This inspection took place on 14 and 21 June 2016. Both days of inspection were unannounced which meant the registered provider and staff did not know that we would be attending. Elizabeth House provides support and accommodation for up to 34 people living with a dementia and / or a physical disability. At the time of inspection there were 34 people using the service. The service was located in a residential area within its own grounds and located very close to local amenities.
The registered manager became registered with the Commission in December 2014. They had previously worked for the registered provider as a carer and had been supported to progress with them. 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.
Staff understood the procedures they needed to follow to raise a safeguarding alert. Staff had received up to date training and could provide examples of the different types of abuse which people at the service could be at risk from. All staff told us they felt confident in whistle blowing [telling someone]. When safeguarding incidents occurred, the service worked quickly to carry out an investigation and minimise the risk of harm to people.
Risk assessments for people and for the day to day running of the service were in place and had been regularly reviewed. This meant the registered provider had procedures in place to recognise the importance of risk management delivering care and support in a safe way to people.
Up to date health and safety certificates were in place to show the service was safe to deliver provide care and support to people. Regular maintenance was also carried out at the service. All staff participated in planned fire drills which were scenario based and included questions designed to test staff knowledge.
Robust recruitment procedures were in place. Potential candidates were invited to attend two taster days at the service to determine their suitability. Staff only started work once two checked references and a Disclosure and Barring Services (DBS) check had been obtained. This helped the registered provider to ensure people employed were of suitable character to work with vulnerable people.
People and staff told us there were enough staff on duty during the day and at night. The registered provider regularly monitored staffing levels and dependency tools were completed each month. This showed there were sufficient staff on duty to provide safe care and support to people.
People received their medicines when they needed them by appropriately trained staff. Topical cream records and ‘as and when required’ medicine protocols were in place.
All new staff participated in a robust induction process which included training and shadowing more experienced staff. Staff training, supervision and appraisals were up to date for all staff. This showed the registered provider supported staff to remain competent in their roles.
People were supported with their nutrition and hydration. Appropriate risk assessments and care plans were in place for people who were at risk of dehydration or malnutrition. The service referred people to dieticians when further support was needed.
The service was decorated to a high standard and had good quality furnishings in place. People’s rooms contained their personal belongings, furniture and photographs. People had access to a wide range of communal areas at the service and a dementia friendly garden had been put in place by the registered provider.
People and their relatives spoke highly about staff and the care provided at the service. Everyone told us they enjoyed living at the service. We could see staff knew people and their relatives well. People told us that care was given when they needed it.
People were involved in planning and reviewing their own care. Staff gave people the information they needed to make their own decisions and told us they were not rushed to do so. Relatives told us the service kept them up to date about matters affecting people. When people were unable to make their own decisions, staff contacted advocacy services for people. This showed the service actively supported people to make sure care and support met their needs and wishes.
During the inspection we saw that people’s privacy and dignity was maintained. People confirmed this to be the case and told us doors and curtains were closed and they were covered over with a towel when personal care was taking place. Discussions about people’s needs were carried out in private.
The service encouraged people to keep in touch with the people important to them. Relatives told us they were invited to all events taking place at the service and were welcomed by staff when they visited. People had access to the telephone, internet and Skype to keep in touch with people.
All staff were trained in end of life care. The service had implemented the gold standards frame work for end of life care. This meant people had advanced care plans in place and staff had informal discussions with people about their wishes.
People’s needs were assessed before they moved into the service to make sure the service could support them. When people moved into the service, personalised care plans were put in place which were reflective of their needs, wishes and preferences. Care plans were reviewed regularly and updated when needed.
The activities co-ordinator and staff carried out activities with people at the service. These were complemented by external activities and visitors to the service. People and relatives told us they enjoyed the quality of activities provided.
From speaking with people, relatives and staff, we could see there was a positive and open culture at the service. All staff spoken to told us they enjoyed working at the service and felt supported by the registered manager and registered provider.
The registered manager and deputy managers all spent some of their working time on the floor with people and staff. They told us this helped them to keep up to date with people. People, staff and relatives spoke highly of the registered provider and felt supported by them.
Robust quality assurance processes were in place. All safeguarding incidents, accidents and other types of incidents occurring at the service were promptly dealt with. Investigations were carried out to try to reduce any repeated incidents. Regular audits were carried out and action plans completed where needed which included dates any actions had been addressed.
The registered provider contacted the Commission in December 2015. They told us they had identified through their own quality assurance processes that the registered manager had not always notified the Commission about incidents at the service when required to do so. We issued the registered provider with a fixed penalty notice which they paid in full. The Commission has since received required notifications from the service.
Regular meetings were held for people and their relatives and staff. A regular newsletter was also produced for the service. This meant each were kept up to date about any changes occurring at the service.