We carried out an inspection of Elms House on 17 and 18 May 2018. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and we looked at both during this inspection. Elms House supports up to six people with a learning disability or autistic spectrum disorder. Nursing care is not provided. At the time of our inspection six people were living at the home.

At the last inspection, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Records showed that staff had been recruited safely and the staff we spoke with were aware of how to safeguard adults at risk. People’s medicines were managed safely.

People living at the service and their relatives were happy with staffing levels. They felt that staff had the knowledge and skills to meet people’s needs.

People told us staff at the home were kind and caring. They told us staff provided them with support when they needed it.

People told us staff respected their right to privacy and dignity and encouraged them to be as independent as they could be. We observed this during the inspection.

Staff received an effective induction and appropriate training when they joined the service. Some staff training had net been updated for some time. We discussed this with the deputy manager and relevant training was updated shortly after our inspection.

People received support with eating and drinking and their healthcare needs were met. Appropriate referrals were made to community health and social care professionals, to ensure that people received appropriate support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice. Where people lacked the capacity to make decisions about their care, the service had taken appropriate action in line with the Mental Capacity Act 2005.

People told us that they received care that reflected their needs, risks and preferences and we found evidence of this. People were regularly supported to take part in a variety of activities in the home and the community. People told us they were happy with the activities available.

Staff communicated effectively with people. They supported people sensitively and did not rush them. People’s communication needs were identified and relevant support was provided, such as information in audio format.

People who lived at the home and their relatives were happy with how the service was being managed. They found the manager and the deputy approachable and supportive. They told us any concerns were resolved quickly. Staff were happy working at the home and felt well supported by the manager and deputy manager.

A variety of audits of quality and safety were completed by the manager and deputy manager regularly. We found the audits completed were effective in ensuring that appropriate levels of quality and safety were maintained at the service. Staffing training had not previously been audited, however, the deputy manager told us this would be included in future audits.

The manager sought feedback from people living at the home through regular service user meetings. We saw evidence that people’s suggestions were acted upon and used to improve the service.

Further information is in the detailed findings below.

The inspection took place on 20 February 2016 and was unannounced. At our previous inspection in June 2014 we found that the provider was meeting the regulations in relation to the outcomes we inspected.

Elms House is a long established care home in Clitheroe that is registered to provide accommodation, personal care and support for up to six people with learning disabilities.

The home has 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 manager was available for part of the inspection and engaged positively with the inspection process. The manager was friendly and approachable; she operated an open door policy for people using the service, staff and visitors.

We found that care was provided by a long term staff group in an environment which was friendly and homely.

People told us they felt safe at Elms House. They told us it was like living with a family and we saw people were settled, relaxed and comfortable living there. The relationships we saw were caring, respectful and dignified and the atmosphere was one of calm and comfort.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act were met. People’s capacity to make decisions was kept under review and the registered manager was aware of actions that would need to be taken where people had reduced capacity.

Staff members had developed good relationships with people living at the home and care plans clearly identified people’s needs, which ensured people received the care they wanted in the way they preferred.

Staff understood their responsibilities with regard to safeguarding people, and people were supported by sufficient numbers of staff. The staff team had seen little change for several years which helped people to receive consistent care from people who knew them well.

People told us they liked the food and had a good choice available to them. People told us that they had been involved in choosing the meals and they were encouraged to make healthy choices.

Medicines were stored and administered safely. Staff had received training in the medicines they were giving to people and the systems were regularly audited to make sure safe practice was maintained.

Each person had a care plan which detailed their choices and preferences in relation to their care. Plans reflected people’s wishes, skills and aspirations as well as areas in which they needed support. People followed an active programme of individual activities. One person told us they enjoyed their daily life so much they “never ever wanted to leave”.

Staff told us they worked well as a team and there were clear lines of authority within the management structure. Staff said the registered manager “knew her stuff” and was very supportive and cared deeply for the staff and the people who lived in the home.

The complaints policy was clearly visible at the entrance to the home and people told us they knew what to do if they ever needed to complain.

The registered manager undertook audits of safety and practice at the home and there were other quality assurance systems such as staff and residents meetings and questionnaires. We saw that the registered manager was in the process of refining the staff rota to ensure staff knew what hours they would be required to work for the month ahead. Records were generally well maintained.

The premises were homely and maintained and adapted where required. People had their own bedrooms which they could personalise as they wished. People told us they were involved in keeping their own rooms clean and tidy.

During the inspection we spoke with four people who used the service, the manager/owner and two members of staff. 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:

Is the service safe?

Risks to peoples’ wellbeing and safety had been identified and managed, taking account of enabling their choices and their right to take risks.

Staff recruitment practices were in place to protect people from unsuitable staff. However, progress was needed to make sure gaps in employment histories are always checked and clarified.

Is the service effective?

People were involved in discussions about support and their on-going reviews. Arrangements were in place for people to consent and agree to their care and support. However, progress was needed on assessing peoples’ capacity and ensuring staff provide support in people’s best interests.

People told us they were satisfied with the quality and variety of the meals at Elms House. They said, “The food is good” and “We can choose meals, there’s some flexibly”.

Processes were in place for staff to attain nationally recognised qualifications in health and social care. Staff spoken with, told us of the training they had received. They were aware of people’s needs and gave examples of how they delivered support.

Is the service caring?

People spoken with told us they were satisfied with care and support they experienced Elms House. They told us, “Everything is okay” and “I like living here”.

During the inspection we observed staff sensitively supporting people with their chosen activities and support needs. People told us they were happy with the staff team. They said, “The staff here are okay” and “The staff are good to get on with”.

Is the service responsive?

Arrangements were in place to assess and review people's needs and abilities. This meant their individual needs and choices were considered and planned for.

We found people were supported to undertake chosen activities both in the home and in the local community. People were getting support with routine heath checks and healthcare appointments.

Is the service well-led?

The service had a registered manager/owner responsible for the day to day management of the home.

We found people were involved with decisions which affected them informally on a daily basis. Residents meetings were held and people had been invited to complete satisfaction surveys for their views in the service.

There were some systems in place to assess and monitor how the home was managed and to monitor the quality of the service.

Staff spoken with had no concerns about the management of the service. They felt they were appropriately supported.

People using the service told us they were satisfied with the support they received at Elms. They told us, “It’s grand, I like everything about it”, “I’m happy with things” and “They have been good with me”.

People were being involved as far as possible in planning their support and were enabled to make decisions about matters which affected them.

People were treated with respect and valued as individuals, they were able to make choices and develop independence skills. They were supported to access resources and activities within the community.

We found people experienced some good care and support. People were getting support with healthcare needs. They had access to ongoing attention from healthcare professionals.

We found some progress was needed in supporting people with their medicines.

People told us they liked the staff. We found people using the service were supported by enough trained, capable staff.

People had no complaints or concerns about the services being provided at Elms House. They knew how to raise concerns and were confident any complaints would be dealt with.

We observed people living in Elms House being treated with respect and dignity. Routines in the home were flexible. People told us that staff assisted them to be as independent as possible and respected their privacy. One person told us, “They are fine with me going out on my own but ask me to let them know that I am OK.”

Care plans were in place and were detailed and person centred. We saw evidence that changes in health were noted, information acted upon and the advice of other professionals sought. People said they were happy living at Elms House. One person said, “I am very happy here.” Another person told us, “It’s great. The staff are brilliant. It is so much better than my last place.”

People living in the home said staff were good and kind and that they felt safe at Elms House. They said they could talk to staff if they were worried about something and staff would help. One person said, ”The staff wouldn’t allow any nastiness to go on, they would deal with it.”

There were satisfactory numbers of staff to support people in the way they needed. People said they were supported well. One person said, “Someone will always go out with me when I want to.” Staff said that they could always have extra staff if they wanted to do an activity with people or if they needed extra help.