The inspection took place on 28 February 2018 and was unannounced. Elizabeth House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Elizabeth House is situated in Bognor Regis in West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. Elizabeth House is registered to accommodate 60 people. At the time of the inspection there were 57 people accommodated in one adapted building, over three floors, which were divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. These units provided accommodation for older people, some of whom were living with dementia. There were gardens for people to access and a hairdressing room.

The home had a registered manager. A registered manager is a ‘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 home is run. The management team consisted of the registered manager, a deputy manager and team leaders. An operations manager also regularly visited and supported the management team.

At the previous inspection on 14 and 17 February 2017 the home received a rating of ‘Requires Improvement’ and was found to be in breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to inform us of what they would do and by when to improve the key questions of safe and well-led to at least good. This was because there were concerns with regards to the sufficiency and deployment of staff to flexibly meet people’s changing needs and ensure their safety. In addition, there were concerns with regards to the completion of records to confirm staff’s actions and the failure to action issues that had been identified within audits. At this inspection improvements had been made and the provider was no longer in breach of the regulations. However, we found one area of practice that needed to improve.

The management team and staff had a good understanding of the Deprivation of Liberty Safeguards (DoLS) and had worked in accordance with this. However, although staff gained people’s consent before supporting them with day-to-day tasks, there was an inconsistent approach to formally assessing people’s capacity and gaining their consent. This is an area of practice identified as being in need of improvement.

The registered manager and staff worked hard to promote a welcoming, inclusive, friendly and lively atmosphere. People told us they were happy living at the home. Without exception, people, relatives and healthcare professionals told us that staff were consistently kind, caring and compassionate and our observations confirmed this. Comments from people were positive. They included, “I like it here very much; the staff are all very kind and attentive”. Another person told us, “Yes, the staff here are very kind, they could not be nicer. I am fortunate and do not have any medication or mobility problems, but I can see the amount of care that is given to some of the other residents. It is wonderful and I know that I would be looked after properly here if ever the time came”. People were treated with respect and dignity, their privacy maintained. Independence was promoted and encouraged and people could choose how they spent their time.

The provider had a clear set of values that encompassed a person-centred approach and these values were embedded in the culture and the practices of staff. The provider and management team had good quality assurance processes and audits that monitored the practices of staff and the effectiveness of the systems and processes at the home. Action plans were implement

The inspection took place on 14 and 17 February 2017 and was an unannounced inspection.

Elizabeth House provides accommodation and care for up to 60 people older people, most of whom have a diagnosis of dementia. The home is purpose built. It consists of six units, two on each floor, each equipped with a living and kitchen area. Bedrooms are en-suite and there is an assisted bathroom for each unit. There are lifts between the floors which people could access freely. Fifty of the beds at the home are commissioned directly by the local authority for dementia care. At the time of our visit there were 59 people living at the home.

The service has 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.

Since our last inspection, the registered manager had made improvements in how staff identified and responded to risks in people’s care. The breach in regulation was met. There had also been improvement in the activities available to people, with an increase in activity staff providing one to one support and company. One relative had written a note of thanks to staff saying, ‘I’d just like to say my Mother did well at Elizabeth House and all the staff are wonderful. It’s a good place with lots to do and lots of nice people’.

Although we found staff understood and managed risks to people’s health and safety, the provider did not have a system to adjust the staffing levels to respond to changes in people’s needs. This meant that staff were often stretched and were not always able to effectively monitor communal areas. There were not always sufficient staff on duty to keep people safe and we have asked the provider to take action.

The provider had not always ensured timely action to address areas identified as needing improvement. Records relating to people’s care were not always accurate or complete. At the time of our inspection, staff were in the process of transferring people’s care plans and records to a new format devised by the provider. The lack of accurate records could lead to inconsistent care being provided and would not support staff to identify and respond to changes in a person’s needs. We have asked the provider to take action.

In other respects, the systems in place to monitor and review the quality of the service and to track planned improvements worked well. Suggestions on improvements to the service were welcomed and people’s feedback encouraged through regular meetings and surveys.

Feedback from people and relatives was very positive. People told us they felt safe at the service, that they enjoyed support and friendship from a regular staff team and that they were regularly asked for their views and opinions.

People told us staff treated them respectfully and that they felt involved in decisions relating to their care. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. People received their medicines safely.

People had developed good relationships with staff and had confidence in their skills and abilities. There was an established team of staff at the home, which offered continuity of care for people. Staff had received training and were supported by the management through supervision and appraisal. Staff were able to pursue additional training, including in dementia care, which helped them to improve the care they provided to people.

People were involved in planning their care and in making suggestions on how the service was run. Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act (MC

We spoke with two people living at the home and two visitors. All were satisfied with the care and support provided; people told us they felt safe and were treated with respect. One person said, "The staff are great. I like it here a lot". A visitor told us, "I would give this place ten out of ten". We observed a variety of ongoing social activities on our visit and noted that the home employed two activities co-ordinators. There was, in consequence, an extensive programme of other activities and opportunities to socialise.

We spoke with the home manager and six other staff members. They all told us that they actively enjoyed working at the home and felt treated as valuable team members. One said, "This is the best place I have worked. The care here is great". Another staff member told us, "We have everything we need to do our jobs. The management will always listen if we need something".

People we spoke to told us they liked living at the home and felt safe. They told us staff spoke and listened to them in a respectful way. They said the home was comfortable and the food was good. People told us if they had any concerns or wished to make a complaint they would tell the staff or the manager.

One person said “the staff are very friendly and respectful, they support me in my day to day life “

Visitors we spoke with said they were happy with the care their relatives received. One visitor told us: "I am very impressed with this home, my mother is so happy, it’s a lovely place and I am fully consulted in my mothers care “

We saw that people's privacy and independence were respected. People experienced safe and effective care based on detailed care plans and risk assessments that documented peoples preferences and met individual needs.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. We saw policies on whistle blowing and safeguarding.

The provider employed sufficient staff to meet the current needs of people at the home. Staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting.

The Provider had effective systems in place to monitor quality assurance and compliance.

We spoke to people and we were told by people able to express an opinion that they were happy in the home. One person told us, “they do a good job” another told us “they do the best they can”

We spoke to three relatives who all expressed satisfaction with the care but they said that there are not enough staff on duty and people sometimes have to wait a little while for attention. They say staff are kind but are very rushed.

We spoke to care staff on duty who told us that the home is a nice supportive place to work but that they are very busy rushing from one thing to another and they do not have time to just sit and talk to the people living there. There are two activity coordinators who do engage with people and organise activities.

The inspection took place on 12 and 13 November 2015 and was an unannounced inspection.

Elizabeth House provides accommodation and care for up to 60 people older people, most of whom have a diagnosis of dementia. The home is purpose built. It consists of six units, each equipped with a living and kitchen area. At the time of our visit there were 60 people living at the home.

The service has 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 harm because prompt action was not always taken to mitigate risks when changes occurred. Some changes in people’s plan of care were not reliably acted upon by staff. Records were not always updated promptly and sometimes contained conflicting information. This put people at risk of receiving care that was inappropriate or unsafe.

People received caring support from staff but had limited opportunity to engage socially or to receive support in pursuing individual interests. Although all staff told us they wished to spend more time with people, they told us, “There is no time to sit and chat”. We found that some people, especially those cared for in their rooms, were at risk of isolation. We have made a recommendation about reviewing staffing levels to ensure that staff are able to provide social stimulation to people.

People felt safe. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. There were enough staff to keep people safe and to meet their physical needs. People received their medicines safely and at the right time.

Staff had received training to carry out their roles. They felt supported and told us that any issues they raised were addressed promptly.

People were treated with kindness and respect. They, and/or their relatives, had been involved in planning and reviewing their care. Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, these decisions had not always been accurately recorded. This was discussed with the registered manager during our visit.

The registered manager had a system to monitor and review the quality of care delivered and was supported by two-monthly visits from a representative of the provider. People, their relatives and staff felt confident to raise issues or concerns with the registered manager. Where improvements had been identified, action plans were in place and used effectively.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.