We carried out this unannounced inspection on 18, 21 December 2017 and 16 January 2018. At our last inspection on 28 October 2015 the service was rated Good overall but Requires Improvement in safe. This was because equipment was not properly maintained or sufficiently clean.

Elwis House provides accommodation for persons who require personal care. The home provides care and support for up to four people with learning disabilities, some of whom have additional physical disabilities. At the time of our inspection there were four people living at the home.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager who was available on the second day of the 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.

Information about the home was accessible and understood by people who used the service. People were listened to and their rights were respected by caring and considerate staff.

Recruitment checks were completed to assess the suitability of the staff employed. Staff received suitable training and good support from the registered manager to enable them to carry out their roles effectively. There was a suitable number of staff to meet the needs of the people who lived in the home.

The safe storage and auditing of medicines needed to be improved to ensure people were safely supported with their medicines. Staff had received medicines training and their competency was assessed.

Care plans were personalised and evidenced how people would like to receive their care, however some records required a review of people’s needs.

Systems were in place to effectively improve the quality of care delivered. Surveys had been sent to obtain people’s views and these were used to implement change within the service.

Suitable arrangements were in place to ensure people received good nutrition and hydration.

Staff understood their responsibilities with regard to reporting suspected abuse in order to safeguard people from harm. Guidelines were followed by staff to minimise the risk of harm to people and minimise re-occurrences of any incidents.

People were supported by staff to attend medical appointments when there were changes to their health needs and/or associated risks to their health.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were encouraged to maintain good relationships with their relatives. People had access to activities that were important to them and were supported to be active in the community to help maintain their independence.

An easy read complaints policy was available to guide people how to make a complaint. The provider had received no complaints since the last inspection and one person told us they had no concerns.

We have made two recommendations about people’s medicines and their care records.

Elwis House provides accommodation for persons who require personal care. The home provides care and support for up to 4 people with learning disabilities, some of whom have additional physical disabilities. At the time of our inspection there were three people living at the home.

The inspection took place on 28 October 2015 and was unannounced. Our last inspection took place on 13 April 2014. We found at that inspection that the home was meeting the regulations inspected.

At the time of our visit the home had a manager and the registered provider had applied to the Care Quality Commission for him to be the registered manager. The application for registration was being assessed and he was registered shortly after our visit. 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 a breach of Regulation 15 of the 2014 regulations of the Health and Social Care Act 2008. People were not kept safe in the event of a fire. A fire safety device fitted to a bedroom door was broken. The door would not close automatically in response to the fire alarm so anyone using the room was not protected in the event of a fire. Also the kitchen was not in a clean and hygienic state. You can see what action we told the provider to take at the back of the full version of the report.

People were protected by safe arrangements for staff recruitment. Staff were knowledgeable about safeguarding issues, how to recognise potential abuse and the reporting procedures to follow.

There were enough staff to provide safe care for the people who lived at the home.

People received their prescribed medicines when they needed them and they were supported to maintain good health. Risks associated with people’s health and care needs were assessed and plans put in place to manage them.

Training for staff provided them with the skills and knowledge they required to meet people’s needs. Staff were supported to do their jobs well.

People were offered choices at mealtimes and assistance when they needed it to ensure they ate and drank enough and had a balanced diet.

The manager and staff understood their responsibility under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were supported to have contact with healthcare professionals.

The premises had been designed and adaptations made to take into account people’s individual needs

Staff were caring towards the people living at the home. Staff knew people well and how best to care for them and encouraged their views about how they were cared for. We observed one person’s privacy was not respected while we were at the home.

People were supported to make decisions regarding the care they received.

People took part in activities which reflected their interests and needs.

People and their representatives had opportunities to complain. People’s views of services managed by Providence Linc United Services (PLUS) were invited and listened to. The provider carried out a range of audits to ensure the services were managed properly and people’s needs were met.

There were four people living at the service and we met them all. One person told us that they liked Elwis House because, as a wheel chair user, "it is easy to get around because it is all on one level". They also said they liked that "the doctors is just across the road" so it was convenient when going to appointments at the surgery.

Another person showed us their bedroom in which they had been helped to display the things they liked. They told us that they got on well with staff and the other people living at the service. They told us they were assisted to go to Church and they were glad about this.

Some of the people living at the service were unable to contribute to the inspection because of the nature of their disabilities. We observed that they were relaxed in their home, with each other and with staff members. We contacted two people with an interest in the service through their involvement with the people who lived there. One of these people told us they felt the service provided was "high quality" and "personalised".

Staff told us that they enjoyed their work, one member of staff told us "I really like the people who live here". They said that they felt well supported in their work by the managers.

We found that the people using the service were well cared for. They were asked for their opinions and they consented to the care they received. People were included in discussions about the running of the home. There were documents relating to the care planning process but a number of them were overdue for review.

We met with all of the people using the service. Two people stated that they thought the home was good, a nice place to live, and that staff looked after them.

Staff had undergone safeguarding training and were familiar with the action they should take if they suspected abuse was taking place. The relevant authorities were notified of any safeguarding concerns.

Staff said that they felt well supported by the provider. They felt that they were provided with a satisfactory amount of training, although they were unable to provide us with documentary evidence of training courses attended.

There were a number of systems in use to monitor the quality of the service but we found that staff were not using these systems appropriately. This meant that the provider could not be assured that the service was of an acceptable standard.

We looked at records about care, medication, risk assessments and audits. We found staff were not keeping all of these accurately or securely. We also found that some of the actions the provider was required to take after the inspection on 27 March 2012 had not been taken.

We spoke with two people who used the service, and observed care being given in the lounge and kitchen areas of the home.

We saw that staff communicated well with people in the home, helping them to understand each other and to deal with any problems in communication between them.

One person who used the service told us they were happy in the home and that “staff help me”. They also said that they were involved in the recruitment of care staff and were on the provider‘s shadow board, taking part in work such as policy reviews.

One person who used the service told us that they were involved in household activities such as shopping and cooking and gardening, and another person said they were supported to go out to social activities such as the Gateway Club each week.

We observed people who lived at the home to be treated with respect by staff who supported them in a sensitive and inclusive manner.

Elwis House is a care home for up to four people, all of whom were present when we visited. The home had a registered manager in post but they were absent for the inspection. The home provides accommodation and personal care for people with learning disabilities, some of whom have additional physical disabilities.

The service had a registered manager in post but in the past year there had been periods of absence and the temporary management arrangements were not always satisfactory. This had resulted in the poor organisation of records.

We found that the home was safe, clean, hygienic and well maintained. Plans were in place to refurbish the kitchen and adapt the height of the worktops to enable a person using a wheelchair safe access to kitchen equipment.

Staff had developed effective relationships with people they cared for and were familiar with people living in the home. Staff were gentle and patient, and treated people with respect. People were involved in decisions about their own support. People’s diverse needs were understood and supported. The service promoted a culture that was centred on the person as an individual, open, inclusive and empowering.

We talked with all four people using the service. People were happy living at the home, some people were able to express this verbally, others communicated by gesturing and using body language. We saw that the staff on duty understood their care needs, likes and dislikes and responded in an appropriate manner. People described the care staff as “my buddy” and “caring”.

Staff made referrals, as appropriate, to other professionals and community services. People had access to healthcare services and received on-going healthcare support. The service worked in cooperation with other organisations such as hospitals to make sure people received effective care and support.

Staffing levels were adjusted to meet the changing needs of people, and so people had support when they needed it, and could access activities in the community. People confirmed they had opportunities to lead meaningful lives; they had access to activities that were important and relevant to them. At meetings for the people who lived at the service people’s opinions were sought on issues such as planning social events and holidays. We found that people were listened to and felt that they mattered. One person attended the local “Speak Up” group and represented the views of people with learning disabilities to local government.

People told us staff had the time they needed to care for them, tasks were unhurried and this enabled them give quality time.

Risks to individuals were managed so that people were protected, but their freedom of choice was supported and respected. People told us they trusted staff and felt safe using the service. There were systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others, including the safeguarding people from the risk of abuse.

Staff told us they were supported, and received up to date mandatory training, and additional specific training when necessary. We saw that staff had the necessary skills required and communicated well with the people they supported. This view was supported by relatives of people living at the home and was also reported in reviews undertaken by social workers.