The inspection took place on 5 June 2018 and was unannounced. Our last inspection took place in April 2017. We found no breaches of regulation at this time, however there were areas that required improvement. This included recording of the administration of medicines and recording of decision making under the MCA. At this inspection we found those areas had improved, However further concerns were found and the rating for the service remained as Required Improvement.

The service provides nursing care and accommodation for up to 12 people with learning difficulties. The accommodation is divided in to three separate villas on the same site. Elysian Villas is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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.

There was a registered manager in place. 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.

We found that people at the service were not always safe. This was due to the security of the building. Nine months prior to the inspection, the provider notified us of an incident where a person using the service left the building unattended because the gate to their villa was left unsecured. There was a second incident of this nature two months after the first. At this inspection, we found that a solution had not yet been put in place and the gates were still being left unsecured.

The service was also experiencing difficulties in recruiting and maintaining staff which meant there were significant staff vacancies at the service. This was being managed through use of regular bank and agency staff. We received varied feedback about this and the impact of it on people being supported. The majority of staff felt the impact on people was minimal due to the way in which it was being managed.

People received safe support with their medicines. These were stored securely and the administration of medicines was recorded on Medicine Administration Record (MAR) charts.

The service was effective. Improvements had been made in the way in which best interests decisions were being made. People were supported to see healthcare professionals when they needed to. Staff were satisfied with their training and support and received one to one supervision.

Staff were kind and caring and treated people with respect. We saw staff spend time with people sharing humour. Staff encouraged one person to change their clothes on several occasions ensuring they were clean and comfortable.

Staff were responsive to people’s personal needs and preferences. One person had recently moved villas as it better suited their needs. People were also able to take part in activities outside of the home, for instance going to day centres and the farm.

The home was not well led in all aspects because the service had been slow to respond to a safety issue with the premises. Staff were positive about the registered manager telling us they were approachable and they could raise any concerns they had.

We undertook an unannounced inspection of Elysian Villas on 4 April 2017. When the service was last inspected in February 2016 no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified and the service had been rated as Requires Improvement.

Elysian Villas is registered to provide nursing care for up to 12 people who have a learning disability. The service comprises of three separate villas. There were 12 people at the service on the day of our inspection.

A registered manager was in post at the time of our 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 home is run. The registered manager was on long term planned leave at the time of our inspection. The home had notified the Commission of this absence and had suitable managerial arrangements in place.

The recording of people’s medicines was not always consistent. The registered manager was making positive steps to address these issues. Staff were not fully supported by an effective programme of supervision in line with the providers’ policy.

People’s capacity had been considered and documented in care records on some occasions. However, capacity assessment and best interest decisions were not always completed where appropriate. We made a recommendation in regards to working in accordance with the Mental Capacity Act Code of Practice.

Staffing levels were safe. The service was working to recruit further staff members to ensure consistency of care. Systems were in place to review and monitor reported accident and incidents. Changes were made to reduce and prevent future reoccurrences. Risk assessments were in place for people with supporting guidance available to staff.

People’s nutrition and hydration needs were met. People had access to healthcare professionals when needed. Care records contained detailed guidance supporting people who may not be able to communicate their health needs.

People were supported by staff who were kind and caring. Relatives told us they were welcomed at the home at any time. Staff knew people well and were aware of personal preferences. We observed staff maintained people’s privacy and dignity and treated people with respect.

Care records were person centred. People had access to a variety of activities of their choosing. The service was well-led. Systems were in place to monitor and improve the quality of the service. However, we did find that audits had not suitably identified some areas which required action. Feedback was sought from people and relatives and actions completed.

The inspection took place on 20 February 2016 and was unannounced. The service was last inspected in 2013 and met with legal requirements.

Elysian Villas is registered to provide nursing care for up to 12 people who have a learning disability. There were 12 people at the home on the day of our visit.

There was a registered manager for 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.

Incidents and accidents that had happened in the home were reviewed by senior staff. Senior staff had been reviewing some records after incidents had happened. However there was no systematic management overview of these occurrences. This meant risks and emerging themes may not be properly identified.

People’s legal rights were protected because the provider had a system in place so that the requirements of the Mental Capacity Act 2005 were implemented when needed. This legislation protects the rights of people who lack capacity to make informed decisions.

People’s nutritional needs were effectively met and they were supported to eat a healthy and well-balanced diet.

People were able to take part in individual activities as well as group ones. Staff supported people to take part in a variety of community based activities that people enjoyed.

People’s care records were personalised, up to date and accurately explained people’s care and support needs. The care plans included information about people’s likes, interests and life before they came to the home. Staff were fully aware of the content of each person’s care records.

People were supported with their physical health care needs. Staff consulted with external healthcare professionals to get specialist advice and guidance when required.

Staff felt they were being well supported in their work. The staff felt they could approach the manager if needed.

We had received information of concern from a whisteblower in July 2013 about excessive agency staff being used, medicine errors occurring, and concerns about changes to the way the home was managed. The home had previously informed us about the medicine errors and action that had been taken to make improvements. We found that agency and bank staff had been used regularly due to staff vacancies and long term sickness. New support staff were in the process of being recruited while further qualified nursing staff were still needed to be employed.

Some areas of the home were in the process of being refurbished to provide individual, self -contained accommodation for people. This was a major change for both the people living at the home and the staff who were to support them. Changes had been made to the role of support staff with a greater emphasis in supporting people in the community.

There were 10 people living at the home on the day of our visit. We met one person in one villa and spoke with two other people in another villa. They told us “I love living here” and “I can do what I like”. They told us that they liked going out for meals and that they liked the food cooked by staff at the home. People said that they had started to talk about Christmas activities and were planning to go to Christmas Fayres.

The registered manager was not available on the day of our visit. The acting manager and deputy manager told us about plans that had been drawn up to develop two of the villas in providing self contained individual apartments for some of the people to live in. This proposal had impacted on the service and we saw evidence that changes had already taken place. We spoke with new team leaders who shared the management’s views in promoting people’s independence. It was evident that the leadership from the management had created a positive atmosphere for staff to embrace the changes.

We spoke with support staff, some were happy that they were more involved with the planning of people’s care, while others confirmed that the changes were needed and accepted the new proposals.

We looked at various records to ensure that people had been cared for in a safe way. We saw there were sufficient staff on duty, up to date health and safety management audits had been carried out. Some staff had their names put forward to update some areas of their training.

We spoke to people living in each villa and the four people consulted about the home said they liked living there.

We asked these people about making decisions and they gave examples of the decisions they had made. For example, who enters their bedroom and when they do not want to participate in activities.

People said they were involved in the planning of the care and treatment that they received. However, not everyone was ‘happy’ with what was written in their care plans. They knew that records were kept about them and that there was a member of staff who acted as their keyworker. Keyworkers supported people with their independent living skills and accompanied them on shopping trips.

Although people said that they did not always feel safe at the home, they all wanted to stay living there.

People acknowledged that they would at times become aggressive and violent. People knew what they needed to do to control their behaviour to calm down. We were told that staff would discuss with them the reasons for becoming angry and knew that if they attacked staff, they would call the police.

We sought feedback from these individuals about the staff, they all said that permanent staff knew how to meet their needs. However, some said that they did not like it when there was bank staff on duty.

When we asked people about making complaints, they said that they would approach the staff. They said that staff would take their concerns seriously and ‘sort it out’.