We undertook the inspection of Elm View Care Home on the 20 & 21 September 2018. This inspection was unannounced, which meant that the provider did not know we would be visiting.

Elm View is a 'nursing home'. People in nursing 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.

The care home accommodates 43 people in one building providing nursing care and personal care. At the time of our inspection 37 people were accommodated in the home.

At the last inspection the service was rated as Good. At this inspection we found the service Requires Improvement in Safe and Well-led.

There was 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 providers quality assurance system had not identified shortfalls found during the inspection.

We found shortfalls relating to people’s individual care needs such as, wound care, nutrition, re-positioning records and the storage of people’s thickener which required improving.

People were supported by staff who received supervision an annual appraisal and training. Checks had been completed prior to starting work at the service. Staff felt the home was a nice place to work and that they felt well supported.

People were happy with the care they received and all felt the staff were kind and caring.

People’s care plans were person centred and contained important information relating to their likes and dislikes. People felt able to raise any complaints and various compliments had been received regarding working at the home and positive experiences of the care people had received.

People felt safe, and staff were able to recognise the different types of abuse and who to report it to.

People had choice in the meals and had access to drinks throughout the day. Medical appointments were arranged as and when required.

People had choice about how they spent their time and there was access to a variety of activities throughout the month.

This inspection took place on 21 and 22 April 2016 and was unannounced. The last inspection was carried out in August 2013, at that inspection the service was found to be meeting the Regulations assessed.

Elm View Care Home is registered to provide accommodation with nursing and personal care for up to 46 people. On the days of our inspection there were 38 people living in the home. The service is located in Clevedon.

There was a manager in post at the time of our inspection who had applied to be registered with the CQC. 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 told us they felt safe at the service. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns.

There were good systems in place to make sure that people were supported to take medicines safely and as prescribed.

Risks to people had been assessed and plans put in place to keep risks to a minimum.

There were enough staff on duty to make sure people's needs were met. Recruitment procedures made sure staff had the required skills and were of suitable character and background. Staff told us they enjoyed working at the service and that there was good teamwork.

Staff were supported through training and team meetings to help them carry out their roles effectively. Staff were led by an open and accessible management team.

The manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted. The registered manager had taken appropriate action for those people whom restricted movement was a concern. Where people lacked capacity to make their own decisions, the MCA had been followed appropriately.

People told us that staff were caring and that their privacy and dignity were respected. Care plans were person centred and showed that individual preferences were taken into account. Care plans gave clear directions to staff about the support people required to have their needs met.

People were supported to maintain their health and had access to health services if needed.

People's needs were regularly reviewed and, where necessary, appropriate changes were made to the support people received. People had opportunities to make comments about the service and how it could be improved.

There were effective management arrangements in place. The manager had a good oversight of the service and was aware of areas of practice that needed to be improved. There were systems in place to look at the quality of the service provided and action was taken where shortfalls were identified.

At the time of our inspection 40 people were living in Elm View nursing home. During our inspection we spoke with people living in the home, staff, relatives and examined the care records for people living in the home. We also looked at the home’s quality assurance systems to see how people’s views were gathered through satisfaction surveys.

We looked at people's personal care files to see if their support documentation met their needs. We spoke with eight people who used the service, two relatives and six staff during our inspection.

Overall people's comments were positive about living in the home. Comments included; “It is nice here it’s got to be. If I wasn’t happy I would tell somebody. I’m well cared for”. “It’s ok I suppose. It’s not home no matter what way you look at it”. “I came from another home. They do all they can here for me”. “Good choice of food but sometimes isn’t all that nice. We have had a meeting about it so things should get better”. “We are lucky to live here compared to some people in this world”.

Comments from relatives included; “they are good here, I have the odd niggles sometimes but I will raise them with the manager and they will sort it”. “You can’t beat it here! Staff are wonderful, It's 100% here!”.

Staff we spoke with were knowledgeable of people's care needs and felt they provided a high quality standard of care to everyone that used the service. Staff also felt supported by the management of the home on a day to day basis.