The Elms Residential Care Home provides accommodation and personal care for up to 27 older people. Twenty-five people were living at the home at the time of our inspection visit. At the last inspection, the service was rated good. At this inspection we found the service remained good in all five questions and good overall.

There was a registered manager in post. 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.

Staff understood their responsibilities to protect people from the risk of abuse. The registered manager checked staff’s suitability for their role before they started working at the home and made sure there were enough staff to support people safely. Medicines were stored, administered and managed safely.

Risks to people’s individual health and wellbeing were identified and care was planned to minimise the risks. People and their families were included in planning how they were cared for and supported. The registered manager regularly checked the premises and equipment were safe for people to use.

People were cared for and supported by staff who had the skills and training to meet their needs. The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to eat and drink enough to maintain a balanced diet that met their preferences and were referred to healthcare services when their health needs changed.

People, relatives and staff felt well cared for. Staff respected people’s diverse needs and interests and encouraged them to maintain their independence in accordance with their wishes and abilities. Staff were happy working at the home because the registered manager cared equally about their wellbeing and understood that happy staff made people feel happier.

The manager and staff understood people’s individual needs, preferences, likes and dislikes. People were encouraged to maintain their interests and to take part in social activities in the home and in the local community. Staff knew people well and respected their privacy and dignity.

People and relatives knew the manager well and had no complaints about the service. Staff were inspired by the registered manager’s leadership, skills and experience to provide a quality service.

Further information is in the detailed findings below.

We met with ten people who lived at The Elms. Due to the complex needs of people, some were unable to verbally share their experiences of what it was like to live at the home.

We spoke with three relatives, a visiting professional and one person who supported people to obtain their views about the home. We also spoke with the manager, three members of the care staff and the cook.

We observed staff interaction and talked with care staff about how they met the needs of people they supported.

Staff demonstrated a clear understanding of people's needs and engaged with people in a positive manner. People appeared relaxed and happy in the company of the staff and were not hesitant when they approached them.

The relatives and visitors we spoke with told us they were happy with the care at The Elms.

We looked at the care planning documentation and we found that care plans were detailed and demonstrated that staff treated each person as an individual based upon their needs.

We saw that people’s nutritional needs had been identified and people were provided with a good choice of food. People told us they were happy with the choices available to them.

Systems were in place to ensure that medicines were managed appropriately on people's behalf.

Staff told us they were supported by the manager and had access to regular training.

We saw that information was available to enable people to make a complaint and a system was in place to record any complaints.

We spoke with three people who lived at the home and two relatives. Everyone we spoke with said they liked the home. One person told us, “I am quite happy and well looked after.” A relative we spoke with said, “I am so glad X is here. The home was recommended by several people. It is very clean, with friendly staff, and they are always at hand when I visit.”

We saw that people were free to spend time how they liked. We saw a list of activities that people could join in with on the notice board. People who lived at the home told us what they enjoyed doing. One person said, “There are meetings, but I don’t want to go. I like to keep myself to myself.” Another person said, “I enjoy doing nothing, living with my memories, little secrets of my own. I just like thinking about my life.”

There were enough staff to support everyone according to their needs on the day of our visit. We saw staff playing scrabble with four people and at lunch time we saw staff assisting one person who was not able to eat independently. The day’s meal choices were shown in large, colour photos in the dining room. People we spoke with told us the food was very good. One person said, “The food is very nice and I can choose what I eat.”

We spoke with three care staff and they all told us they enjoyed working at the home. One member of care staff said, “I love working here. I love it. X is a brilliant boss,” and another said, “It is good here, we are close, we work together as a team.”

We undertook an unannounced visit to The Elms arriving at 9.10am. During our visit we spoke with the home's owner, manager, three members of care staff, four people living at the home and two visitors. We spent time observing daily life at the home. We saw that staff had a good relationship with those living at the home. Staff spent time chatting to people, joining in activities and the atmosphere was friendly.

People who live at the home appeared to be relaxed and comfortable. We were told "make yourself comfortable, I will get someone to get you a drink." "The food is good, I love the dog." "I like it here, I don't want to move."

Visitors spoken with said " I cannot fault the home and if I needed to be cared for in a home I would move in here." "I cannot fault the place and I don’t want XX to move anywhere else." "This is like a big family home, a good family atmosphere everyone is involved. The food is good, they give XX finger food, the cook knows what she likes and staff seem to know about everyone’s needs and how to help them."

We saw that people were engaged in activities for part of the day. People were given a choice of food and drink. We were told that people are always well dressed and the home is always clean and tidy.

Staff spoken with had a good knowledge of the likes, dislikes and care needs of people at The Elms.

We inspected this service on 18 and 19 November 2014. The inspection was unannounced. At our previous inspection in November 2013, the service was meeting the regulations that we checked.

The service provided accommodation and personal care for up to 27 older people who may have dementia. Twenty people were living at the home on the day of our inspection. There was no registered manager in post at the time of our inspection, however, the newly appointed manager planned to register with us straight away.

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.

People who lived at the home told us they felt safe and were happy living at the home. The manager and staff understood their responsibilities to protect people from harm.

The manager assessed risks to people’s health and welfare and wrote care plans that minimised the identified risks. Staff had a good understanding of people’s needs and abilities because they read their care plans and had time to get to know them well. The number of staff on duty was sufficient to meet people’s physical and social needs.

The provider had appropriate policies and procedures in place to minimise risks to people’s safety. The provider checked that the premises were well maintained and equipment was regularly serviced. Staff received appropriate training to make sure people’s medicines were stored, administered and disposed of safely.

Staff received training that was appropriate to meet people’s needs and had opportunities to reflect on their practice and learn from other staff.

People told us they liked the staff and made their own decisions about their care and support. We saw staff offered people a choice in how they spent their day and what they would like to eat. Risks to people’s nutrition were minimised because staff understood the importance of offering appetising meals that were suitable for their individual dietary requirements.

People were supported to maintain good health and accessed the services of other health professionals. People told us they saw doctors, dentists and opticians when they needed to.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). No one was under a DoLS at the time of our inspection. For people who were assessed as not having capacity, records showed that their families and other health professionals were involved in discussions about who should make decisions in their best interests.

Everyone we spoke with told us staff were kind and caring. We saw people were relaxed and chatted easily with staff. Staff understood people’s individual needs and abilities. Staff reassured and encouraged people in a way that respected their dignity and promoted their independence.

Staff took the time to get to know people and encouraged them to maintain their interests and try new hobbies. People’s art and craft work was displayed around the lounge so they could take pride in their achievements.

People and their relatives were involved in planning and agreeing how they were cared for and supported. The care we observed matched the information on people’s care plans.

The provider’s quality monitoring system included regular checks of people’s care plans, the premises, equipment and staff’s practice, to make sure people received care and support safely. Accidents, incidents and falls were investigated and actions taken to minimise the risks of a re-occurrence. People who lived at the home and their relatives were supported and encouraged to share their opinions about the quality of the service.