This inspection took place on 10 and 11 September 2018 and was unannounced.

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 consolida

This comprehensive inspection took place on 30 November, 4 and 5 December 2017 and was unannounced. At our last inspection on 15, 16, 23 June 2017 we found that the provider was not meeting all the regulations that we inspected.

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

This comprehensive inspection took place on 15, 16 and 23 June 2017 and was unannounced. At the last inspection on 21 May 2015, the service was rated ‘Good’.

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 s

This inspection took place on 21 May 2015 and was unannounced. When we last visited the home on the 17 October 2014 we found the service was not meeting all the regulations we looked at.

Eliza House is a service for older people who are in need of personal care. Eliza House provides accommodation to a maximum of twenty-six people, many of whom were living with dementia. 12 people were using the service on the day of our inspection.

The home does not have a registered manager. 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. An acting manager had recently been appointed and they had applied to become the registered manager for the service. The application is being processed by CQC.

The people who used the service was kept safe from abuse. Staff knew how to identify abuse that might occur in the service and knew the correct procedures to follow if they suspected that abuse had occurred.

Systems were in place to monitor the quality of the service and people and their relatives felt confident to express any concerns, so these could be addressed. People who used the service, their relatives and staff said the manager was approachable and supportive

Risks to people and how these could be prevented were identified. Staff were available to meet people's needs.

Care plans were in place to address people’s identified needs, and these had been reviewed monthly or more frequently such as when a person’s condition changed, to keep them up to date.

Appropriate arrangements were in place to assess people’s capacity and to comply with the Mental Capacity Act 2005 and Deprivation of Liberty safeguards.

People were provided with a choice of food, and were supported to eat when required. People were supported effectively with their health needs. Medicines were managed safely.

Staff treated people with kindness and compassion, dignity and respect. They responded to people’s needs promptly.

People using the service, relatives and staff were encouraged to give feedback on the service. There was an accessible complaints policy which the manager followed when complaints were made to ensure they were investigated and responded to appropriately.

This inspection took place on 17 October 2014 and was unannounced. When we last visited the home on the 23 July 2014 we found the service was meeting the regulations we looked at.

Eliza House is a service for older people who are in need of personal care. Eliza House provided accommodation to a maximum of twenty-six people, many of whom were living with dementia.

The home had a registered manager. 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 were not always protected from the risk of bullying and harassment because staff were not able to identify this form of abuse.

Not enough staff were available to meet people’s needs as the registered manager had not assessed the level of staffing required. Staff were not always provided with support they needed to carry out their roles.

The registered manager had not carried out regular audits of care plans and medicines administration to ensure that people were not risk from unsafe care as they had not identified the issues we found.

People were provided with a choice of food, and were supported to eat when required. People were supported effectively with their health needs. Medicines were managed safely.

Staff treated people with kindness and compassion, dignity and respect. They responded to people’s needs promptly.

People using the service, relatives and staff were encouraged to give feedback on the service. There was an accessible complaints policy which the manager followed when complaints were made to ensure they were investigated and responded to appropriately.

At this inspection there were breaches of regulations in relation to safeguarding people from abuse, staffing and consent to care and treatment and quality assurance. You can see what action we told the provider to take at the back of the full version of the report.

An inspector carried out a planned inspection and gathered evidence against the outcomes we looked at to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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 staff understood their needs and responded to them in a caring and supportive way. One person's comments were typical when they said, "they know how to help me.” We looked at five care records for people who use the service. Care plans and risk assessments described how people's needs should be met.

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.

We looked at five care records and found that people's needs were not clearly identified. Changes to people's needs had not been addressed in their care plans. People told us that they liked their meals. A person said, “the food is nice." Relatives said there were insufficient staff to meet people's needs. They gave examples of staff not being available when people needed assistance with personal care. We asked the provider if they had carried out an assessment to determine the level of staffing needed to meet people's needs. The provider told us that no such assessment had been carried out. People may be at risk from unsafe care as staffing may be insufficient to meet their needs.

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.

The three people spoken to said they were involved and consulted about decisions affecting their care. This was confirmed by a person who said, “Staff are helpful and kind.” The three staff spoken to understood people's support needs. We observed that staff assisted them at mealtimes.

People told us they were not offered a choice of food. A person said, "No one talked to me about what I would like to eat." We observed that no snacks were offered between meals. People spoken to did not feel they could ask for a snack. One person said, “I don't think that staff would get me a sandwich". People were not being offered a choice of food and drink to meet their needs.

People said to us that staff were available to help them. People who use the service were asked for their views about their care and treatment.

People and their relatives told us that staff involved them in decisions about care and treatment. They were being treated with respect. One person said, "Staff are respectful to me." Staff asked them how they wanted their needs to be met. People received the care and support they needed. A person said, "They asked how I wanted things done." People liked the food. When asked about the food a person commented, “The food is nice.”

There had not been regular dementia training. Given that most people living at the home have dementia it is important that staff receive regular training in this area. This will make sure that the home continues to meet their dementia care needs. Most of the staff we spoke to felt that they had not been supervised, or supported in their work with people. Staff needed to be supported so that people get the care they need.

People spoken to confirmed that they trusted staff and felt safe. They could discuss their concerns with the staff. A person told us, "Staff are caring. They know what they are doing." Staff were available to meet the individual needs of people.