This inspection took place on 8 December 2016 and was unannounced.

Elizabeth Lodge is a care home that does not provide nursing. It provides support for up to 18 older people, some of whom are living with dementia. At the time of our inspection there were 16 people living at the home.

A registered manager was in place. 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.

Medicine records were not always kept appropriately.

People’s care had been appropriately assessed and plans had been developed to ensure that staff met people’s needs consistently and reduced and identified risks.

People confirmed they felt safe and that staff involved them in making decisions and staff knew people well.

Observation demonstrated people’s consent was sought before staff provided care.

People described staff as lovely and caring. Staff treated people with respect and recognised the importance of promoting independence, dignity and privacy.

Staff demonstrated a good understanding of safeguarding people at risk. They were confident any concerns raised would be acted upon by management and knew what action to take if they were not.

Thorough recruitment checks were carried out and the provider ensured there were enough staff on duty to meet people’s needs. Staff received an induction when they first started work which helped them to understand their roles and responsibilities. They felt supported through supervision and training.

People and their relatives knew how to make a complaint and these were managed in line with the provider’s policy. Systems were in place to gather people’s views and assess and monitor the quality of the service.

We carried out this inspection as part of our routine inspection programme to answer our five questions. Is the service safe, is it effective, is it caring, is it responsive and is it well led? The inspection was carried out by a single inspector. At the time of our inspection there were 16 people using the service. We spoke with three of them and a visitor in order to understand the service from their point of view. We observed the care and support people received in the shared areas of the home. We looked at records and files. We spoke with the registered manager and four members of staff.

This is a summary of what people told us and what we found.

Is the service safe?

We observed that people were happy and comfortable in the home. A visitor told us they found everybody to be happy and friendly. There were risk assessments and action plans in place to protect people’s safety and welfare.

The premises were maintained and decorated to provide a safe and pleasant environment. Appropriate processes were in place to ensure the environment was kept clean and hygienic. People were protected against risks of infection and the spread of infection.

The manager was aware of the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). DoLS were in place for two people using the service at the time of our visit. The service was applying for DoLS for other people who were judged to be a risk of being deprived of their liberty.

Is the service effective?

Staff were supported to deliver effective care. They received appropriate training and support by means of regular supervision and appraisal.

We found people’s care and support were based on thorough assessments and detailed and personalised support plans. Systems were in place to ensure care was delivered according to people’s plans.

Is the service caring?

We observed positive interactions between staff and people who used the service. Staff we spoke with were motivated and committed to providing high quality support in a caring environment.

One care worker we spoke with described how a person who used the service had been admitted to hospital. They and a colleague had visited and stayed with the person in their own time. The manager confirmed to us that this had happened.

Is the service responsive?

The service had a complaints procedure but received few if any complaints or suggestions to improve the service.

People’s care plans and assessments were reviewed regularly and amended if required. The service responded to changes in people’s conditions or behaviours and amended their care and support plans as required.

Is the service well-led?

Staff told us they were supported to deliver high quality care and spoke highly of the manager. They were confident any problems would be dealt with properly if they were to arise.

There was a combination of formal and informal systems in place to assess and monitor the quality of the service. Risks were assessed and appropriate action plans were in place. There were processes in place to review and learn from incidents, accidents and complaints.

On the day we inspected there were 17 people living at Elizabeth Lodge, some of whom had memory impairment and or a physical health problem. During our inspection we spoke with two members of staff and two people who used the service.

Staff we spoke with explained how the care and medicine administration were monitored and how issues and concerns were identified and action taken.

We carried out an inspection in July 2013 when we identified concerns with medicines and their administration. We made a compliance action asking the provider to take action in order that we were reassured that people were in receipt of safe and adequate care. The provider wrote to us and told us what action they were going to take and that they would be compliant by the end of August 2013.

We inspected on 1 November 2013 to review the progress the provider had made. We found that the provider had taken steps to improve medicines administration.

On the day we inspected there were 14 people living at Elizabeth Lodge, some of whom had memory impairment and or a physical health problem. During our inspection we spoke with three members of staff, a relative and four people who use the service. People we spoke with said that “Nothing is too much trouble for the staff, they are lovely”. The relative told us “Mum is always smiling at the staff, if she was not happy she would not do that”.

We saw that people had their privacy and dignity maintained whilst being supported with care. Care needs had been assessed with a personalised care plan devised with guidance for staff on how to support people.

The home was clean and well maintained. People had personalised their rooms with their own possessions including their own furniture. There were risk assessments for all equipment used to support people.

Staff we spoke with explained how the care and medicine administration were monitored and how issues and concerns were identified and action taken.

We carried out an inspection in December 2012 when we identified concerns with the assessing and monitoring the quality of service provision. We made a compliance action asking the provider to take action in order that we were reassured that people were in receipt of safe and adequate care. The provider wrote to us and told us what action they were going to take.

We carried out an inspection on 15 April 2013 to review the progress the provider had made in taking action to be compliant in the area where we had previously assessed them as non compliant.

Staff we spoke with explained how the provision of care for example care plans medicine administration were monitored and how issues and concerns were discussed with people who use the service, their representatives and staff.

Elizabeth Lodge is a home for older people and they are registered for up to 18 people. On the day we inspected there were 18 people living at the home the majority of whom had memory. During our inspection we spoke with five staff and three people who use the service.

As not everyone who lived at Elizabeth Lodge was able to tell us what they thought about the care and support provided, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spent time in their company in the lounge / dining area observing the support people received before and during their meal. We saw that the staff were friendly and respectful and that they were quick to respond if anyone appeared unhappy or distressed or required support. We observed people receiving assistance and support in a timely manner and people were spoken to in a respectful manner.

Staff told us that they liked working at the home and felt involved and had a say in how they provided care. They told us that they had regular training and that some staff for example senior carers had additional responsibilities such as the ordering and receipt of medicines.