Elm Tree House is a residential care home for eight people with learning disabilities or autistic spectrum disorders. At the time of the inspection, six people were living there. The home had been renovated and re-decorated and communal areas included a lounge, dining room and kitchen with a seating area. People had access to a secure garden.

There was a registered manager in post. 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, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good.

People were protected from abuse because staff understood how to keep them safe, including more senior staff understanding the processes they should follow if an allegation of abuse was made. All staff informed us concerns would be followed up if they were raised. People received their medicines safely. There were enough suitable staff to meet people’s needs. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others.

Staff received training to ensure they had the skills and knowledge required to effectively support people. People were supported to eat and drink according to their likes and dislikes. People who lacked capacity had decisions made in line with current legislation. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

We observed that staff were kind and patient. People were involved in decisions about the care and support they received. People received care and support which ensured they were able to make choices about their day to day lives.

People were supported to engage in activity programmes. People knew how to complain and there were a range of opportunities for them to raise concerns with the registered manager and designated staff.

Further information is in the detailed findings below

This inspection took place on the 7 November 2015 and was unannounced. When the service was last inspected in April 2014 there were no breaches of the legal requirements identified.

Elm Tree House is registered to provide care and support for up to eight people with a learning disability. At the time of our inspection there were eight people living at the home. On the day of our visit three people were staying with their parents for the weekend.

A registered manager was in post at the time of 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’s rights were being upheld in line with the Mental Capacity Act 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. We saw information in people’s support plans about mental capacity and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been applied for appropriately. These safeguards aim to protect people living in homes from being inappropriately deprived of their liberty

People had their physical and mental health needs monitored. All care records that we viewed showed people had access to healthcare professionals according to their specific needs.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.

Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely. Staff we spoke with felt the staffing level was appropriate. People were supported with their medicines by staff and people had their medicines when they needed them.

People received effective care from the staff that supported them. We received positive comments from relatives we spoke with about the staff. One relative commented; “The deputy manager is great. She’s just the type of person x needs. X likes a good laugh and x is happy.”

Staff were caring towards people and there was a good relationship between people and staff. People and their representatives were involved in the planning of their care and support. Staff demonstrated and in-depth understanding of the needs and preferences of the people they cared for.

Support provided to people met their needs. Supporting records highlighted personalised information about what was important to people and how to support them. People were involved in activities of their choice.

There were systems in place to assess, monitor and improve the quality and safety of the service.  Arrangements were also in place for obtaining people’s feedback about the service.

We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by staff. People told us that staff treated them well. People were cared for by staff who were aware of the risks to people's safety and health and staff knew how to support them in a safe way.

People were protected from the risks associated with medicines. There were systems in place to ensure the safe storage and administration of medicines.

Systems were in place to make sure the manager and staff learn from events such as accidents, incidents and complaints. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This means that people will be safeguarded as required.

Is the service effective?

People told us that they were happy with the care they received and that their care needs were met. It was clear from observations and from speaking with staff that they had a good understanding of people's care and support needs. One person told us, "I have regular keyworker meetings and staff provide the care I need”. Staff had received training to meet the needs of the people living in the home.

Is the service caring?

People were supported by kind and respectful staff. We saw that staff showed patience and compassion when supporting people. People told us that they could do the things they enjoyed. Our observations confirmed this. One person told us, "Staff treat me very well, they are kind.” Staff told us they were able to provide the care that people needed.

People using the service, their relatives and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

Is the service responsive?

People's needs were reviewed regularly and in response to any changing needs. We saw information in people’s records which indicated they had been consulted over the care they received. This meant that information about people’s preferences were gathered and used to plan care to meet their specific needs. People were supported to maintain relationships with people that were important to them.

The service worked well with health and social care professionals and services to make sure people received their care in a joined up way.

Is the service well led?

The service had a quality assurance system and records we saw showed that the registered manager monitored people's care needs and the care provided. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

As part of our inspection we spoke with four people who used the service, one relative and one social care professional. In addition we spoke with six members of staff who held various roles at Elm Tree House.

We also observed the support provided by staff and checked a sample of records.

On the day of our inspection there were eight people living at Elm Tree House.

Some of the people who were using the service were not able to communicate with us verbally. They shared their views through gestures, facial expressions and body language wherever possible.

We observed that the service was run as an ordinary household. The people who used the service had an active role in daily activities and we observed some of them helping out in the kitchen to prepare their meals as part of an independent lifestyle.

We saw people who lived in the house were supported by six members of staff. We spoke with four people individually. They told us they were happy at Elm Tree House. Comments made included, "I am happy here, they look after me well" if I have any complaints I will tell the manager and my keyworker”.

We found systems were in place to ensure people were safeguarded from abuse.

We found the environment was clean and adequately maintained.

We found staff were trained and supported to deliver care to an appropriate standard.

We found the provider had an effective system in place to monitor the quality of the service to ensure people received safe care.

On the day of our inspection eight people were living in the home and three people were present during our inspection. We looked at the care records of four people living in the home to determine how people were being supported. We observed the support being provided and spoke with members of staff that were on duty.

People told us they had regular house meetings called “your voice” where they could raise any concerns. People told us they were asked their opinions on activities, food and decoration of the home. They told us that the manager told them about any staff changes during the meeting.

People commented on the choices that they had and what they enjoyed doing such as "I go to college” I go home sometimes” “I go to clubs”. One person told us “I help to tidy up

We spoke with three people who use the service who gave us positive comments on their experience of living at Elm Tree House. They commented on the choices that they have and what they enjoy doing such as “I go to college where I make new friends” and “the best thing about living here is my key worker who takes me shopping and we went on holiday to Butlins”.

We spoke with people who use the service who told us that “if I wasn’t happy I would tell the manager as she is in charge”. Others told is about their activities and outings which include, “I go to the pub with the staff”, and “I went on holiday with my key worker and I go to the pictures with him”. Two of the people who we spoke with told us “I have a meeting with my key worker, my mum and my social worker”.

We found that people we spoke with knew their key worker and had built up a good relationship with them. Telling us “I go shopping with my key worker into Bristol”.

People who use the service that we spoke with told us I feel safe here, sometimes people can shout, but I tell the manager or person in charge” and “Staff talk nicely they don’t shout”.

We reviewed the care plans for three people who use the service and saw that they were person centred with each care aspect including likes and dislikes and detail on peoples behaviour, goals and aspirations, hobbies and finances. Clear guidance on the support people require both with personal care and emotional support was also documented along with triggers which may prompt negative behaviours.