We carried out an unannounced comprehensive inspection on 29 September 2018.

Eldon House Residential Home is a care home without nursing for up to 20 people. On the day of our inspection there were 20 people living at the service. It specialises in care for older people some who are living with dementia.

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.

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 the last inspection on 30 January 2016, the service was rated 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.

Why the service remains Good:

We met and spoke with most of the people living in the service during our visit. However, some people were not able to fully verbalise their views. Due to people’s needs we spent time observing people with the staff supporting them. Others could tell us about the care and support they received. Staff told us and we observed used other methods of communication with people who could not verbally express their views, for example by the use of pictures.

People remained safe at Eldon House. People who were able to told us they felt safe living there. One person said; “Its safe for me, I wouldn’t change a thing its perfect.”

People continued to receive their medicines safely by staff who had received regular updated training. People were protected by safe recruitment procedures. This ensured staff employed were suitable to work with vulnerable people. People, relatives and the staff team confirmed there were sufficient number of staff to keep people safe. Staff said they could meet people’s needs and support them when needed. However, some people and staff felt the service would benefit from and extra staff member during the evening time, for example working until 10pm to support the night staff. The area manager confirmed they had discussed this with the provider and looking at how to address this issue.

After our visit we received information of concern that the management team had informed staff there would not be a third member of staff placed on the evening shift to support the night staff in assisting people to bed at a time of their choice. However, we followed this up with the registered manager who provided reassurances that this statement was not correct and the new rota put in place from the 1 November 2018 would include a third staff member working until 10pm.

People’s risks were assessed, monitored and managed by staff to ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible.

People continued to receive a caring service. The staff team had the skills and knowledge required to effectively support people. Staff had completed safeguarding training. New staff completed the Care Certificate (a nationally recognised training course for staff new to care). The Care Certificate training looked at and discussed the Equality and Diversity and Human Rights policy of the company. One staff member said; “I wouldn’t work anywhere else!”

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 support

Eldon house is a residential care home which predominately provides care for older people, some of whom have a form of dementia. The home can accommodate up to a maximum of 20 people. On the day of the inspection 20 people were living at the service. Some of the people at the time of our inspection had physical health needs and some mental frailty due to a diagnosis of dementia.

The service is required to have a registered manager and at the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the CQC 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.

We carried out this unannounced inspection of Eldon house on 30 January 2016. We saw people were happy living at Eldon house. The atmosphere was friendly and relaxed and we observed staff and people using the service enjoying each other’s company. People’s comments included; “Staff are good, they take care of me”, and “The staff are very kind and very understanding.” People told us they were completely satisfied with the care provided and the manner in which it was given.

When we arrived at Eldon House we had difficulty gaining entry to the service. When we phoned the service there was no reply and the call went to voicemail. Three relatives said that contacting the service by phone could be difficult. However when they physically visited the service they had the key code so that they could enter the property themselves. We discussed with the area manager the difficulty in gaining access and our concern that if there was an emergency situation services might face similar problems. The area manager reassured us that this would be addressed immediately. Following the inspection we were told by the area manger that the service had already obtained quotes to connect the gate intercom to the call bell system.

People looked well cared for and their needs were met quickly and appropriately. People who used the service and their relatives were complimentary about the care they received from staff who they felt were knowledgeable and competent to meet their individual needs. Relatives comments included; "Staff are so attentive and “I couldn’t ask for a better home, staff go that step beyond.” Relatives told us they were always made welcome and were able to visit their family members at any time

People told us “I feel safe here they take care of me.” They told us they were completely satisfied with the care provided and the manner in which it was given. Relatives felt their family member was cared for safely. Staff were aware of how to report any suspicions of abuse and had confidence that appropriate action would be taken.

People’s care and health needs were assessed prior to admission to the service. Staff ensured they found out as much information about the person as possible so that they could get to know the persons wishes and preferences. Relatives felt this gave staff a very good understanding of their family member and how they could care for them.

People were supported to live their lives in the way they chose. People’s preferences in how they wanted to spend their day were sought, listened to and respected. Activities were provided by the service individually and in a group format. Activities available included arts and crafts and outside entertainers coming into the service. Visitors told us they were always made welcome and were able to visit at any time.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Where people did not have the capacity to make certain decisions the service involved family and relevant professionals to help

There were seventeen people living at Eldon house at the time of our inspection. We spoke with the registered manager, the assistant manager, two staff and three people who lived at the home.

We toured the building and spent time observing people and staff during the day. We noted there was a strong odour in some parts of the home at the time of our inspection. We saw people’s privacy and dignity was respected and staff were helpful. We saw people chatted with each other and with staff. Some of the people who used the service were not able to comment in detail about the service they received due to their healthcare needs. Comments included “it’s lovely here, they (staff ) are all lovely” and “food is terrific”.

We found peoples’ views and experiences had been taken into account in the way the service was provided and delivered in relation to their care.

People were protected from the risks of inadequate nutrition and dehydration.

We found that people who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse happening.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

We asked some of the people who used the service about life at Eldon House care home. They said they were very comfortable and happy living in the home, They said that the home was well maintained and kept very clean. They told us they chose what they did each day, for example, they went to bed and got up when they liked, chose what clothes they liked to wear, food was appetising and in sufficient quantity and there were activities they could join in if they wished. During our inspection we saw people joined in group activities, socialised in the lounges, watched TV or listened to music and received visitors.

People told us they could raise concerns to staff or the manager if the need ever arose. We spoke to relatives who echoed this and said that they felt welcomed to the home.

We saw staff approach people using the service in a gentle and reassuring manner and checking with them that they had all that they needed. We saw staff talk to people and ask them what they would like to do. We saw that people’s wishes were respected. We observed people moving around the home with no restrictions. Our observations concluded people appeared happy with the service and the staff that supported them. We observed that privacy and dignity were respected during our visit.

People using the service were positive about the care that they receive and were complimentary about the skills of the staff team. People using the service told us that ‘staff are fabulous’, ‘the food is good’ and that they choose how they will spend their day. People using the service told us that they can choose when to get up, go to bed and if they want to participate in any planned activities or not.

We saw people using the service socialising with each other in the lounge, reading papers, writing letters and doing crosswords. We also saw spoke with people who had chosen to spend time in their rooms watching TV or listening to music. They did not raise any concerns about the care they receive.

We saw staff approaching people using the service in a gentle and reassuring manner and checking with them that they had all that they needed.

The Department of Adult Care and Support and us have both received three independent anonymous complaints from different sources. Therefore a Service Improvement Officer and we visited the home together to look at the concerns raised.

We spoke with some people who were able to talk to us about the service and about how they make choices in the care they receive. We spoke with people in a group and individual settings. All told us that they are happy with the care they receive, they are able to make choices, food is of a good standard and satisfactory portions, staff are nice, ‘nothing is too much trouble for them’, and the atmosphere at the home has improved in that it is more relaxed. People were happy with the facilities that Eldon House provides and felt there ‘was enough to do’.

People using the service told us that they could see a doctor when needed. They also told us that they could raise a complaint or concern if they wanted to. No one was able to identify any areas for improvement.

One person told us that he felt involved in the choosing of coming to stay at Eldon House and that from the places he had visited, ‘this one was the best’. This person said he was happy that he ‘made the right decision.’

A relative told us that he feels that his mother receives good care from competent staff and that he ‘no longer worries about mum’ stating he feels she is ‘in safe hands’. This relative could not identify any improvements the home could make.

We spoke with some people who were able to talk to us about the service and about how they make choices in the care they receive. They told us that they have the opportunity to express preferences and felt supported to do so. Some people at the service were not able to talk with us. For people who do not have the capacity to tell staff about choices they have, there is little evidence of the involvement of the person or their representatives in the care plans to ensure that their preferences are being managed.

Five people told us that they were happy with the service provided and were able to make choices. One person was unhappy with the care given.

People told us that the staff were mostly very nice, but some were not, but declined to identify those staff who they did not consider to be kind. One person told us that they thought the staff did not have enough training to meet their needs.

People using the service told us that they could see a doctor when needed. They also told us that they could raise a complaint or concern if they wanted to.

People using the service told us that they liked their rooms and could access bathrooms and toilets when needed. They also told us that bathing was undertaken in the afternoons and they were not asked if this was convenient for them.

Those who were able to talk to us were complimentary about the choice and standard of food.