Elizabeth Fleming Care Home is nursing home for 36 people. The home is divided into two separate units on one floor. When we inspected there were 36 people living at the home. Some of whom were living with dementia.

At our last inspection we rated the service 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.

We received exceptionally good feedback from people and relatives about the excellent care provided at the home and the caring approach of the staff team. People and relatives enthusiastically told us about the exceptional care provided at the home. They used phrases such as “a terrific place”, “absolutely fabulous” and “first class attention". We heard about numerous occasions when staff went ‘above and beyond’ for people and took time to make them feel special.

People, relatives and staff felt the service was a safe place. Staff knew about safeguarding and the provider’s whistle blowing procedure. They also knew how to report concerns.

There were sufficient staff on duty to meet people’s needs. We only received positive feedback about the number of staff and there was a visible staff presence throughout our visits to the home.

Medicines were managed safely with accurate records maintained to confirm the medicines staff had given to people. Regular health and safety checks were carried out and the provider had procedures to help ensure people were safe in an emergency.

Staff were well supported and received the training they needed. They told us they could speak with the registered manager anytime.

People were supported to meet their nutritional and health care needs. Due to the complexity of people’s support needs, mealtimes took a long time to complete. The provider was consulting an external auditor about this and was committed to improving people’s dining experience.

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.

People’s needs had been assessed both before and after their admission to identify their care needs. Care plans were detailed and reflected people’s needs and preferences. Care plans were evaluated regularly and included meaningful information about people’s needs. People were actively engaged in a range of activities. The provider had a complaint procedure should anyone wish to complain. There had been no complaints received since we last inspected.

The provider had a structured approach to quality assurance. People, relatives and staff gave good feedback about the registered manager and the management of the home. They also described the home as having a warm and friendly atmosphere. People and staff had regular opportunities to share their views about the home. The provider had received a high number of compliments about the care provided.

Further information is in the detailed findings below.

We inspected Elizabeth Fleming Care Home on 24 February 2016. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting. We last inspected the service on 18 July 2013 and found the service met the standards we inspected against at the time.

Elizabeth Fleming Care Home is a residential home which provides personal care for up to 36 people (both older and younger adults),with dementia, physical or mental health needs. At the time of our inspection 33 people were living there.

The registered manager had been registered with us since 12 March 2015. 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 we spoke with told us that they felt safe living at the service. They told us they felt they received good care and that staff were very kind and respectful. Staff spoke confidently about the procedures they would follow to take action to ensure the safety of people if they suspected someone to be at risk of harm or abuse.

Staff understood and acted in accordance with the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards, which meant they were working within the law to support people who may lack capacity to make their own decisions.

Appropriate checks of the building and maintenance systems were undertaken to ensure risks to people’s health and safety were minimised. Personal Emergency Evacuation Plans (PEEPs) were not subject to regular review to ensure accurate reflection of people's dependency needs.

Medicine administration was not always carried out safely. Staff did not demonstrate the knowledge required to ensure safe administration when mixing two medicines together. They were unaware of the possible side effects and how the drugs could interact with other medicines. Care plans were not in place detailing this practice and no pharmaceutical information relating to this practice was available (i.e. consideration of the impact on efficacy or the impact of the interaction of the two medications).

Care records demonstrated the needs of people who used the service were subject to initial and on-going assessment. We saw these assessments accurately captured the needs of people and were used to plan and deliver effective and appropriate care. Where appropriate, risk assessments were completed, which identified risks and the measures in place to ensure that people were protected from the risk of harm. We saw that where appropriate, for example where people’s care

needs had changed, staff made referrals to other healthcare professionals to ensure effective and safe care could be delivered.

Staff employment files demonstrated that staff were subject to rigorous pre-employment checks before they commenced work. Staff told us they always

completed training and that they felt well supported. Training records showed staff had completed mandatory and role specific training.

Staff we spoke with demonstrated knowledge about the care needs of people they helped to support and care for. We found staff knowledge of people’s needs was corroborated by care records and from observations we carried out.

We found people who used the service were provided with information about how they could raise any concerns and complaints as necessary. We found there were systems in place to enable the service and the provider to learn from complaints and incidents.

The service promoted a positive culture that was person-centred, open, inclusive and empowering. They ensured that people who used the service and staff had opportunities to become involved and could suggest ways in which the service could be improved. The service also worked alongside external commissioning bo

We spoke to two people using the service and two relatives. One relative said “The staff are brilliant, they phone me at all times regarding my mother”. Another relative said “The care is okay, I have concerns about the little things which are not attended to”.

One person told us “Staff are very nice and hardworking”. Another resident said “The staff are great with me”.

We saw that suitable arrangements were in place to obtain consent to care and treatment. People did experience care, treatment and support that met their needs.

We found there were sufficient numbers of suitably qualified staff and the provider had a system to regularly assess and monitor the quality of service that people received. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

People told us about their experiences of being at Elizabeth Fleming Care Home. People told us that they were involvement with the assessments that were carried out by the home and social workers and they agreed to come into care.

People we spoke with told us they received regular medical care from their general practitioner, and also from other healthcare professionals such as dentists, opticians, chiropodists and dieticians. One person told us about the “good service” that she gets from her keyworker.

People spoke with us about the care they received, and number of people described the care as “excellent care”.