating to management oversight of the service and the sustainability of improvements and effectively supporting people with their oral hygiene.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Eliza House on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Eliza House is a residential care home providing accommodation and personal care to up to 26 people aged 65 and over some of whom were living with dementia. At the time of the inspection the service was supporting 13 people. Eliza House accommodates and provides care and support to people in one adapted building.

People’s experience of using this service and what we found

The nominated individual, registered manager and the staff team had made significant improvements overall in the management of the home and the quality of care people received. This was reflected in the feedback we received from relatives, staff and health care professionals.

We observed people to be safe and were supported by care staff who knew them well and responded to their needs accordingly.

Care plans were person centred and were reflective of people’s current care needs. Individualised risk associated with people’s health and care needs had been assessed and documented with clear guidance for staff on how to minimise the identified risk and keep people safe.

Health, safety and infection control issues identified at the last inspection had been addressed. The provider and registered manager were working proactively to ensure that health, safety and infection control was regularly monitored. Where potential risks are identified these are immediately addressed.

Processes in place supported the recruitment of staff who had been assessed as safe to work with vulnerable adults. There were enough staff available to ensure the safety of people.

The home smelled fresh and was clean. There were increased infection control measures in response to the coronavirus outbreak. The provider reacted appropriately to keep people safe.

People were receiving care and support that was person centred and responsive to their needs and requirements. Relatives had been involved in the care planning process and in the absence of visits due to the COVID-19 pandemic, had been kept up to date about their relative’s health and care needs.

People were supported and encouraged to participate in a variety of activities to promote their well-being. All staff took a responsibility ensuring there was varied programme activities planned and delivered.

The nominated individual with the registered manager had reviewed and implemented several audits and checks to monitor the overall quality of care people received. Issues identified were clearly linked into an evolving action plan which was reviewed and updated regularly.

The provider was working closely with the local authority to implement and sustain improvements.

We have made a recommendation about the provider and management sustaining the improvements and embedding all learning and development going forward.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 17 February 2020) and there were multiple breaches of regulation. We took enforcement action due to the significant concerns found. A Warning Notice for the breach of regulation 17 was issued to the Provider and Registered Manager following the inspection. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations and had met the requirements of the Warning Notice.

Why we inspected

We carried out an announced focused inspection of this service on 13 August 2020 to check that the provider had followed their action plan, to confirm they now met legal requirements and to check if the provider had met the requirements of the warning notice we previously served. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. Whilst improvements have been noted under each of the key questions looked at, the overall rating for the service has remained as requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Eliza House on our website at www.cqc.org.uk.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Eliza House is a residential care home providing accommodation and personal care to 21 people aged 65 and over at the time of the inspection.

Eliza House can accommodate up to 26 people in one adapted building.

People’s experience of using this service and what we found

The provider had failed to embed and sustain improvements that had been made at the last inspection on September 2018.

We found similar issues as identified at previous inspections in relation to health and safety, infection control, care planning, activities and the overall management of the home.

Management oversight processes in place were ineffective and did not identify any of the issues we found as part of this inspection. The registered manager only worked at the home on a part-time basis which impacted on the quality of management oversight of the home.

Staff morale was low and staff expressed concerns around the disrespectful nature of senior managers.

Issues identified with cleanliness, infection control and maintenance of the home meant that people could be place at risk of harm.

People were not always stimulated or involved in activities that promoted their well-being, especially when the activities co-ordinator was not available.

Poor staff deployment meant that communal areas were at times left unattended. This placed people at risk of harm.

Risk associated with people’s health and care needs had been assessed and guidance was available to staff on how to keep people safe. However, for some people, specific individualised risks had not been assessed.

Care plans were detailed and person centred. However, where change had been noted, care plans had not been updated to reflect the change. This meant that care staff did not have the most current information available to enable them to respond to people’s needs.

Language used within care plans did not always promote dignity and respect.

We have made a recommendation about supporting people effectively with their oral hygiene.

People received their medicines on time and as prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Recruitment processes ensured that all staff had been assessed as safe to work with vulnerable adults were employed.

People and relatives complimented the care staff and found them to be kind and caring.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Good (published 30 October 2018). However, the key question ‘well-led’ was rated as requires improvement. There were no regulatory breaches identified but improvements were required. At this inspection sufficient improvements had not been made and sustained and the provider was now found to be in breach of regulations 9, 12 and 17 of the Health and Social Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

The inspection was prompted in part due to the provider previous history of non-compliance. Concerns had also been brought to our attention around infection control, activities and the care and support people received. A decision was made for us to inspect and examine those risks.

Enforcement

At this inspection, we have identified breaches in relation to the overall management and governance of the service, care planning and review and the lack of appropriate stimulation and activity provision for people.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Eliza House has been inspected twice in the past 15 months. Significant issues and shortfalls in care were identified at the inspection on 15 June 2017 and the service was rated requires improvement overall with an inadequate rating under the key question of well-led. The Care Quality Commission (CQC) took enforcement action in the form of issuing warning notices for breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which meant that the provider was given a specific timeframe within which the service was to meet the regulations.

At the last inspection on 30 November 2017 we found continued breaches of Regulation 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to lack of detailed risk assessment, concerns related to health and safety, infection control and the condition of the fabric of the home and ineffective quality audit systems. Although some improvements had been made, overall the service had failed to improve the standards of care and had not met the requirements of the warning notice. The service was again rated requires improvement overall with a rating of inadequate again under the key question of well-led. Due to the second and consecutive time the service had been rated requires improvement and inadequate under well-led we placed the service under special measures. Enforcement action was again taken by the CQC, with warning notices issued for the continued breach of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the provider had addressed these breaches and was now meeting the regulatory standards.

Eliza 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. Eliza House accommodates up to 26 people in one adapted building. At the time of this inspection there were 22 people living at the service.

There was a registered manager in post at the time of this inspection. 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.

Feedback from people and their relatives was overall positive and comments were made about the improvements that had been made over the last nine months. People and their relatives commented that they felt safe and well looked after at Eliza House.

Risk assessments were detailed and comprehensive and gave clear direction and guidance to care staff on how to reduce or mitigate identified risks in the least restrictive way; keeping people safe and free from harm.

We observed sufficient numbers of care staff available throughout the inspection who were available to provide care and support that appropriately met people’s needs.

Significant improvements had been made to the environment and decoration of the home. The home was observed to be clean and health and safety processes in place ensured people’s safety within the home. Plans continued to be in place for further environmental and decorative improvements.

The provider and the registered manager completed a wide range of audits and checks to monitor the provision and quality of care services that people received. Where issues and concerns were identified we generally saw that actions taken had been clearly recorded. The service demonstrated keenness to learn and make necessary improvements where required. However, the provider and the registered manager needed to consolidate all the checks and audits they were each completing to ensure there was one shared action and improvement plan that could be clearly tracked and monitored.

Medicines administration and management processes were found to be safe which meant that people received their medicines on time and as prescribed.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report to if people were at risk of harm. Staff understood the systems in place to protect people who could not make decisions and were aware of the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

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.

The service had robust systems in place to ensure that only care staff assessed as suitable to work with vulnerable adults were employed. Care staff were regularly supported through training, supervisions and annual appraisals to ensure they carried out their role effectively.

Accidents and incidents were clearly documented and analysis of these were completed on a monthly basis to identify any trends or patterns with a view to learning and improving to minimise re-occurrences where possible.

People had access to a variety of healthcare professionals to support them with their health and care needs. Where the service identified specific needs or concerns referrals to the appropriate services had been made for people to receive the required support.

People were able to choose what they wanted to eat daily with menu options available based on people’s likes and dislikes. Where people had specialist dietary requirements, this was catered for.

The registered manager had implemented new care plans for each person residing at Eliza House. Care plans were detailed and person centred and gave clear information about the person and how they wished to be cared for.

The service had made improvements in the provision of regular activities. An activity co-ordinator was available throughout the week and had implemented a daily plan of activities. In the absence of the activity co-ordinator, care staff were also required to initiate and facilitate activities.

People, in consultation with their relatives, the service and involved professionals had documented their end of life wishes.

We saw people were supported in a respectful and caring manner by care staff. People had established close relationships with care staff and people were seen to be confident and comfortable when interacting with care staff.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate under the key question of well-led. Therefore, this service is now out of Special Measures.

At the last inspection we identified breaches of regulations 9, 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was a lack of activities provision for people. Medicines were not always managed and stored safely. Accidents and incidents were not analysed for trends and patterns. The provider did not ensure that all areas of the home used by the service were clean, suitable for the purpose for which they were to be used and properly maintained. Quality assurance audits that were being completed were not effective as they did not highlight concerns and issues around the home. Poor recording and analysis of complaints, safeguarding, accident/incident and customer satisfaction surveys meant that the provider had no management oversight on the quality of care. There was a lack of evidence that staff were supported through regular supervision.

Following the last inspection in June 2017, we asked the provider to complete an action plan to show what they would do and by when to improve each of the key questions to at least good. In addition we also took enforcement action against the provider and issued a warning notice in relation to good governance and the breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The warning notice required the provider to address the concerns related to the breach and become compliant within one month. We checked the provider’s compliance of the warning notice as part of this inspection.

Eliza 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. Eliza House accommodates up to a maximum of 26 people in one adapted building. However, following our last inspection and findings, the local authority placed an embargo on Eliza House accepting any new referrals. This means that the service was not allowed to admit any new residents. At the time of this inspection there were 20 people using the service.

The home did not have a registered manager in post. The previous manager present at the last inspection in June 2017 was no longer employed by the provider. A new manager had been appointed in October 2017 and was in the process of applying for registered manager status with the Care Quality Commission (CQC). 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.

The provider, manager and a commissioned consultant continued to complete a number of audits and checks to monitor the quality of the service. However, we found that these audits continued to be inadequate and failed to identify any of the issues that we identified as part of this inspection. Where issues were found, there was no record or action plan in place stating how the issues were to be addressed or resolved and by when.

Relatives and external visiting professionals had completed satisfaction surveys, giving feedback on the quality of service provided to people. Where emerging concerns had been raised around activities and the condition of the home, no action plan had been developed on how these issues were to be addressed and no further feedback had been provided to relatives and professionals on the results of the survey and the actions they proposed to take.

At the last inspection we found significant concerns around the health and safety of people in relation to the fabric and condition of the home. Although these concerns had been addressed at the time of the previous inspection, we found significant new concerns as part of this inspection. This placed people at the risk of significant harm.

At the last inspection we found that although care plans identified and detailed risk associated with people's health and support needs, information contained within the care plans was not always consistent with the associated risk assessments.

However, at this inspection we found that this issue had not been addressed. Risk assessments were not always in place for people with significant health conditions. Where risk assessments had been devised specific guidance or direction on how to manage specific risks had not been incorporated into the risk assessment.

At the last inspection we found that medicines were not managed safely. There were a number of concerns around the storage of controlled drugs, room temperature checks for the storage of medicines and incomplete paperwork confirming the safe and appropriate administration of covert medicines. At this inspection we found that these concerns had been addressed and that people were receiving their medicines safely.

At the inspection in June 2017 the manager was unable to provide us with records in relation to staff supervision, appraisals, medicine competency assessments, safeguarding investigations, complaints, accidents and incidents and the results of previously completed satisfaction surveys as they were not available within the home. At this inspection we found that these records were readily available in a more organised format for us to be able to review.

At the last inspection we found that scheduled activities did not always take place. People and relatives all told us that there was very little provision of activities taking place within the home and that activities listed on the activity timetable did not always take place. During this inspection we found that improvements had been made in the provision of activities.

In June 2017 we found that care plans did not always contain information about the person's likes and dislikes, choices and preferences. At this inspection we found that the provider had made significant improvements in this area. However, we found that care plans were inconsistent with a variety of care plan templates in use, which had all been reviewed as current, and so it was difficult to ascertain which version was the most recent and up to date document to be followed.

People and relatives told us that they knew who to speak with if they had any concerns or issues to raise.

All staff demonstrated a good level of understanding of the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLS). At the last inspection we found that care plans did not always evidence that people or where appropriate their relatives had consented to the care and support they received. At this inspection we found that this had been addressed.

Care staff demonstrated a good understanding of the terms safeguarding and whistleblowing and were able to describe the actions they would take if abuse was suspected. However, where people had presented with unexplained bruising or marks on their body, the manager had not taken any action to investigate these.

The provider demonstrated safe recruitment processes were in place to ensure that each person employed at the service was safe to work with vulnerable adults.

Care plans contained records of all visits and appointments made by a variety of healthcare professionals such as GPs, dentists, chiropodists and district nurses. Details of the visit and any actions to be taken had been recorded.

Throughout the inspection we observed positive and caring interactions between people and staff. People were observed to be treated with dignity and respect. Care staff knew people well and demonstrated a sound awareness of supporting people from different backgrounds.

People and relatives knew the new manager and felt confident in approaching them. Staff were equally positive about the new manager and found him to be supportive in the short time that he been present at the home.

At this inspection we found continued breaches of Regulation 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to lack of detailed risk assessment, concerns related to health and safety, infection control and the condition of the fabric of the home and ineffective quality audit systems.

The overall rating for this service is ‘Requires improvement’. This is the second and consecutive time the service has been rated Requires Improvement and therefore we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be co

At this inspection we found a number of concerns and breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Eliza House provides accommodation and support with personal care for up to 26 people some of whom were living with dementia. At the time of our inspection there were 26 people using the service.

The service did not have a registered manager, however the manager in place who took up the position in November 2016 had submitted an application to the Care Quality Commission (CQC), to become the registered manager of this service. 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.

The manager completed a number of audits and checks to monitor the quality of the service. These included audits for medicine, care plans, fire checks, room checks, maintenance of the home and infection control. However, we found that these audits inadequate and failed to identify any of the issues that we identified as part of this inspection.

Health and safety, infection control and care plan audits were completed as per a tick box format and did not identify any of the issues we found. This included issues such as broken radiator covers, poor fabric and condition of the home, chemicals and toiletries left exposed in a bathroom and a broken bin which contained clinical waste.

Where external audits had been completed by the environmental health department for food hygiene ratings and the Clinical Commissioning Group (CCG) for medicines management, issues that had been highlighted had not been addressed. These issues remained and were identified again as part of this inspection.

The manager was unable to provide us with records in relation to staff supervision, appraisals, medicine competency assessments, safeguarding investigations, complaints, accidents and incidents and the results of previously completed satisfaction surveys as they were not available within the home.

Medicines were not managed safely. There were a number of concerns around the storage of controlled drugs, room temperature checks for the storage of medicines and incomplete paperwork confirming the safe and appropriate administration of covert medicines.

Scheduled activities did not always take place. People and relatives all told us that there was very little provision of activities taking place within the home and that activities listed on the activity timetable did not always take place. We saw very little interaction, activity or stimulation that was initiated by care staff that were on duty. People were taken to the lounge and positioned to watch television or listen to music. During the three inspection days, many people were seen to be in the same place throughout the day. People regularly gave feedback, ideas and suggestions at weekly residents meetings about activities that they would like to see organised. However, the home had failed to take action on this feedback.

Accidents and incidents were not recorded in a way which enabled the service to analyse and identify any trends or patterns so these could be reduced or mitigated against in order to keep people safe.

Where staff had completed training in topics such as medicine administration, we were unable to confirm that staff members competencies had been assessed once they had completed the training course to confirm that they were competent in the assessed area.

Care staff told us that they received regular supervision and felt supported in their role. Staff files contained supervision records that had been carried out since the new manager had been in post. However, we were unable to confirm whether staff had received regular supervisions since the last inspection. In addition there were no records of any completed appraisals for any staff members, some of whom had been employed by the service for a number of years.

Over the first two days of the inspection, the inspector and the expert by experience recorded a mixture of positive and negative observations of the lunchtime meal experience. Whilst it was observed that meals served were hot and people were seen to enjoy their meals and ate well, little consideration had been given to the setting and preparation of the dining room which would promote a positive mealtime experience.

Care plans did not always contain information about the person’s likes and dislikes, choices and preferences.

People and relatives told us that they knew who to speak with if they had any concerns or issues to raise. However, we found that no complaints had been recorded since the last inspection in 2015. The manager, who had been in post since November 2016, was unable to confirm if there had been any complaints and where these had been recorded prior to his arrival. The manager told us that they had not received any complaints since November 2016.

All staff demonstrated a good level of understanding of the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLS) and seeking consent when supporting people with their care needs. We found that the service had appropriately submitted authorisation requests for people lacked capacity and who were possibly being deprived of their liberty. However, care plans did not always evidence that people or where appropriate their relatives had consented to the care and support they received.

Care staff demonstrated a good understanding of the terms safeguarding and whistleblowing and were able to describe the actions they would take if abuse was suspected.

Risks associated with people's care and support needs had been identified and these had been assessed, giving staff instructions and directions on how to safely manage those risks.

The provider demonstrated safe recruitment processes were in place to ensure that each person employed at the service was safe to work with vulnerable adults. This included criminal record checks, identification verification, visa verification and reference requests confirming staff conduct in previous employment.

Care plans contained records of all visits and appointments made by a variety of healthcare professionals such as GPs, dentists, chiropodists and district nurses. Details of the visit and any actions to be taken had been recorded.

Throughout the inspection we observed some positive and caring interactions between people and staff. People were observed to be treated with dignity and respect.

Care staff demonstrated a sound awareness of supporting people from different backgrounds, varying religious and cultural backgrounds and supporting people who may identify as being lesbian, gay, bi-sexual or transgender.

People and relatives knew the manager and felt confident in approaching them. Staff were equally positive about the manager and found to him to be a supportive and good manager.

At this inspection we found breaches of Regulation 9, 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to unsafe medicine management, concerns related to health and safety, infection control and the condition of the fabric of the home, lack of activities, ineffective quality audit systems and lack of supervisions, appraisals and medicine competency assessments.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they were treated with respect and dignity by the staff. We observed people being supported appropriately and sensitively by staff. People told us they felt safe.

Sufficient staff were provided to deliver people's care needs and they received the training they needed to provide appropriate care and support.

There were systems in place to analyse accidents and incidents in the home, to ensure lessons were learned and improvements were made to protect people. Records were accurately maintained, which meant the risk of people receiving unsafe care had been minimised.

Is the service well led?

People we spoke with, their relatives and staff were all very positive about the impact the manager had had on many aspects of the service even though they had been in place less than a year. One relative told us, 'The new manager seems to be in good control of things. He is a very pleasant man.'

We found that regular monitoring and reviews of the service were carried out with any highlighted actions completed in a timely manner. This meant the quality of the service could be assured by people living at Eliza House, their relatives and staff.

Staff told us they felt supported by the manager. Comments included, 'The manager always listens to concerns. Any changes made are for the good.'

Is the service effective?

People's health and care needs were assessed with them, but there was limited evidence to show they were always involved in agreeing with and consenting to their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People we spoke with and their relatives told us they received the support they needed. Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service responsive?

One person told us they had complained about a minor aspect of the service some time ago and it had been dealt with appropriately and promptly. We saw there was an effective complaints procedure in place. A relative told us, 'The manager is very responsive to any concerns I may have. He always listens.'

Is the service caring?

We observed that people were supported by kind, attentive staff and empathetic staff. We saw that care workers showed patience and gave encouragement when supporting people. One person told us, 'Everybody really helps me to do things I want to do.' A relative told us, 'The staff really do care about people and they know what people want and need.' Another relative told us, 'The manager is so patient and caring. He can't do enough for (my relative). I am so grateful.'

People told us that sufficient staff were available to meet their needs. One person said staff were, 'always there to help.' Staff told us and we observed that sufficient staff were available to meet people's needs. For example, at lunchtime enough staff were available to help people to eat and drink.

Staff received appropriate professional development. People told us that staff understood how to meet their needs. The training matrix showed that the majority of staff had completed refresher training. A supervision plan showed when staff should receive supervision. Staff files contained supervision notes which showed that staff had supervision on a regular basis. Staff told us that the manager had supported them to improve how they cared for people.

Audits and monitoring had been carried out of incidents, care plans and medication records to make sure that people received safe and effective care and support. The manager had notified us of incidents and the action they had taken to maintain people's safety.

People and relatives told us that they were confident that staff have the skills to meet their needs. However, the training matrix showed that there were a number of areas where the majority of staff had not had refresher training based on the provider's policies and were not receiving appraisals. We saw that the provider had carried out a survey about the quality of the service provided. However, care plans, for example, showed that there were a several inconsistencies in the way that care were assessed and planned which showed a lack of monitoring and review. Medication records had not been reviewed as there were a number of occasions when medication had not been signed for, but had been given. The service's own system for monitoring the quality of the service had not identified these issues.