This unannounced inspection took place on 15 May 2017. We last inspected Elmhurst in November 2015. At that inspection, we found the service was not meeting all the regulations and we asked the provider to take action to make improvements. We issued two requirement notices in relation to levels of staffing and staff deployment and because the quality monitoring systems in use were not being effective.

The registered provider gave us an action plan setting how what they were going to do to improve and the timescales to carry out the improvements. At this inspection 15 May 2017, we found that the requirement notices had been met and the changes and improvements stated in the action plan had been completed.

Elmhurst is a purpose built 40 bedded residential home. It is a single storey building, divided into four 10 bedded units. All bedrooms are for single occupancy and some have en-suite facilities. There are also bathing and showering facilities on each unit. The separate units each have a sitting room with a dining area and kitchenette. There are gardens to the front and rear of the home and some car parking available at the front of the building.

At the time of our visit the home was in the final stages of a major refurbishment programme to modernise and improve the facilities for people living there. The decoration, furniture and facilities have been significantly improved to help in the creation of an environment to support and enable people living with dementia. The home had not taken new admissions during the construction work consequently there were 10 people living in the home at the time of the inspection.

The service had a registered manager in post at the time of this inspection. 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.

We saw that the people who lived at Elmhurst were being well cared for and were comfortable in the home and we observed they were at ease with the staff that were supporting them. The atmosphere within the home was friendly and inclusive. People who lived there told us the staff were “Kind”. We saw examples during the inspection of staff giving people their attention, offering reassurance and displaying empathy.

We found that the home was clean and tidy and the improvements that had been made to the premises we saw were of a high standard. They had been planned and designed to make it as supportive and enabling environment to support the different needs of people living with dementia and to promote their independence.

The staff on duty we spoke to knew the people they were supporting very well and about their lives and personal preferences. Staff were aware of the choices people had made about their care and daily lives.

People confirmed they had a choice of meals and drinks and they told us the food was “Good” and that they enjoyed their meals. Relatives we spoke with told us they were able to see their relatives and there were no restrictions on when they could visit them in their home. People were able to follow their own interests, practice their religious beliefs and see their friends and families as they wanted and to go out into the community with support.

Systems were in place for the recruitment of staff, for their induction and their on-going training and development. Staff told us they had received training in safeguarding adults and the training records confirmed this. Staff we spoke with knew the appropriate action to take if they believed someone was at risk of abuse. The staff we spoke with were confident that the registered manager would follow up any concerns about people’s safety and take action promptly.

The registered manager had a system to calculate dependency and staffing need

This unannounced inspection took place on 24 November 2015. We last inspected Elmhurst in November 2013. At that inspection we found the service was meeting all the regulations that we assessed.

Elmhurst is a purpose built 40 bedded residential home. It is a single storey building, divided into four 10 bedded units, three of which are dedicated to supporting people living with dementia. All bedrooms are for single occupancy and some have en-suite facilities and there are bathing and showering facilities on each unit. The separate units each have a sitting room with a dining area and kitchenette. There are gardens to the front and rear of the home and some car parking available at the front of the building. At the time of our visit there were 30 people living in the home.

One of the 10 bedded units was not in use by people living there as work was being carried out to resolve a drainage problem. We saw during the inspection that the access door from the occupied unit was padlocked on the outside to prevent access.

The service had a registered manager in post. 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 and associated Regulations about how the service is run.

We found at this inspection there was a breach of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there was not clear evidence that the staffing levels and range of staff skills required within the home to meet people’s needs were being systematically assessed. This was to make sure staffing levels could be adjusted to make sure people were always supported in accordance with their needs and preferences.

There was also a breach of Regulation 17(Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014). This was because the systems for the monitoring of the quality of the service had not been effective in some instances

The people we spoke with living at Elmhurst and their relatives made positive comments about their home. They told us that the care staff were “kind” and “Very nice”. Care staff knew how to protect people’s privacy and we observed this in practice.

We spent time with people on all the units during the day. We saw that the day staff offered people assistance and took up the opportunities they had to interact with them and offered reassurance if needed.

The registered provider had systems in place to make sure people living there were protected from abuse and avoidable harm. The staff we spoke with were aware of their responsibilities in protecting people from harm or abuse.

They service had safe systems for the recruitment of staff to make sure the staff taken on were suited to working there. We saw that care staff had received induction training and on going training and development and had regular supervision and annual appraisal.

We saw that people could move freely around their units and there was signage in place to support people living with dementia to orientate themselves.

Medicines were being safely administered and stored and we saw that accurate records were kept of medicines received and disposed of so they could be accounted for.

We made a recommendation to look at best practice in relation to providing evidence of who holds Power of Attorney (PoA) for individuals to help ensure that the right people had been involved in the review of DNACPR forms and decisions.

We made a recommendation that guidance was sought on care management and records to support person centred care. This is so that staff have a consistently clear picture of events and personal care needs in the care plan to refer to and work from.

You can see what action we told the provider to take at the back of the full ve