This inspection took place on 22 August 2017. We gave the service 48 hours' notice of the inspection because the manager is often out of the service supporting people to attend medical appointments. We needed to be sure that they would be in.

The last inspection took place on 18 and 20 March 2015 and we rated the service as ‘Good.’ We found the service was exceptionally responsive and rated this domain as ‘Outstanding.’ However, at this inspection we found some action was needed to ensure a nominated individual was appointed. A nominated individual represents the provider and has responsibility for supervising the way that the regulated activity is managed. Following our last inspection this was rectified and a nominated individual was appointed.

Elpha Lodge Residential Care Home provides accommodation for up to 24 people. The service specialises in caring for people who have acquired brain injuries or degenerative diseases, and who, as a result, require assistance with personal care. The service consisted of a converted church and a newer purpose built bungalow. The bungalow was known as Sydney House. We will refer to the service as Elpha Lodge Residential Care Home throughout the report because Sydney House is registered as part of Elpha Lodge Residential Care Home. There were 19 people in receipt of care from the service at the time of our inspection.

There was a registered manager in post at the time of our inspection who had held this post for the last 20 years. 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.

Staff at Elpha Lodge Residential Care Home had worked collaboratively with people to assist them to ensure their voices were heard by healthcare professionals. Staff went over and above the expectations for residential care homes in order to ensure people had equity of access to healthcare and would vigorously assert the rights of people to good care and treatment. The GP and community healthcare staff we spoke with discussed how the tenacity of staff to advocate on behalf of the people and their dedication to the people who used the service had improved their quality of life. The GP, district nurse and wheelchair services staff discussed how they worked closely with the staff from Elpha Lodge Residential Care Home and had formed a strong working relationship. We also heard how staff had worked with hospital staff when people had needed to be admitted to hospital, to ensure the continuity of their care and demonstrate how medical devices were used.

The service was making a difference to people’s wellbeing by working well as a team, in harmony with one another sharing the same values and principles. The service was proactive in providing people with a range of information to assist them to make decisions about their health and wellbeing. Staff worked with health and social care professionals in ways that benefited people and had supported individuals to improve their general health. Also staff supported people to pay remembrance to their loved ones and took people to visit their graves as and when they wanted.

We found staff had formed strong therapeutic bonds between them, people who used the service and their relatives. The nature of many people’s degenerative conditions meant family members could be genetically predisposed to develop this health condition. People told us how a number of their relatives had, over the years, used Elpha Lodge Residential Care Homes for respite and long-term care. All felt this had been very beneficial. People told us that if not for the care and support their relatives had received they believed they would not still be around. Also we heard how the skilled interventions of staff had enabled peop

People told us they were happy living at Elpha Lodge Residential Care Home. One person said, "All the staff are really friendly. They help us straight away. They are smashing people, they are like family!" Another person told us, "It's champion here, we are well looked after and if we need a doctor or anything they get one." Another comment made was, "The food's great!"

We found that people's care needs were assessed and their care and treatment was planned. Where necessary, external healthcare professionals had been consulted about people's care needs.

We looked at how the home managed medicines and found there were appropriate arrangements in place for the safe administration, recording, obtaining, handling, storage and disposal of medicines.

We saw that people had enough equipment available to enable them to maintain their independence as much as possible and this equipment was suitably maintained.

The records held in relation to people's care and treatment were suitably maintained in order to ensure that their care needs were met and their health and welfare promoted. Other records related to staff and to the management of the service were also well maintained.

However, we found that there were shortfalls in relation to the safety and suitability of premises, and as a result, people, staff and visitors were not protected against the associated risks.

People told us they were happy with the care and support they received at Elpha Lodge Residential Care Home. One person said, "The care is no bother. You can ask for anything and you get it. If I need help they (staff) come." Another person said, "The care is very good. The staff are good and there is a relaxing atmosphere."

People told us their consent was gained prior to care being delivered and we found that staff acted in accordance with their wishes. We found that the provider acted in accordance with legal requirements if people did not have the capacity to consent themselves.

We found that people's care and support needs were appropriately assessed and their care was planned. They received care safely, and to an appropriate standard.

There were enough suitably skilled and qualified staff on duty to met people's needs safely and appropriately.

We saw the provider had a complaints policy and procedure in place and people told us they were confident the manager would deal with any complaints they raised.

However, although people who received care and support from this service told us they were happy, and we saw they were well supported, we found that shortfalls in the management of infection control, may put people's safety at risk.

We spoke with people who use the service and with relatives. Two of the people we spoke with said they were aware they had a care plan. They told us they were happy with the way staff discussed the contents with them when any changes were made. One person we spoke with said he had been "very impressed by the care he was given”. Another person said she was involved in the process of assessing her needs and felt the staff at the home had got to know her extremely well. Relatives we spoke with said they felt able to speak up if things needed changing and the manager and staff do listen. People living in the home were asked about the food and the responses were very positive. One said "it's lovely and I get what I like" another said “more than enough food to eat here”. People said they liked how the manager knows all of their names, and the care staff always made sure any concerns were passed to the senior staff members if they could not resolve it easily themselves. One said they were "happy any problems would be sorted out" and any complaint or concern would be taken seriously by the service. No one we spoke with had needed to use the complaint process.

This inspection took place on 18 and 20 March 2015 and was announced. The provider was given 48 hours’ notice of the inspection because both the registered manager and people who lived in the home were often out in the local community. We needed to be sure that they would be in the home at the time of the inspection.

We inspected the home in January 2014 and found they were not meeting one regulation relating to the safety of the premises. We carried out a review in March 2014 and found that improvements had been made and the provider was now meeting this regulation.

Elpha Lodge Residential Care Home provides accommodation for up to 24 people. The service specialises in caring for people who have acquired brain injuries or degenerative diseases, and who, as a result, require assistance with personal care. There were 20 people living at the home at the time of our inspection.

The home consisted of a converted church and a newer purpose built bungalow. The bungalow was known as Sydney House. There were 11 people living in the converted church building and nine in Sydney House. We will refer to the service as Elpha Lodge Residential Care Home throughout the report [with the exception of the safe domain] because Sydney House is registered as part of Elpha Lodge Residential Care Home.

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 and associated regulations about how the service is run.

People, relatives and health and social care professionals spoke positively about the service. One social worker said, “I think it’s an outstanding home in an all-round point of view.” A care manager from the local NHS Trust said, “They are outstanding in every way, I have no concerns.”

People told us they felt safe. Staff knew what action to take if abuse was suspected. We spoke with one care manager from the local NHS Trust. She told us, “This is one care home that I can honestly and confidently say I have no concerns about.”

We saw that Sydney House was clean and well maintained however; the converted church building was showing signs of wear and tear. There was a robust system in place for the receipt, storage, administration and disposal of medicines.

People, staff and relatives told us there were enough staff to meet people’s needs. This was confirmed by our own observations. Many of the staff had worked at Elpha Lodge Residential Care Home for a considerable number of years. We saw that safe recruitment procedures were followed. The manager was in the process of renewing DBS checks for all staff. Staff informed us that there was plenty of training available. This was confirmed by staff training records which we viewed.

People told us they were happy with the meals provided. We saw that people were provided with a nutritious diet and supported to be independent with eating and drinking.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. Most people who lived at the home had the capacity to make decisions about all aspects of their lives. The local authority had approved two DoLS applications following the completion of mental capacity assessments by the local NHS Trust.

People, relatives and health and social care professionals told us that there was a positive atmosphere at the service. We saw there was a close bond between people and staff. One care manager from the local NHS Trust said, “It’s everyone’s home.” All of the people we spoke with told us that staff were caring. A member of the Rotary Club said, “I would say it is outstanding” and “They [staff] put their hearts and souls into it.”

The service was tailored to meet the individual needs of people who lived there. There was an emphasis on meeting people’s social needs and ensuring that people maintained their hobbies and interests.

There was a complaints procedure in place. The manager told us that no complaints had been received. There were a number of feedback mechanisms in place to obtain the views of people, relatives and staff. These included meetings and surveys.

The nominated individual was not currently monitoring the service because of an ongoing investigation. A nominated individual represents the provider and has responsibility for supervising the way that the regulated activity is managed. We had requested that an interim nominated individual be appointed eight months ago; however no interim nominated individual has been appointed.

We had no concerns about the registered manager or her leadership; we considered however, the absence of an active nominated individual needed to be resolved promptly, to ensure that clear and transparent processes were in place for all staff to account for their decisions, actions, behaviours and performance.