Lady Elsie Finney House Home for Older People is a residential care home offering accommodation and personal care for up to 46 older people who may be living with dementia. The home is divided into three separate areas known as Meadows. Each Meadow has an open plan lounge and dining area plus a smaller lounge. All bedrooms are single and have en-suite facilities. There are enclosed gardens with patio areas and both of the first floor Meadows have large outdoor balconies. At the time of our inspection there were 44 people living at the home.

Lady Elsie Finney House Home for Older People 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.

There is a registered manager at the service. 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.

At our last inspection we found that care plans did not always contain information around identifying and managing risks to people. This was a breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe care and treatment).

We looked at how risks to people were being managed during this inspection. We found people were protected from risks associated with their care because the registered provider had completed risk assessments. These provided updated guidance for staff in order to keep people safe.

During our last inspection we found that although feedback had been gained from people who used the service. There was not always evidence that the feedback had been acted upon. This was a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we looked at the feedback gained and any improvements made in this area. The registered manager told us they encouraged and sought feedback on the service provided from people who lived at the home and relatives. We saw minutes of ‘resident’s meetings’ which had taken place since our last inspection. The provider also used questionnaires to gain people’s views about the service they received. This information was feedback to staff and management in meetings and any actions needed were taken.

At our last inspection we found issues with ‘as and when’ plans for people’s medicines. The MAR chart did not always have the same information as the 'as and when' documentation and variable doses were not always recorded. We made a recommendation about this.

During this inspection we looked at how the service was managing medicines. We found monthly audits were being completed and management had oversight of these. We found protocols for ‘as and when required’ medicines were in place as per the provider’s medicines policy. These protocols were in depth and contained person centred information to guide staff.

At our last inspection we found that some of the training documentation for the staff was inaccurate. We made a recommendation about this. During this inspection we found staff training was on going and evidence was seen of staff completing training. We checked the full training records of four staff and viewed the training matrix for the service. Training subjects included areas which affected the wellbeing of people, such as safeguarding. Staff told us they received adequate training in order to care for people effectively.

The home was clean and tidy however some areas required attention such as carpets and areas of high dust. Audits and daily walk rounds were being completed. However, upon further inspection we found that bath and shower chairs had ingrained dirt

The inspection visit at Lady Elsie Finney House Home for Older People took place on 20 and 21 July 2017. The first day of our inspection visit was unannounced.

Lady Elsie Finney House Home for Older People is a residential care home offering accommodation and personal care for up to 46 older people who may be living with dementia. The home is divided into three separate units known as Meadows. Each Meadow has an open plan lounge and dining area plus a smaller lounge. All bedrooms are single and have en-suite facilities. There are enclosed gardens with patio areas and both of the first floor Meadows have large outdoor balconies. At the time of our inspection there were 43 people living at the home.

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 2008 and associated Regulations about how the service is run.

At the last inspection on 14 November 2014, we found the provider was meeting the requirements of the regulations inspected. However, although people who lived at the home felt there were enough staff to keep them safe, some relatives thought staff were too busy at times to provide effective care. Since we last inspected, staffing levels had been reviewed and increased.

During this inspection, we looked at care plans and guidelines on how to support people safely. We noted one person was identified as having diabetes. A second person was identified as having a history of problematic behaviour. A third person’s care plan stated, ‘Sometimes I am unable to stand.’ However, care plans did not guide staff on managing the risk and did not reflect people’s needs.

We observed powder used to thicken drinks was accessible to people who lived at the home. NHS England had previously raised a nationwide patient safety alert highlighting the risks of choking related to inappropriate storage of these powders. The registered manager was unaware of the alert.

This was a breach of Regulation 12 HSCA (RA) Regulations 2014 (Safe care and treatment).

The registered manager arranged surveys with people who lived at the home. They used a mixture of happy and sad faces to allow people to reflect their views plus they had the option to leave comments. When concerns had been shared the registered manager was unable to show how they analysed, responded and addressed information gathered.

This was a breach of Regulation 17 HSCA (RA) Regulations 2014 (Good governance).

We have made a recommendation about the management of some medicines.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs. We have made a recommendation about the documentation and analysis of staff learning and development.

We found staffing levels were regularly reviewed to ensure people were safe. There was an appropriate skill mix of staff to ensure the needs of people who used the service were met.

Staff had received training around recognising abuse and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who were able told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We found people had access to healthcare

This inspection took place on 14 November 2014 and was unannounced.

The last inspection took place on 16 July 2013 and there were no breaches of regulations found at that time.

The home is registered to accommodate up to 46 people including many who have some form of dementia. At the time of our inspection the home was full.

Lady Elsie Finney House is divided into three separate units. Each unit has an open plan lounge and dining area plus a smaller lounge. Bedrooms are single and have en-suite facilities. There are enclosed gardens with patio areas and one of the units had a large outdoor balcony.

There was a registered manager in place. 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.

All of the people we spoke with and relatives told us they felt safe or that it was a safe service for their relative.

People who lived at the home told us that there were enough staff on duty to keep them safe and meet their needs. However relatives we spoke with raised concerns about staffing levels. We found staffing numbers were not adequate to meet people’s needs. We observed staff completed required tasks in a hurried manner.

Robust recruitment procedures were in place which enabled the service to check on the background of staff before they were allowed to work with vulnerable people.

Staff had been trained to handle medication and records gave detailed information about individuals’ medication requirements. Records and audits were in place which ensured people received their medication in a safe manner.

People we spoke with and their relatives all felt the service was effective. Staff told us they had received sufficient training to perform their role whilst records we looked at confirmed this.

We saw staff at the home involved people and or their relatives in planning care. Policies and procedures were in place and management and staff knew how to protect and involve people who did not have the capacity to make decisions for themselves around their care.

Staff had received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides legal protection for people who may not have the capacity to make some decisions for themselves whilst DoLS provide legal safeguards for such people who may have restrictions placed on them as part of their care plan. We saw evidence that this training had been put into practice.

People who lived at the home were protected from poor nutrition and hydration. People told us that they received enough food and drink. People’s weight was monitored and where problems were highlighted referrals had been made to appropriate professionals.

We observed on the day of our inspection that when required medical assistance was sought promptly and people were appropriately referred on to medical professionals. Which showed people’s on going health needs were met.

Everyone we spoke with told us the staff were caring, kind and responsive to people’s needs. Staff we spoke with showed a genuine affection for the people they supported.

People received a thorough pre admission assessment before they came to live at Lady Elsie Finney Home for older people. This was followed up after admission with further risk assessments and person centred care plans.

People were protected from the risk of isolation. There was no restriction on visiting and relatives had been issued with electronic key fobs which allowed them to come and go at anytime they wished.

We were shown several facilities and amenities available for people to use whilst at the home however on the day we saw no activities taking place. We did see evidence that activities had taken place and people were able to tell us some things they had done or been involved with.

People we spoke with and their relatives had been given information on complaints and knew how to raise issues if they had any. The home had policies and procedures in place to handle complaints and a kept a full log of such incidents and the outcome.

The home demonstrated clear vision and values. The management and staff were interested and committed to supporting people who lived at the home. People we spoke with felt involved with the service and told us the registered manager and staff were available and supportive.

Staff we spoke with told us they felt supported and were able to voice their opinions on the service and raise concerns. The home also made good use of volunteers, many of whom had relatives in the home.

We saw that a full range of checks and audits were completed by the home as well as regional and external auditors to ensure the quality of service provided remained at a high standard or improved where necessary.

The majority of residents were unable to tell us about the care they received. The relatives we spoke with were in the main extremely positive about the standard of care at the home. Relatives told us they were kept informed of important issues and had confidence in the manager and the staff team. Comments included; “This is a very good home.” “Everyone is very kind.” And “I have no complaints."

We spent time observing how staff supported those living at the home. Staff explained what they were doing and offered reassurance to people. In discussions staff showed a good understanding of residents' needs.

Nutritional needs were assessed and support plans guided staff in how to meet any identified needs. The people we spoke with were happy with the meals provided at the home.

People were cared for by staff that had been appropriately recruited and were trained for their role. Checks helped to ensure that only suitable staff were employed at the home. New staff received a good level of support.

There were quality monitoring systems in place. Regular audits and checks were carried out. Risks were identified, monitored and managed.

There was an effective complaints procedure. The relatives we spoke with confirmed they felt able to speak with senior staff if they had any complaint and were confident that it would be dealt with. One relative told us, “Nowhere is perfect and there have been little niggles, but they are quickly sorted.”

We spoke with people living at the home, relatives who were visiting, care staff and the manager.

The majority of residents were unable to give their views about the care they received, however two people were able to confirm that they were happy at the home. The relatives we spoke with were in the main extremely positive about the standard of care experienced by those living at Lady Elsie Finney House.

Relatives confirmed they were kept up to date with any changes and that health issues were well managed. We were told that they had been involved in discussions and review meetings about the care of their relative and that the manager and staff were very friendly and approachable. Comments from relatives included; “the manager is really on the ball” and the staff “couldn’t do any better”.

Care staff told us that they were given good training, had regular staff meetings and individual supervision meetings and that they felt well supported by the manager and other senior staff at the home.

Due to people having varying degrees of communication diffulties we could not obtain their views about how their medicines were being handled.

People we spoke with raised no concerns about the way their medicines were being handled.