This inspection took place on the 15 and 17 November 2016 and was unannounced.

St Elmo Care Home is registered to provide care for up to 23 people. There were 23 people using the service at the time of our inspection including people living with dementia. The accommodation was spread over two floors.

The home had 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.

Recruitment checks needed to be more robust and include all of the requirements laid out in the Regulations.

People told us they felt safe and staff were aware of the procedure to take if abuse was suspected.

People's needs had been identified and the risks associated with people's care and support had been assessed and managed.

There were enough staff deployed to meet the care and support needs of the people living in the home. The registered manager monitored staffing levels on a monthly basis to ensure appropriate numbers of staff were deployed.

Medicines were stored, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records. The manager regularly audited the medicine records.

The registered manager was knowledgeable about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). When people were assessed as unable to make decisions for themselves the requirements of the MCA 2005 had been followed. DoLS are put in place to protect people where their freedom of movement is restricted to prevent them from possible harm. The registered manager had taken appropriate action for people who needed their movement restricted.

People had sufficient to eat and drink and were supported to maintain a balanced diet. They had access to a range of healthcare professionals and services.

People were looked after by kind and caring staff who knew them well. They were supported to express their views and to be involved in all aspects of their care. People were treated with dignity and respect.

Care records were person-centred and reflected people's needs. People were supported to follow their interests and take part in social activities.

People and their relatives thought that the home was well-led. They all spoke positively about the registered manager, their deputy and the staff team.

There was a robust system of monitoring checks and audits to identify any improvements that needed to be made. The results of these audits were monitored by the management team, who acted on the results to improve the quality of the service and care.

Complaints policies and procedures were in place and were available to people and visitors. Relatives told us they were confident that they could raise concerns or complaints and that these would be dealt with accordingly.

We inspected St Elmo Care Home on 23 April 2014. During that inspection, we considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

We found the service to be effective, caring responsive and well led, however we found that the home was not protected from the risk of infection because some areas of the home had not been cleaned properly. The provider sent us an action plan to demonstrate how they would address the issues found.

On 7 August 2014 we re-inspected St Elmo Care Home to assess whether compliance had been achieved.

This is a summary of what we found-

If you want to see the evidence supporting our summary please read the full report.

We reported on only one of the five questions.

Is the service safe?

We found there were effective systems in place to protect people from the risk of infection.

Further staff training had been provided in relation to infection control and an inspection of the home showed that cleaning schedules were now being completed. We saw that the home was clean.

During our inspection on 21 September 2013 we found there were not always suitable arrangements in place for obtaining consent to care and treatment and that not all systems to manage risk of infection had been completed. The provider prepared an action plan to address the issues identified. We inspected the home on 23 April 2014 to assess whether compliance had been achieved.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People’s care records contained assessments which covered the risks associated with staff providing the care and support they needed. This helped to ensure that people who used the service were safe because staff had taken action to identify and assess the risks to their health and wellbeing.

The registered manager took people’s needs into account and ensured that care workers with the relevant knowledge, skills and experience were scheduled to care for people. This helped to ensure that people’s needs were met.

Recruitment was robust, two references, a full employment history and a Disclosure and Barring (DBS) check were carried out before staff were employed. The provider put actions in place in order to identify staff with appropriate values and match them with people using the service.

Is the service effective?

Arrangements were in place to undertake pre-admission assessments which enabled the service to reach judgements about whether they could effectively meet people’s needs. People and their relatives told us they received the help and support required.

Where people lacked capacity to make decisions about their care, mental capacity assessments were carried out and documented. This meant that the service complied with the requirements of the Mental Capacity Act 2005.

Is the service caring?

People were supported by kind and attentive staff. Staff treated people with dignity and respect.

The service had responded to care needs to ensure that care and support was provided in accordance with peoples wishes.

People we spoke with during the inspection were positive about their care. One person told us, “It’s very good, I’m quite happy, I have no moans.” Another person described the staff as “Lovely.”

Is the service responsive?

Staff and people using the service told us they had not made a formal complaint. Some had raised informal concerns verbally and all felt they were listened to and responded to. Staff told us that meetings were held monthly and they were able to raise concerns openly during these meetings. Staff and people using the service said they would feel comfortable approaching the registered manager if they wanted to raise a concern.

Is the service well led?

The service had a consistent management structure that maintained oversight of the home and provided leadership to the staff team.

The registered manager was able to demonstrate a good knowledge of the needs of people who used the service and their care and support needs.

The service had taken measures to ensure that it had quality assurance systems in place to monitor the quality of the service and identify where improvements could be made.

We found that the provider did not always have suitable arrangements in place to obtain consent from people living at the home in relation to the care and treatment provided for them.

Many of the people had memory loss and were unable to speak to us but we did speak to two people. One person told us the home was "nice". Another person told us they were "happy".

A relative told us "Mum is a wheelchair user and they are very attentive to mum".

We inspected 10 of the bedrooms and all of the communal rooms, kitchen, toilets and bathrooms within the home.

We found that people were not always protected from the risk of infection because not all systems to manage risk had been completed and that some equipment was not clean.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We saw records which evidenced that new staff had received a formal induction which followed the Skills for Care Induction Standards.

We spoke to two relative of people living at the care home. They told us that they knew how to make a complaint and who to complain to but they did not have any complaints.

Before this inspection took place we received information of concern about the home. This was in relation to people being restricted in their movements around the home and a lack of recruitment checks and training being carried out for new staff. We carried out this inspection to follow up on these concerns. We also checked that the home had taken appropriate action in relation to a compliance action we had set at our last inspection in November 2012 about care planning and monitoring of people's needs.

We found that people received care that met their needs and upheld their rights. Care plans and monitoring charts had been improved to ensure it was clear that people were drinking enough to meet their needs. Staff were aware of their responsibilities to monitor people's needs and knew what action to take if they had concerns.

Procedures were in place to keep people safe and ensure they were not restricted unnecessarily in their movements around the home. Staff had a good understanding about abuse and knew how to report concerns about people's welfare. People who used the service and their relatives told us that people were treated well and were safe.

Appropriate recruitment checks were carried out on staff before they started work in the home. Suitable arrangements were in place to ensure all staff received training and support to carry out their work. People told us that staff were "very good" and they had confidence that staff were able to meet their needs.

We spoke with three people who lived in the home and three relatives. They told us that staff treated people with respect and kindness. They also told us that they were involved in decision-making about their care. This helped ensure that people's views influenced the care they received and decisions were made in their best interests.

People had confidence in the care they received from staff. They told us they received personalised care which was reviewed as their needs changed. Care plans were in place to ensure staff knew how to meet people's needs. However, improvements were needed to ensure that one person's care plan was always followed and monitoring of people's fluid intake was effective in identifying potential risks.

The home had procedures in place to ensure that staff understood abuse and knew how to report any concerns. People told us they felt safe in the home and that staff had taken appropriate action to manage risks to their safety and welfare.

People reported that there were enough staff in the home to meet their needs. They told us they received care from a stable staff team who knew them well and had the knowledge and skills to give them effective support. Staff worked flexibly to ensure people received continuity of care and received relevant training to help them understand people's needs.

Appropriate records were maintained about people's care and were kept securely.

We spoke with two people who use the service and they told us that they liked living in the home. The home was “like living in a large family. Everyone here takes care of everyone else.” They told us that members of staff were “always there for you.” One relative told us that members of staff “went out of their way to make my mother feel at home here. She is so happy here. She loves it.”