This inspection took place on 3 June 2015 and was unannounced. The service met the requirements of the regulations during the previous inspection which took place on 30 January 2014.

There was a registered manager at the service. 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.

Elwin Lodge Care Home is a small care home for two people with learning disabilities. It is located in Tooting, South-West London. It is close to local amenities and has good transport links. It is one of three homes owned by Mark A Peake.

People using the service live in separate flats in the home, both with their own bedroom, bathroom, kitchen and lounge.

People were treated with kindness and respect and were able to take part in activities both in the home and out in the community.

Effective methods were used to communicate with people using the service, who were not able to communicate verbally. Care plans identified the most appropriate techniques to communicate with them, for example the use of a communication book or by using objects of reference. Staff were familiar with these methods. We observed staff communicating with people and they did so confidently and in an engaging manner. We saw that people responded to them in a positive manner.

Where people did not have the capacity to consent to certain decisions related to their care, the service followed guidance in line with the Mental Capacity Act 2005 (MCA). Decisions were taken in people’s best interests after consultations with professionals involved in their care. Where it was deemed that people required restrictions on their liberty to keep them safe, authorisation was sought from the local authority which helped to ensure people’s rights were protected.

There was evidence that people’s behaviours were managed effectively by the service. Support guidelines were in place to support staff when people displayed behaviour that challenged the service. Staff were familiar with these techniques. The service worked closely with psychologists and psychiatrists to understand the reason for these behaviour patterns and care plans were produced to minimise behaviour that challenged from occurring in future.

People’s needs in terms of their medicines and their diet were met by the service. People told us they were able to see healthcare professionals such as their GP or consultant psychiatrist if they needed.

There were enough staff to meet people’s needs and they displayed an excellent understanding of the best way to support people with respect to all aspects of their lives. They demonstrated an excellent understanding of people’s medical and nutritional support needs. They received regular supervision and told us they were given responsibility as key workers for people.

Care plans and risk assessments were reviewed regularly to ensure they were still relevant to people. Audits, for example medicines, financial and health and safety were carried out as a means of quality assurance.

We were unable to speak with people using the service during our inspection. One person had gone to the day centre and the second person was unable to communicate verbally.

Staff gave us examples of how they supported people to become more independent. One staff said "we worked with the speech and language therapist (SLT) and the community team on their communication needs". Another staff said one person using the service "is more involved in the community now; he does his own shopping".

We looked at both care plans for people using the service. These had been reviewed recently and we saw that they were individual to the needs of people using the service.

The kitchens were well stocked with food. Fresh fruit and plentiful drinks were available to people. The food in the fridge was clearly labelled with the date it was opened or prepared and when it was to be used. Daily fridge and freezer temperatures were recorded in the morning and evening.

We spoke with three staff during our inspection. They told us there were plenty of opportunities for training and to take on more responsibility. One person told us "I'm very happy; I am developing all the time". Another staff told us "we work together as a group" and "we meet daily to discuss any concerns".

Records related to maintenance and health and safety around the home were fit for purpose. Records that we saw included a current Portable Appliance Testing (PAT), gas safety and fire alarm certificates.

We were unable to speak with people using the service during our visit due to their complex needs.

People using the service had their own bedroom within their flat which enabled them to have their own privacy. We saw that people were able to personalise their home. We saw both of the care plans for people using the service, these contained a list of activities that they enjoyed doing and also a weekly activities timetable. A carer told us that people using the service went to the day centre every weekday and they also enjoyed "going for long walks and to the shops".

Care plans contained risk assessments which were reviewed every six months or as and when staff noticed a change in people. Families of people using the service were encouraged to attend review meetings. Staff told us "we are constantly in touch with families and speak to them on a regular basis".

We saw evidence in a training matrix that staff had attending training in Safeguarding of Vulnerable Adults (SOVA). We spoke with relatives of people using the service who told us they were confident in the abilities of staff working at the home. They told us "I have no concerns, my relative is well looked after".

One care worker we spoke with told us "the organisation has supported me in my professional development". They told us they felt supported by the managers and they were in constant contact with them.

The people who live at the home are not able to tell us about their experiences so we asked people who are familiar with them to give us their opinions. We were told that

• the management team and staff have worked well with a range of health and social care professionals to improve the quality of lives of people who live at the home;

• incidents of challenging behaviour have reduced as a result of the work of the home;

• in the case of one person living at the home doctors have been able to successfully reduce medication while observing an increased quality of life;

• the staff at Elwin Lodge are extremely motivated and able to develop their practice to support improved client care.