The service was registered to provide accommodation and personal care for up to six people. The people accommodated were men who had a learning disability and/or autism. The home was part of the range of services provided by the Wirral-based company Potensial Limited.

The home was a large terraced property that blended in with its neighbours and was not identified as a care home. On the ground floor there were two bedrooms, a comfortable lounge, a large combined kitchen, a dining room, a small office, and a shower room. On the first floor there were four bedrooms and a bathroom. At the back of the house there was an enclosed garden.

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

We spoke with one person who lived in the home and two relatives who all gave positive feedback about the home and the staff who worked in it.

Staff spoken with and records seen confirmed training had been provided to enable them to support the people with their specific needs. We found staff were knowledgeable about the support needs of people in their care. We observed staff providing support to people throughout our inspection visit. We saw they had positive relationships with the people in their care.

The registered provider understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that people were supported to make their own decisions where possible and their choices were respected.

Care records were clear and person centred. The important information that was needed to care for people safely was clear and available for staff to access.

Medicines was stored, administered and managed safely.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included collaborative ways of working with the staff team and it was very much a team approach to problem solving.

The inspection took place on 17th November 2014 and was unannounced. The care home was a domestic style property in a residential area, but close to the shops and other amenities in Prenton.

The home was a large terraced property that blended in with its neighbours and was not identified as a care home. On the ground floor there were two bedrooms, a comfortable lounge, a large combined kitchen and dining room, a small office, and a shower room. On the first floor there were four bedrooms and a bathroom. At the back of the house there was an enclosed garden and a laundry room with separate entrance. Smoking was not permitted in the house and there was a smoking shelter in the back garden.

The service was registered to provide accommodation and personal care for up to six people. The people accommodated were men who had a learning disability and/or mental health needs. The

home was part of the range of services provided by the Wirral-based company Potensial Limited and had a manager who was registered with the Care Quality Commission. 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 and associated Regulations about how the service is run.

At the time of the inspection, four people lived at 23 Elm Road North and had done so for several years. There was a small team of seven staff, including the manager and a team leader.

The staff we spoke with were able to tell us how they ensured that people were protected from abuse. All staff had received training about safeguarding and this was updated every year. There were enough qualified and experienced staff to meet people’s needs.

We found that the home was clean and well-maintained. Records we looked at showed that the required health and safety checks were carried out.

We found that medicines were managed safely and records confirmed that people always received the medication prescribed by their doctor.

People we spoke with confirmed that they had choices in all aspects of daily living. Menus were planned to suit the choices of the people who lived at the home and alternatives were always available.

People were all registered with a local GP practice and had an annual health check. The care plans we looked at gave details of people’s medical history and medication, and information about the person’s life and their preferences.

People were encouraged to complete satisfaction surveys and we saw that people who lived at the home, staff and stakeholders had done this. The manager had taken action to address any issues raised.

Six men lived at 23 Elm Road and all had lived there for at least five years. They were aged between 50 and 65 years and required 24 hour support from staff due to learning disability and, in some cases, mental health issues. Care records identified people's needs and the support required to meet their needs. Risks associated with daily living, life-style choices and hobbies had been assessed and actions put in place to minimise identified risks.

All areas that we saw were clean and there were no unpleasant smells in the building. People had spacious single bedrooms that were personalised with their own belongings. Records we looked at showed that services and equipment were tested and serviced regularly.

Enough qualified and experienced staff were employed to ensure that people’s care and support needs were met. Most of the staff had worked at the home for several years and had a national vocational qualification in care.

Records we looked at showed that the quality of the service was monitored and regular health and safety checks were carried out.

People told us that they are involved in the planning of their care and the running of their home.

We found records clear and they contained historical and current information.

Records identified people’s needs, the level of support they needed and details about their interests and hobbies. Any risks associated with daily living, life style choices and hobbies had been assessed and actions had been put in place to minimise identified risks. One person told us it was the best decision they had made moving to the home.

Two people we spoke with living in the home told us they felt safe there.

Improvements were made in maintaining good hygiene practice and cleaning schedules.

Records were maintained of one to one work with individuals and any activities undertaken with them.

There was an effective complaints procedure. One person said they never had anything to complain about everything was “perfect”.

Limited information was obtained from the people using the service due to communication difficulties. However they made the following comments:

'I'm happy living at Elm Road, if I wasn’t happy I’d speak to the staff'.

'I can do what I want during the day. Sometimes I go out to the shops and the staff come with me'.

‘The staff are nice’.

‘The staff are always here and they talk to me’

'I like living here, it's nice'.

'I've lived here for ages, and I’m very happy'.

The relatives of the people using the service made the following comments:

‘I’m happy with the care provided to my brother’.

‘The staff are knowledgeable and do their best, I have never heard staff speak badly to any of the people using the service’.

‘I don’t have a copy of the complaint procedure but I would speak to the manager if I wanted to make a complaint. I have had a few minor concerns over the year, but these have been handled well’.

‘The staff are good. They never know when I’m going to visit, but they are always nice’.

‘I’m always kept informed about my brother’s welfare’.

‘The staff group is consistent which I believe is good’.

‘Some aspects of the service are good but communication with relatives could be better’.

‘I’m not sure my relative gets the individual staffing hours that have been allocated to him’.

‘I’m no longer invited to the care planning meetings and staff don’t keep me informed about my relative's welfare’.

Health care professionals made the following comments:

'I am very impressed with the staff team, they are very knowledgeable about my client's care needs'.

'The management of the service seems good'.

'Staff take on board my ideas and keep me informed about what is going on’.

‘I had several patients at Elm Road but never visited the site. However, I when they visited me I never saw any signs of abuse or neglect and I have no concerns to raise’.

‘I have no problems with service. The staff are knowledgeable about my patients’ care needs and carry out my instructions. I have never seen staff speak or treat people badly.

‘The care and management of the home is good, staff appear well trained and knowledgeable about my patients’ care needs.