We inspected Elizabeth House Care Home Adults (known to the people who live and work there as ‘Elizabeth House’) on 4 June 2018. The inspection was unannounced.

At our last inspection on January 2017 we found five breaches of legal requirements. These were breaches of Regulation 12 because the management of medicines was not safe: Regulation 11 because the principles of the Mental Capacity Act 2005 had not been followed: Regulation 17 because there was a lack of effective governance processes and Regulation 18 because staff had not received regular supervision, appraisal or training to effectively undertake their role. We also found a breach of Regulation 18 of the Care Quality Commissions (Registration) Regulations 2009 because the registered persons had not always notified CQC of significant events that happened in the home. The provider was required to send us an action plan telling us what they would do to meet the requirements of the law. They sent this to us and we saw at this inspection improvements had been made.

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 provides support for up to 20 people with mental health issues and/or learning disabilities. It consists of two large terraced houses knocked into one, situated in a quiet residential area of Portsmouth. The home has 18 bedrooms, two of which are for two people to share. The home has four floors. Offices and meeting rooms are on the lower ground floor; the kitchen, two lounges, the dining room, a smoking room and some bedrooms to the ground floor; and other bedrooms and bathrooms on the first and second floor. There was a stair lift on one short section of stairs between the first and second floor. On the day of inspection there were 18 people living at the home.

A registered manager was 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.

The service complied with the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLs), and people were encouraged to make choices about their day to day life. However, we found that the recording of mental capacity assessments needed to be improved and we have made a recommendation about this.

People and staff told us they lived and worked in a safe service. All staff had undertaken training in safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and were able to describe what action they would take to protect people from harm.

Risks associated with people’s care were well known by staff, clearly documented in people’s care plans and well managed. Environmental risks were assessed, monitored and measures had been taken to reduce these. The home was clean and infection control procedures were in place.

The management of medicines had improved and was safe.

There were sufficient numbers of staff to meet people's needs and to keep them safe. The provider had effective recruitment procedures in place and carried out checks when they employed staff to help ensure people were safe. Training for staff had improved and staff had the necessary skills to care for people appropriately. Staff were well supported through induction, supervision and appraisal systems.

People told us they received care and support that was very good and was delivered in a way that met their needs and preferences. Staff treated people with dignity and respect and people were supported to be as independent as possible.

People had enough to eat and drink

We inspected Elizabeth House Care Home Adults (known to the people who live and work there as ‘Elizabeth House’) on 16 and 17 January 2017. The first day of the inspection was unannounced. This meant the home did not know we were coming.

Elizabeth House is a care home for up to 20 people with mental health issues and/or learning disabilities. It consists of two large terraced houses knocked into one, situated in a quiet residential area of Portsmouth. The home has 18 bedrooms, two of which were originally for two people to share. The home has four floors. Offices and meeting rooms are on the lower ground floor; the kitchen, two lounges, the dining room, a smoking room and some bedrooms to the ground floor; and other bedrooms and bathrooms on the first and second floor. There was a stair lift on one short section of stairs between the first and second floor, but no other lift access in the building.

The registered manager told us people no longer wished to share rooms so the home accommodated a maximum of 18 people. One the first day of inspection there were 17 people living at the home, although one moved to a different care home later that day.

Elizabeth House was last inspected in May 2014. At that time it was found to be compliant in all areas examined. This was the first inspection to give the home an overall rating and for the different aspects of care.

The home had a registered manager; he was also one of the partners who acted as registered providers of the home. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

We identified various issues with medicines administration and management. The registered manager, who was responsible for medicines at the home, had not been on medicines training for 20 years.

Most aspects of the building, utilities and equipment had been checked on a regular basis. However, the registered manager had not taken steps to reduce the risk of a Legionella outbreak at the home.

People and their relatives told us there were sufficient staff deployed to meet people’s needs. Our observations on inspection supported this view.

Accidents and incidents had been documented at the home, although records lacked detail about actions taken to prevent further occurrences. Care staff could describe how they supported people with behaviours that may challenge others, and we observed them doing so effectively. However, some people’s behavioural management care plans lacked detail.

People and their relatives told us they thought the home was clean. Whilst the décor of the home was tired in places, we found the home to be clean and odour-free.

Training records could not evidence staff had received the training they needed to meet people’s needs effectively. Whilst staff told us they felt supported, the registered manager had not provided staff with supervision or appraisal since 2015.

The home was compliant with Deprivation of Liberty Safeguards, but not with the Mental Capacity Act 2005 (MCA). This was because people’s ability to consent to care and treatment had not been assessed. Care staff knowledge of the MCA was poor.

People were happy with the food and drinks on offer at the home and told us they had a choice. Records showed people with specific nutritional needs were supported appropriately. People also had access to a range of healthcare professionals in order to help maintain their physical and mental health. The home tracked people’s appointments and supported them to attend them, when necessary.

Interactions we observed between staff and people during the inspection were all positive. All staff, including the management team, knew people well as individuals. People and their relatives told us staff were

We spoke with ten people who lived at the home during our inspection. We also spoke with two care staff, one domestic staff member, the deputy and the manager.

We also used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

People confirmed they received the support and care they needed.

The home ensured relevant health care professionals were contacted when appropriate.

People were cared for in an environment that was safe, clean and hygienic.

We looked at four staff files to make sure the system in place to recruit staff was safe and protected people from those who may not be suitable to work with them. We saw all files checked complied with legal requirements and this showed care had been taken in appointing these members of staff.

The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

The health and safety of people who lived in the home was being consistently promoted through regular health and safety audits and routine safety tests on all equipment and installations.

Is the service effective?

All people had an individual care plan which set out their care needs. We looked at four individual care plans which we found to be detailed and comprehensive and clearly identified people's needs.

There was evidence in the care records we looked at that demonstrated they had been reviewed and updated each month. This meant that information recorded reflected the current needs of each person.

People told us they were satisfied with the care and support they received. They said that staff gave them the help they needed with things like personal care and getting around. One person said "staff look after me well, they are marvellous".

One person told us "I like living here, if I did not like it, I would have moved out a long time ago".

Is the service caring?

People living at Elizabeth House Care Home were very positive about the staff and management.

We saw people were happy and relaxed during our visit and there were good relationships between the staff and people living at the home. We spoke with two members of care staff who had a good knowledge of the people they cared for. The staff we spoke with told us what would indicate to them a person's needs had changed, and what steps they would take to ensure their needs continued to be met.

People told us they had good relationships with the staff that were described as kind and caring.

Is the service responsive?

We saw that care plans were reviewed regularly by a member of the management team.

It was noted the health and safety of people who lived in the home was being consistently promoted through regular health and safety audits

We saw people were able to participate in a range of activities both in the home and in the local community.

Is the service well led?

There was a clear management structure with good lines of communication and accountability. Staff spoken with were clear about reporting arrangements.

The provider had an effective system to regularly assess and monitor the quality of service people received. We were told by the management team that they ‘walked’ the service daily which enabled them to be aware of any issues as they arose.

People told us they regularly complete surveys asking for the views on the home.

They confirmed that they talk to one of the management team if they need guidance for anything or have any concerns.

We spoke with eight of the 17 people who lived at the home at the time of our visit. All of the people we spoke to with one exception told us that they were satisfied with the service provided by the home. One person told us that would like to move. The provider told us that this person was awaiting a new placement and that they would be moving in the near future.

People we spoke with told us they were happy and that they were supported by staff to receive the care they needed. Comments included: “I am quite happy” and, “I have lived in other places and this is good.”

We spoke with two members of staff who both told us they liked working at Elizabeth House. One person said “I like working with people and it’s nice to give people the help and support they need”.

We spoke with nine of the 18 people who lived at the home at the time of our visit. Each person we spoke to told us that they were satisfied with the service provided by the home. People told us they were happy and that they were supported by staff to receive the care they needed.

Comments included: “It’s very comfortable I get all the support I need,” and, “The staff are very good and give you help when you need it.”

One person told us “The home and staff are very good, they give me the support I need.” Another person told us “If I have any concerns I raise them with a member of staff and things are quickly sorted out”.

We also spoke with a healthcare professional who told us that the home was proactive and would ask for advice and support if needed.

Staff said that they would always respect people’s wishes. When asked what they would do if they felt there may be a conflict between a person’s wishes and their care needs they told us that they would speak with the manager.