This inspection took place on 26 October 2016 and was unannounced. At the last inspection of the service on 24 and 25 November 2015 we found breaches of the Health and Social Care Act 2008 in that the provider did not have systems in place to ensure staff received an appraisal of their practice and performance and care plans and records were not always accurate nor reviewed on a regular basis, in line with the provider’s policy to ensure people’s needs were appropriately documented and met. We carried out this inspection to check the outstanding breaches had been met and also to provide a review of the rating for the service.

Elmwood lodge provides accommodation and personal care support for up to ten people. People who use the service have mental health support needs. At the time of our inspection the home was providing support to ten people. The home had 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 this inspection we found the provider was compliant with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risks to the health and safety of people using the service were assessed and reviewed in line with the provider's policy. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies. There were safeguarding adult’s policies and procedures in place. Accidents and incidents were recorded and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff were deployed throughout the home to meet people’s needs.

There were processes in place to ensure staff new to the home were inducted into the service appropriately. Staff received training, supervision and appraisals that enabled them to fulfil their roles effectively. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with respect and were consulted about their care and support needs. Staff respected people’s dignity and privacy. People’s support needs and risks were identified, assessed and documented within their care plan. People were provided with information on how to make a complaint. The service worked with health and social care professionals to ensure people’s needs were met.

There were robust systems and processes in place to monitor and evaluate the service provided. People’s views about the service were sought and considered through service user meetings and satisfaction surveys.

People at Elmwood lodge were supported in activities of daily living and some people were working towards independent living. We observed during our inspection that people were treated with care and respect. People we spoke to told us that “it’s a good home” and another said “it’s alright here.”

We found that people had risk assessments and care plans. People had a staff member allocated as their key worker who would regularly review their care.Staff told us that people were supported to make their own decisions and that they wanted to get the best for them. People told us that they were supported in making choices on activities they attend in the community.

We found that staff had been trained on the control of infection and appropriate arrangements were in place for the cleaning of the home environment. We found that there were sufficient staff on duty to meet people’s needs and staffing had increased on occasions to meet people’s planned appointments. People told us that the staff were helpful and nice.The provider had plans in place to recruit to two vacant posts.

The provider regularly assessed the quality of the service and we found they had implemented changes to the service following audits, for example we found that a monitoring system for staff training had been put in place following recommendations from a recent audit.

People using the service we spoke with liked living at Elmwood Lodge. They said the staff were nice, friendly and easy to talk to. People said they were going out a lot more since the last time we visited the home. People told us there were monthly residents meetings where they planned outings, other activities, and the running of the home.

People told us they knew who their key worker was and that they had good meetings with their key worker where they could chat about things. People said they were well cared for.

People also told us everything was in good working order at the home and that they felt comfortable there.

This inspection took place on 24 and 25 November 2015 and was unannounced. At our last inspection on 12 November 2013 we found the provider was meeting the regulations in relation to the outcomes we inspected.

Elmwood lodge provides accommodation and personal care support for up to 10 people. People who use the service have mental health support needs. At the time of our inspection the home was providing support to nine people.

The home had 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 this inspection we found breaches of legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report. We have also made a recommendation to the provider where improvements to the service should be made.

The provider failed to ensure that effective systems were in place to provide staff with annual appraisals of their practice and performance. Care plans and records were not always reviewed on a regular basis and in line with the provider’s policy to ensure people’s needs were appropriately documented and met. Medicines were not always managed and recorded appropriately. We have made a recommendation to the provider where improvements to the management of medicines should be made.

The home had a policy in place for safeguarding adults from abuse and staff demonstrated a clear understanding of the actions they would take to ensure people were kept safe. There were safe and robust recruitment procedures in place that ensured staff were suitable to work with people using the service. Assessments were completed to assess levels of risk to people’s physical and mental health, and care plans contained guidance for staff that helped protect people from harm by minimising identified risks. There were arrangements in place to deal with foreseeable emergencies and staff knew what to do in the event of a fire. Accidents and incidents involving the safety of people using the service were recorded and acted on appropriately.

Staff were supported through regular supervisions and by attending appropriate training. New staff members completed an induction programme which included mandatory training. People were supported to maintain good health and had access to a range of health and social care professionals when required. People told us they were involved in the decisions about their care and were able to voice their wishes and preferences. Care plans contained mental capacity assessments where appropriate, and applications for Deprivation of Liberty Safeguards (DoLS) were made in accordance with the Mental Capacity Act 2005 (MCA). The MCA protects people who may lack capacity to make decisions in relation to consent or refusal of care and treatment. DoLS protects people when they are being cared for, or treated in ways that deprives them of their liberty for their own safety. People were supported to eat and drink sufficient amounts to meet their needs and maintain a balanced diet.

People were provided with information about the service and attended regular meetings in order to share their views on the running of the service. People told us they had been consulted about their care and support needs and were allocated a named key worker to co-ordinate their care. People’s privacy and dignity was respected and staff were knowledgeable about their needs in relation to disability, race, religion, sexual orientation and gender.

People’s physical and mental health needs were assessed before they moved into the home. They were provided with information about how to make a complaint and this information was displayed throughout the home for reference. They were also supported to engage in local activities and events, and to maintain social support networks, such as visiting friends and relatives.

Staff told us the registered manager was approachable and supportive. There were procedures and systems in place to evaluate and monitor the quality of the service provided although these had not identified the issues that we found on inspection. The home encouraged involvement from health and social care professionals in assessing the quality of the service provided to people through the use of surveys and by seeking feedback. The provider also took account of people’s views about the quality of the service provided through resident’s satisfaction surveys and through the homes comments and suggestions box.