About the service: Elm House is a residential care home that provides accommodation and personal care for people with learning difficulties and mental health. At the time of the inspection, five people were living at the service. Elm house is a mid-terrace property with people’s bedrooms over three floors. There is a garden at the rear of the property which people had access to.

People’s experience of using this service: People that we spoke with told us that they were happy living at Elm House. Where people were unable to communicate verbally we observed positive interactions between staff and people. A relative that we spoke with was positive about the progress their relative had made since moving into the home. Staff knew people well and supported people to be as independent as possible.

People were supported by staff that knew them well and there were always regular staff on duty. This ensured that people felt comfortable and were able to build rapport with staff. Staff understood how to keep people safe and report any concerns. Risks to people’s safety was recognised and management plans were in place to guide staff appropriately. Medicines were safely managed and people were actively encouraged to understand their medicines.

People’s needs were assessed in line with current legislation. People were involved in choosing the home and where they were able, had input into the pre-assessment. Staff understood the principles of the Mental Capacity Act (2005) and how this impacted on the care that was provided. People were encouraged to make decisions about their care where possible. Nobody living at the service had been unlawfully deprived of their liberty. People could choose the food that they wanted to eat and there was a varied menu available.

The home actively supported staff understanding around equality, dignity and respect. Staff had access to up-to-date information around people’s rights. People, staff and relatives were involved in understanding dignity in care and the home had held several events to promote this.

People received person centred care and people’s care records supported this. Staff understood that each person was different and this was reflected in records, observations and discussions with care staff. There were systems in place for people and relatives to complain. People were actively informed of the complaints process in residents’ meetings.

There were systems in place to look at how the home was being managed. Various audit were completed to monitor the home and where areas for improvement were identified, action plans were completed to address this. The registered manager was visible around the home and people knew who she was and appeared comfortable approaching her. Staff were positive about the support they received from the management and there were various ways for staff to feedback to the registered manager and senior management.

More information is in the detailed findings below.

Rating at last inspection: Good (report published in September 2016)

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place over two days on 28 July and 1 August 2016 and was unannounced. At our last inspection on 6 November 2015 we found that the provider was not meeting all the standards that we inspected. We identified a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Care and treatment for people was not being provided safely. Risk assessments to identify and mitigate one significant risk to people were not in place. At this inspection we found that the provider had addressed these concerns.

The home 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.

The home is registered to provide care and support for five people with mental health issues and learning disabilities. On the day our inspection there were four people using the service.

People told us that they felt safe within the home and well supported by staff. We saw positive and friendly interactions between staff and people.

Staff understood people’s individual needs in relation to their care. People were treated with dignity and respect.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report it to if people were at risk of harm.

Staff had an understanding of the systems in place to protect people who could not make decisions and were aware of the legal requirements outlined in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

Care plans were person centred and reflected individual’s preferences. There were regular recorded keyworking sessions. There were focused keyworking session that looked at specific aspects of an individual’s care. People were involved in writing their care plans and risk assessments and were able to express their care needs.

People were supported to have their medicines safely and on time. There were records of medicines audits and staff had completed training on medicine administration. The home had a clear policy on administration of medicine which was accessible to all staff.

People’s views on how the service was run were listened to. There were regular residents meetings that allowed people to have their views and opinions heard.

People were supported to maintain a healthy lifestyle and had healthcare appointments that met their needs. Staff were aware of how to refer people to healthcare professionals when necessary. There were records of appointments and reviews in people's files.

Staff training was updated regularly and monitored by the registered manager. Staff had regular supervision and annual appraisals that helped identify training needs and improve the quality of care.

People were supported to have enough to eat and drink. People were encouraged and supported to cook and plan their meals.

There was a complaints procedure as well as an accident and incident reporting system. Where the need for improvements was identified, the manager used this as an opportunity for learning and to improve care practices where necessary.

There were regular health and safety audits and monthly medicines audits. These allowed the provider to ensure that issues were identified and addressed. The provider undertook comprehensive six monthly audits that looked at all aspects of care provided and how it was managed by the home.

There were systems in place to identify maintenance issues. Staff were aware of how to report and follow up maintenance.

There was an open atmosphere within the home. The management encouraged a culture of learning and staff development.

This inspection took place on 6 November 2015. The home opened in June 2015 and had not been inspected before.

The home 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.

The home is registered to provide care and support for five people with mental health issues and learning disabilities. On the day our inspection there were three people using the service.

People told us that they felt safe within the home and well supported by staff. We saw positive and friendly interactions between staff and people. People were treated with dignity and respect.

Procedures relating to safeguarding people from harm were in place. However, not all staff understood what to do and who to report it to if people were at risk of harm. Staff had received training in the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS), although some staff were unable to explain how this would impact on people when we spoke with them. There are concerns around how management ensure that staff understand training they have received.

Risk assessments were detailed and gave guidance on how to mitigate risk in the least restrictive way. However, we saw that one risk had not been mitigated against. This put people at risk of harm. Following the inspection, we spoke with the registered manager to discuss this issue. The registered manager told us that he would address the problem as soon as possible.

Care plans were person centred and reflected individuals preferences. There were regular recorded keyworking sessions.

People told us that they felt safe within the home. Relatives said that they felt their loved ones were safe. People were well supported by staff who had the necessary skills. Staff received on-going training and support from the manager. People were treated with respect and dignity and relaxed around staff.

People were supported to maintain a healthy lifestyle and had healthcare appointments that met their needs. Staff were aware of how to refer people to healthcare professionals when necessary. There were records of appointments and reviews in people's files.

People were supported to have enough to eat and drink. People had individual weekly menu plans and staff supported people to prepare their own food.

People were supported to have their medicines safely and on time. There were records of medicines audits and staff had completed training on medicine administration. The home had a clear policy on administration of medicine which was accessible to all staff.

There was a complaints procedure as well as an accident and incident reporting. Where the need for improvements were identified, the manager used this as an opportunity for learning and to improve care practices where necessary. There was evidence of audits around medicines and health and safety which helped identify areas for improvement or good practice.

We were saw that there was an open culture within the home and this was reflected by the staff. Staff felt safe and comfortable raising concerns with the manager and felt that they would be listened to.