This inspection was unannounced and took place on 15 December 2016.

Ellenborough Nursing Home is registered to provide accommodation with nursing care for up to 27 people. On the day of the inspection there were 23 people living in the home.

The care home provided nursing care and a registered nurse was on duty 24 hours a day.

The last inspection of the home was carried out 8th April 2014. No concerns were identified with the care being provided to people at that inspection.

There is a registered manager 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 registered manager was open and approachable and supported people and staff well. Their leadership resulted in people receiving skilled and effective care and support in a relaxed, happy environment.

The provider and manager had robust systems in the home to monitor the quality of the service offered to people and to bring about improvements to people’s care.

There were sufficient staff to make sure people received care and attention in an unhurried and safe manner. There were registered nurses on duty at all times to meet the needs of people.

People told us staff were kind and caring and respected their privacy and dignity. One person said “There are no worries here. They are very good to me.” Another person said “We are very well looked after. We get everything done for us. Staff are very kind. Very nice.”

People felt well looked after when they were unwell. The home arranged for them to see healthcare professionals according to their individual needs.

People received care that was responsive to their needs and personalised to their wishes and preferences. People were able to make choices about all aspects of their day to day lives.

Staff were aware of how to assist people to make decisions if they lacked the mental capacity to make decisions for themselves. People were involved in discussions about the care and support they received and were made aware of any risks. The staff responded to changes in people’s needs and adjusted care accordingly.

People enjoyed the food in the home. They had a very good choice of food and staff catered for people with specific dietary needs and preferences when required. Food was plentiful and the size of people’s meals varied according to their appetite and preferences.

Staff had access to on-going training that enabled them to care for people with skill and knowledge.

Staff had received training in recognising and reporting abuse and were confident that any concerns would be fully investigated to make sure people were protected.

People knew how to make a complaint and everyone told us they would be comfortable to do so. All were confident they would be listened to and action would be taken to address any issues.

We considered our inspection findings to answer questions we always ask; 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, speaking with people using the service, the staff supporting them and from looking at records. If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

All parts of the home we inspected were clean and hygienic. Staff followed appropriate safe practice to ensure effective infection control. The home had secure storage facilities for medicines. Medicines administration was performed safely. Where issues relating to recording of medicines had been identified, the new manager was taking action to ensure the issues were addressed.

We saw the home sought assistance from relevant external professionals when needed to ensure people’s safety. For example one person’s records showed their GP had recently been contacted urgently when they had shown signs and symptoms of a mini-stroke.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. One application had been submitted from this home. Relevant external professionals had been involved. The person’s situation was reviewed in accordance with agreed dates. Relevant staff we spoke with were aware of appropriate actions to follow in relation to these safeguards.

Is the service effective?

People we spoke with said the home met their needs. We saw staff effectively supporting people, including people who needed assistance with moving and handling. We met with a person who had bandages on both their legs. They told us when their legs had last been dressed and how their wounds were progressing under treatment.

Some of the people were living with dementia. The new manager had introduced behavioural charts so they could assess the extent of any behaviours and any trigger factors. They were using these records to make further assessments and review care plans to ensure people were effectively supported.

We observed two people who remained in bed all of the time. We saw their positions were changed throughout our visit, to ensure they did not develop pressure ulcers.

The new manager had identified staff needed support to ensure all records were fully and clearly completed. Progress had been made, but there remained lack of consistency between staff in standards of record-keeping.

Is the service caring?

We saw staff were polite and respectful to people. At lunchtime, we observed a care worker assisting a person to eat their meal. They engaged in conversation with them, making the meal a social occasion. They were caring towards the person and did not rush them in any way, assisting them to eat at their own pace. We observed a person who was living with dementia, who was being slightly verbally aggressive to a care worker. The care worker remained consistently polite and helpful to the person throughout the time they were supporting them. We observed where a person needed time to take their medication the registered nurse did not hurry them in any way and supported each person appropriately.

Is the service responsive?

People told us staff responded to their needs. One person told us “the girls are very, very good here.” One of the people we met with had been newly admitted to the home. They told us they had seen the home before they moved in and had been involved in the decision to be admitted.

A person told us about being supported in making choices, saying about the meals, “there’s always something to choose if you don’t like what you’re offered.” A person said staff helped them to maintain their independence. They reported “I’ve got a job to walk,” They said they appreciated the way staff were supporting them in helping them to use their frame as much as possible.

Is the service well led?

The home had not had a registered manager for a period of time. A new manager had been appointed. This person was in the process of applying to the CQC to be the registered manager.

The new manager had set up a range of quality audit processes including infection control and wound management audits. The new manager had also set up systems for consultation with people, relatives and staff. They were taking action where issues were identified. The new manager had reviewed training and staff supervision and was in the process of developing further plans. Staff we spoke with were aware of plans for improvement in the condition of the building. These were not always completed in writing, to ensure transparency.

People told us they received the care they needed at a time of their choosing. Comprehensive assessments and personalised care plans were in place. The service involved people in the planning and delivery of their care. The service responded effectively to complex needs.

The provider had undertaken improvements and refurbishment in areas of the home we had identified at our last inspection required attention. A new kitchen and bathroom had been installed. There were cleaning schedules in place and records confirmed where cleaning had taken place on a daily and weekly basis. We saw that all areas of the home were of a good standard of cleanliness.

The provider had made improvements in the environment of the home and addressed non-compliance in relation to infection control. Care staff demonstrated a good understanding and knowledge of how to protect people from the risks of infection and cross infection.

There were shortfalls in the management and administering of medicines.

Staff told us they felt well supported by the management team. There were good arrangements for the supporting of staff through one to one supervision and appraisals. Staff received the necessary training so they had the skills and knowledge to effectively meet the needs of people using the service.

We found there were shortfalls in the arrangements for auditing and monitoring the quality and safety of the service.

We spoke to the six people who used the service, three relatives, four members of the care staff, two registered nurses and the manager during our inspection.

People told us they were happy living in Ellenborough Nursing Home and most of the staff were caring and friendly. People told us there were activities organised and this was improving.

People told us they were involved in making decisions and their views were sought about how the service could be improved.

Care was assessed, planned and delivered in a person centred way. People had access to other professionals ensuring their care needs were being met.

Staff recruitment processes were robust ensuring people were protected from unsuitable staff.

We have asked the provider to make some improvements in relation to the environment including infection control. This included a refurbishment of the bathroom to ensure it was accessible and fit for purpose.

The purpose of this review was to check that improvements had been made to achieve compliance with outcome 4 and 21. We were also following up some concerns we had received about staff recruitment

On this inspection we did not speak people who lived in the home, but we observed care and support delivered to people with complex needs. We also spoke with staff and visitors to the home, including health professionals and relatives of people who lived in the home.

We reviewed the information held about people and plans for their care. We also reviewed care, staff rotas and recruitment records. We found the service to be compliant with outcome 4 , 12 and 21, but we recommended improvements were made in all areas to maintain compliance.

People who use the service told us that the food was good and at breakfast time there was a choice “I asked for bacon and eggs and I got it” and “beautiful breakfast, everything’s gone”. Others told us “the food is very good, and we have a choice. Staff ask what we want to eat the next day and I always have access to fresh water”. Some people choose to eat their breakfast in their room and others were eating in the lounge area. Staff were seen to be attentive and where one person had not eaten their toast they offered to make some more and a fresh cup off coffee as the last one was cold.

We spoke to people who use the service who told us “I like to stay in my room”, and “my son talks to the owner.” “The cleaner comes in my room most days and I am happy with the cleaning.” “I see the GP when I need to and I can ask the nurses to request a visit.” We spoke with a relative who told us that staff always kept them informed of any GP visits.

People also told us that “the nurses are very good”, others told us “staff are all right, I pull the bell when I need to and staff generally come quickly.” We spoke with a relative who told us they felt that staff gave good dementia care and that they were involved in discussions regarding changing care needs. Staff told us that there has been a focus on increasing activities outside of the home with some people attending a local darts charity event, photographs of which were on display in people’s rooms and on notice boards. People we spoke with said they “enjoyed the evening out and were looking forward to other trips”.

Staff told us that some of the people using the service that suffer from dementia are able to make decisions for themselves but that for others staff have to make decisions for them. There was no assessment of this in the care plans for people suffering from dementia. During the morning of our visit we observed that one person was taken to a lounge where there were no other people. Throughout the day very little staff interaction was seen with this person and apart from putting on a tape of music there was no attempt at spend some time with them or involving them in an activity. The person appeared distressed at times calling out. We raised a concern with the visiting manager from another home in the group that staff did not appear to be meeting the needs of people with dementia. One new member of staff told us that their induction had been “a bit patchy” but that they had managed to catch up with the relevant aspects as they were an experienced senior care worker. Another new staff member had not received any training since they started in post some three months previously.

We spoke to people who use the service and they made comments that ‘’once a week I have a bath’’ and that ‘’I get to choose my clothes’’. People also told us ‘’I like it here’’ and that ‘’there is singing once a month’’.

People who use the service told us that sometimes they have to wait for staff when getting up in the morning. On occasions when staff came they said they would be a minute and then disappeared, so they had to ring the bell again. Some people that require help to be put to bed commented that they have had to wait and feel that it is worse at night.

People who use the service made several positive comments that ‘’food is very good and there is a choice’’. People are also able to choose to eat in their room if preferred. One person told us ‘’I asked for something different and had poached egg on toast’’. We did receive one negative comment that ‘’sometimes they forget me at mealtimes so I have to ring’’.

We also spoke to a relative who had noticed a high staff turnover in recent months.

We found that people’s care needs are not always met. We found that sometimes care and treatment were not assessed, recorded or delivered as planned. This included helping people with diabetes to manage their blood sugar levels and with their diet and food intake.