About the service: The Elms@Kimblesworth is a care home which provides accommodation for people who require nursing and personal care. The service can provide care for up to 19 people. At the time of our inspection 17 people with mental health needs, learning disabilities or autism were using the service. People with learning disabilities were therefore living in a home larger than current best practice guidance recommends.

People’s experience of using this service: The outcomes for people with learning disabilities did not fully reflect the principles and values of Registering the Right Support for the following reasons: lack of choice and control, limited independence and limited inclusion. Practices in the home were under developed to consider risks and support people to reach any personal goals in line with best practice guidelines.

Pre-employment checks were carried out to ensure staff were suitable to work in the home. Insufficient staff were employed in the service to support people to leave the home and engage in community activities. Consequently, people spent their days within the confines of the perimeter of the home. A staff training matrix showed staff had received training in a variety of topics. Not all staff had received training in autism.

New nursing staff had been recruited to the service to provide people with consistent nursing care. However, agency nurses had been employed in the service and the provider had failed to carry out checks on them before they began working in the service.

People’s oral medicines were administered in a safe manner. There were deficits in the administration of topical medicines. There were also some gaps in the guidance given to staff for medicines required on an ‘as and when’ basis.

People were protected by staff who had received training in safeguarding and understood how to raise concerns with their manager.

People’s diets were compromised through a lack of choice; kitchen staff were not always aware of people’s dietary needs. Advice from professionals was not documented within a care plan. Food and fluid charts were not completed.

Staff engaged people in making decisions about their care during the day. Systems were in place to obtain people’s consent. When the Mental Capacity Act principles and code of practice had been applied, and people were found not to have capacity to make decisions, these did not result in best interests’ decisions.

The provider had a procedure for complaints. Information was not on display in an easy read format to help people with additional learning needs.

People confirmed that staff treated them with kindness and respected their wishes. Opportunities for people to influence their service were limited. Resident’s meetings were infrequent.

A new manager began working in the service the day before our inspection began. Governance improvements were required in the service to ensure audits were effective, records were up to date and accurate, and people’s voice about their experiences using the service were heard.

Rating at last inspection: This service was registered with CQC in November 2018 as the provider D3 Care Limited. Before that the provider was known as Jigsaw Care Limited. There have been no changes in the directors or the name of the service, but the name of the company providing the service has changed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected: We inspected this service as concerns had been raised with us by the local authority.

Improvement Action:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We will continue to monitor the service through the information we receive and discussions with partner agencies. We will be speaking to the provider about their next steps to improve the service to an overall rating of Good. We have rated the effective key question inadequate. This means we will insp