The inspection took place on 26 and 27 July 2016. The inspection was unannounced.

Elvy Court nursing home was registered to provide nursing and personal care services for up to 55 people. There were 53 people living at the home on the day of our inspection.

Elvy Court nursing home was a purpose built home with nice gardens and a parking area at the front. There were two floors in the home providing nursing care to older people with varying needs. People with complex general nursing needs were cared for on the ground floor and people living with dementia were cared for on the first floor. All rooms had en suite toilet and vanity basin facilities. The entrance and reception area was light and airy with a ‘bistro’ offering a hot drinks machine and tables and chairs with easy access for people and visitors. There were various seating areas around the home, with some areas designed to be ‘quiet’ lounges. A spacious lounge on the ground floor led out onto a large, very pleasant private garden where people could sit when the weather was fine.

We last inspected the service on 15 June 2015. We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to Regulation 10, Dignity and respect; Regulation 11, Need for consent; Regulation 12, Safe care and treatment; Regulation 17, Good governance and Regulation 18, Staffing. Following the inspection the provider sent us an action plan to show how they intended to improve the service and meet the requirements of the regulations.

At this inspection we found that the provider had taken action to address the breaches from the previous inspection and had made many improvements to the environment and the service provided. However there continued to be areas for concern around the safe management of people’s medicines. We made a recommendation about this.

There was a registered manager based at the service who had taken her post after the last 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.

People and their relatives told us they felt safe living at the home. They told us who they would speak to if they were worried about anything and were confident they would be listened to. We spoke to staff who were able to tell us how they kept people safe. They understood their responsibilities in ensuring people were safe from abuse and their role in reporting any concerns they had.

There were suitable numbers of staff to be able to provide the nursing and personal care people had been assessed as needing. Registered nurses were employed to provide the professional expertise required to respond to people’s often complex care needs. Care staff were not expected to undertake cleaning or cooking duties as experienced chefs and domestic staff were employed. This meant care staff concentrated on providing the care people required. Safe recruitment processes were used when employing new staff to make sure only suitable staff were employed to work with people.

The registered manager had a training plan in place and all staff received the training they required to carry out their role well. The registered nurses were supported by the provider to undertake training to ensure their professional development continued in order to keep their registration up to date.

People’s nursing and care needs were assessed before moving into the home by the registered manager and nurses to make sure they were able to cater for their individual needs. Following assessment, the nurses developed a care plan to record how to provide person centred care, taking into account people’s individual preferences and choices. We found that some care plans, particularly fo

This inspection was carried out on 15 June 2015. The inspection was unannounced.

Elvy Court is registered to provide Accommodation and nursing care for up to 55 older people, including people living with dementia. Accommodation was provided on two floors, with a passenger lift providing easy access between floors. People had a variety of complex needs including dementia, mental and physical health needs.

The service had a registered manager. 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 2014 and associated Regulations about how the service is run.

Avery Homes (Nelson) Limited took over the provision of regulated activities at Elvy Court Nursing Home in November 2014. This was our first inspection of the service under the new provider.

Avery Homes (Nelson)

Before our inspection we received information of concern from the local authority safeguarding team, a member of the public and a whistle blower. During our inspection most people made complimentary comments about the service they received. People told us they felt safe and well looked after. However, our own observations and the records we looked at did not always match the positive descriptions people had given us. There were mixed views from relatives about the service.

Systems to assess, monitor and improve the quality and safety of the service or identify and manage all the risks to people’s safety were not effective. Where shortfalls were identified during audits by the manager, action was not taken in a timely manner to improve the quality of the service. Staff understood how to safeguarded people from abuse.

People did not always receive their medicines as prescribed. Medicines were not always stored securely to ensure people’s safety.

People’s privacy and dignity was not respected because bedroom doors were left open throughout the home when people were in bed or in their rooms. There was no evidence that people were consulted about this practice.

People and their relatives felt there were not enough staff deployed in the service. People were left unsupervised for periods of time in communal areas. The provider did not have a clear system to assess how many staff were required to meet people’s needs and to arrange for enough staff to be on duty at all times.

People and their relatives were involved in planning their care. Care plans were personalised to make sure staff knew how to care for people’s physical, emotional and social needs. People were provided with opportunities to take part in a range of activities. Care plans were reviewed and updated regularly to make sure staff had up to date guidance about how to care for each person.

Staff felt well supported by the management team. New staff received induction training. All staff had essential training and opportunities for additional training. Each member of staff had an annual appraisal to assess their performance and any further training needs. Staff told us they received regular supervision.

People were complimentary about the food and were provided with enough to eat and drink. Choices of menu were offered each day. Some improvement was needed at mealtimes to make sure people were offered choices in ways they could understand and had as much control as possible over the content of their meals and portion sizes. We have made a recommendation about this.

There was a system for managing complaints about the service. People felt they were listened to and knew who to talk to if they were unhappy about any aspect of the service.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Guidance in the Mental Capacity Act 2005 was not always followed to make sure people were safe when they made decisions that were not in their best interest.

Staff were kind and caring in their approach and had a good rapport with people. The atmosphere in the home was calm and relaxed and there were lots of smiles and laughter.

People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time and were complimentary about the care their relatives received. People were consulted through residents and relative’s meetings and their views taken into account in the way the service was run.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.