This inspection took place on the 2 and 10 August 2018 and was unannounced. Elmstead Care Home is a ‘care home’. People in care homes receive accommodation and nursing, or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Elmstead Care Home provides accommodation and personal care support for up to 49 older people. The home is situated within the London borough of Bromley and is spread out over three floors. The middle floor has been designed for people living with dementia. Care provided within the home ranges from respite services, day care facilities for people who enjoy socialising or their informal carer is unavailable or requires a break, residential care and dementia and convalescent care for people recovering from surgery or illness. At the time of our inspection there were 39 people living at the service.

The service continued to have a long standing experienced registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager was aware of their legal requirement to display their current CQC rating which we saw was on display within the home and on the provider’s website.

At our last inspection of the service on 5 and 6 July 2016 we rated the service overall as 'Good'. At this inspection we found evidence that not only continued to support the rating of good, but we also found for the key question 'is the service Responsive?' the service had improved to 'Outstanding'. There was no evidence or information from our inspection and on-going monitoring that demonstrated any risks or concerns.

Risk were managed positively in the least restrictive way to protect people from possible harm. Medicines were managed, administered and stored safely. People were protected from the risk of abuse, because staff were aware of the types of abuse and the action to take to ensure peoples safety and well-being. There were systems in place to ensure people were protected from the risk of infection and the home environment was clean and well maintained. Accidents and incidents were recorded, monitored and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff to meet people’s needs in a timely manner.

People’s needs and preferences were met by suitably skilled staff with the right knowledge and experience. There were systems in place to ensure staff were inducted into the service appropriately. Staff received training, supervision and appraisals. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s physical, mental and social needs were holistically assessed before they moved into the home to ensure staff and the home environment could meet their needs safely and appropriately.

The home environment was suitably maintained and adapted to meet people’s needs. People were supported to eat a healthy, well-balanced diet and people told us they enjoyed the meals on offer at the home. People were supported to maintain their health and well-being.

People were proactively supported and encouraged to maintain relationships with people that were important to them. People and their relatives told us that staff were caring. There were well established and affectionate relationships between staff, people and their relatives which was promoted by the stable longstanding staffing team. People were able to express their views, were involved in decisions about their day to day care and were provided with information about th

This inspection took place on 5 and 6 July 2016 and was unannounced. At the last inspection of the service on 1 May 2014 we found the service was meeting all the regulations we looked at.

Elmstead Care Home provides accommodation and personal care support for up to 49 older people. The home is situated within the London borough of Bromley and is spread out over three floors. The middle floor has been designed for people who have dementia. Care provided within the home ranges from respite services, day care facilities, residential, dementia and convalescent care.

At the time of our inspection there were 34 people using the service. There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.

The provider failed to support staff through regular supervision and appraisals of their practice and performance in line with the provider’s policy. Although there were plans in place to address these shortfalls, we were unable to check them at the time of our inspection but will check them at our next inspection of the service. This required improvement.

Risks to the health and safety of people using the service were identified, assessed and reviewed in line with the provider's policy. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies. There were safeguarding adult’s policies and procedures in place to protect people from possible abuse and harm. Accidents and incidents were recorded and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff were deployed throughout the home to meet people’s needs.

There were processes in place to ensure staff new to the home were inducted into the service appropriately. Staff received training that enabled them to fulfil their roles effectively and meet people’s needs. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with respect and were consulted about their care and support needs. Staff respected people’s dignity and privacy. People were supported to maintain relationships with relatives and friends. People’s support needs and risks were identified, assessed and documented within their care plan. People’s needs were reviewed and monitored on a regular basis. People were provided with information on how to make a complaint. The service worked with health and social care professionals to ensure people’s needs were met.

There were systems and processes in place to monitor and evaluate the service provided. People’s views about the service were sought and considered through residents meetings and satisfaction surveys.

We considered our inspection findings to answer questions we always ask providers when we visit to inspect a service; is the service caring, responsive, safe, effective and well led.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and from examining records. If you want to see the detailed evidence supporting our summary please read the full report.

At the time of our inspection there were 34 people residing at Elmstead Residential Home. We used different methods to help us understand the experiences of people who use the service as not everyone who lived at the home was able to communicate verbally with us in a significant way. We used our Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care provided which helps us to understand the experiences of people who could not talk with us.

Is the service caring?

People expressed their views and were involved in making decisions about their care and treatment. People who use the service were given appropriate information and understood the care and support choices available to them. People using the service who we spoke with told us they were very much a part of the planning of their care and had been given choices about their support and how it was delivered. One person told us “I like living here, the staff are great and I am supported to be as independent as possible”. Another person told us “This is the best place. The staff are wonderful and the food is good. I have support when I need it and staff know me well”.

We spoke with relatives and friends of people using the service who visited the home on the day of our inspection. Comments included “The home is lovely”, “It’s always cheerful and friendly here”, “Staff are ready to have a laugh and joke with people to brighten their day” and “The staff and management are great, nothing is too much trouble”. Relatives and friends of people using the service told us they were always kept informed of any changes to their relative’s health and communication with the home was good.

Is the service responsive?

We spoke with the registered manager who told us the home holds residents and relatives meetings every quarter. They said that they discussed all issues related to the home and care provided including the building, housekeeping, catering, activities, care plans and staffing. Records we looked at confirmed this. The registered manager also told us the home produces a quarterly residents and relative’s newsletter which informs them of any news related to the home and up and coming events or days out that the home organises. People we spoke with using the service told us that they found the meetings useful and that they felt involved and included and their views were taken seriously.

Is the service safe?

We spoke with several members of staff. They understood the types of abuse that could occur, the signs they should look for and what to do if they thought someone was at risk of abuse or harm including who to report this to. They told us they had attended training on safeguarding adults from abuse. Staff told us they were aware of the organisations whistle blowing policy and procedures and were able to explain how to use this process. We spoke with the registered manager who told us of the provider’s policy called “Speak Up”. They informed us that this was introduced into the home to enhance staff awareness of safeguarding and whistleblowing.

Is the service effective?

During our tour of the home we visited the middle floor which was designed for people with dementia. We noted there were clear and suitable pictorial signs displayed on walls or above doorways to remind people of which room they were approaching. We saw that memory boxes were being introduced at people’s bedroom doors with familiar things displayed in them like pictures or badges to help remind them of the location of their room.

People were provided with a choice of suitable and nutritious food and drink. Comments from people living at the home about the meals provided included, " You can’t beat the food here it is really first class” and “There is always plenty of it. It is freshly cooked and I always enjoy it ". People told us that when they did not like the meal choice on offer they were provided with an alternative of their choice. During the lunch time meal we observed people being offered alternative meals to those on the menu. One person explained, "Sometimes I don’t always like the choices on offer but staff will always give you something else that you like".

Is the service well-led?

There were effective recruitment and selection processes in place. Staff we spoke with told us they had been recruited by completing an application form and attending an interview where they were asked questions which were relevant to their role and qualifications gained were checked. One person told us “The recruitment process was robust and my induction period was very helpful to me when learning the job”. The registered manager confirmed staff were recruited by an application process followed by an interview using competency based questions.

We spoke with the registered manager who told us that the provider also conducts internal quality reviews called “Quality Metric Reports”. We looked at the last report which was conducted in March 2014. The results of this quality report demonstrated the homes performance against four key themes which included the quality of care, quality of life, quality of leadership and management and quality of the environment. The registered manager explained that the results of these reports would enable them to make necessary improvements to the home and the service provided.

People told us they were happy at the home and enjoyed the activities on offer and one person we spoke with said "I have been happy since I’ve been here and they treat me well". People told us their choices and decisions were respected by staff and they were always asked for their consent. For example, a person we spoke with said "they are very particular about asking and getting my permission for everything, especially pills". We found that there were sufficient staff on duty in the home and people were offered support in a timely manner. People knew how to make a complaint where necessary and felt listened to: a person told us "if I had a complaint, I would speak to a manager- a really nice lady". The premises were well maintained.

However we found that people's individual risk assessments were not all correctly calculated and action was not always taken where risks were identified.

People and their relatives told us the home was a good place to live, and the staff were helpful and treated them well. People said they were happy at the home.