Elizabeth House

Elizabeth House is situated in Bognor Regis in West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. Elizabeth House is registered to accommodate 60 people. At the time of the inspection there were 57 people accommodated in one adapted building, over three floors, which were divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. These units provided accommodation for older people, some of whom were living with dementia. There were gardens for people to access and a hairdressing room.

The home had a registered manager. A registered manager is a '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 home is run. The management team consisted of the registered manager, a deputy manager and team leaders. An operations manager also regularly visited and supported the management team.

At the previous inspection on 14 and 17 February 2017 the home received a rating of 'Requires Improvement' and was found to be in breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to inform us of what they would do and by when to improve the key questions of safe and well-led to at least good. This was because there were concerns with regards to the sufficiency and deployment of staff to flexibly meet people's changing needs and ensure their safety. In addition, there were concerns with regards to the completion of records to confirm staff's actions and the failure to action issues that had been identified within audits. At this inspection improvements had been made and the provider was no longer in breach of the regulations. However, we found one area of practice that needed to improve.

The management team and staff had a good understanding of the Deprivation of Liberty Safeguards (DoLS) and had worked in accordance with this. However, although staff gained people's consent before supporting them with day-to-day tasks, there was an inconsistent approach to formally assessing people's capacity and gaining their consent. This is an area of practice identified as being in need of improvement.

The registered manager and staff worked hard to promote a welcoming, inclusive, friendly and lively atmosphere. People told us they were happy living at the home. Without exception, people, relatives and healthcare professionals told us that staff were consistently kind, caring and compassionate and our observations confirmed this. Comments from people were positive. They included, "I like it here very much; the staff are all very kind and attentive". Another person told us, "Yes, the staff here are very kind, they could not be nicer. I am fortunate and do not have any medication or mobility problems, but I can see the amount

of care that is given to some of the other residents. It is wonderful and I know that I would be looked after properly here if ever the time came". People were treated with respect and dignity, their privacy maintained. Independence was promoted and encouraged and people could choose how they spent their time.

The provider had a clear set of values that encompassed a person-centred approach and these values were embedded in the culture and the practices of staff. The provider and management team had good quality assurance processes and audits that monitored the practices of staff and the effectiveness of the systems and processes at the home. Action plans were implemented as a result of audits to ensure that any improvements noted were planned for and completed. The provider, management team and staff, worked with external agencies and professionals and continually reflected on their practice and learned from incidents and occurrences to ensure that the service continually improved.

People received a service that was responsive and centred around their needs. People received timely interventions when they were unwell and had access to medicines to maintain their health. People were supported by external healthcare professionals and there were good links and communication to ensure that people received a coordinated approach to care. One person told us, "Yes, I see the doctor from the local surgery if I need to. I can also see the optician, dentist or chiropodist when I need to. I only have to ask one of the girls".

Staff were had access to learning and development and support from external healthcare professionals to develop their skills and understanding about supporting people living with dementia. People were safe, there were sufficient staff, risks were assessed and managed and people were supported by staff that understood what to do if there were concerns about a person's safety. People were protected by the prevention and control of infection and told us that the home was clean and our observations confirmed this.

The home was designed in such a way to enable people to orientate themselves around the building and enjoy time on their own as well as interact with others. People had meaningful interactions with staff and observations showed that people enjoyed themselves and had opportunities to partake in activities to occupy their time. The registered manager and staff were proactive in sourcing and providing pastimes for people to enjoy such as an interactive television so that people could access the internet to watch old films and listen to music. In addition, one person who enjoyed gardening was provided with a small garden area, tools and a shed. One person told us, "The home has a person to organise things every day. There is a notice board of the programme. They are really good and I usually attend. They are also willing to take suggestions of anything an individual would like to do, so we get a variety of things to enjoy. It works out that there is more than enough to do in the day".

People were involved in the development of care plans and were able to voice their wishes and contribute to a plan of care that was specific to their goals and aspirations. People were involved in decisions that affected their lives at the home. Regular meetings ensured that people were able to express their wishes and preferences. The registered manager welcomed feedback and used this to continually improve the experiences of people. People received good end of life care and were offered the opportunity to plan for this to ensure that their needs and preferences were known.

People told us that they enjoyed the food and were provided with choice. People's hydration and nutritional needs were met. One person told us, "The food here is generally good and they will change the menu for me if I want something different. I have no complaints. The staff will always being me a cup of tea or coffee whenever I want it".

A comment made by one person, summed up people's feedback about their experience living at the home, they told us, "I think this place is perfect, the whole experience".

The five questions we ask about services and what we found