About the service: 1-2 Elmfield Way is a care home for people with learning disabilities and autistic spectrum conditions. At the time of our inspection there were four people using the service.

People’s experience of using this service:

• People using the service experienced positive outcomes. Care was designed to meet their needs and support people to develop their independence. Staff were able to provide positive behavioural support to reduce the risks from behaviour which may challenge by de-escalating situations and maintaining routines which were important to people. People were supported to develop their independence and to improve their health and community involvement.

• 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 provider followed safer recruitment processes. Staffing levels were planned to meet people’s needs. There were sometimes short periods when staffing levels were not safe due to staff sickness and there was not a clear risk management plan to address this. We have made a recommendation about this.

• We observed positive interactions between people using the service and staff. Staff were able to communicate effectively with people using a range of tools. People’s plans were reviewed regularly to make sure their needs and goals were met. The provider worked closely with the local authority and health teams in order to meet people’s needs and manage risks to their health and wellbeing. The provider assessed peoples’ ability to make particular decisions and met legal requirements to act in people’s best interests when they were not able to do so.

• Managers had systems in place to ensure good communication, to develop staff skills and knowledge and to ensure the service remained of a good standard. There were systems to learn from incidents and from people and the service was open about when things had gone wrong. People were safeguarded from abuse and improper treatment. People’s medicines were safely managed with appropriate oversight and measures to prevent over-medication.

• A relative of a person using the service told us, “Overall I’m completely satisfied with Elmfield Way and the staff, they’re very very nice. All of them.”

Rating at last inspection: At our last inspection we rated the service ‘requires improvement’. Breaches of regulations were also found. At this inspection we found the provider was now meeting these regulations.

Why we inspected: This was a routine inspection. We also carried out this inspection to check that the provider had followed their action plan.

Follow up: The service has been rated ‘good. We will continue to monitor the service and will carry out another comprehensive inspection within 30 months of this report.

This inspection was carried out on 31 August, 7 September and 9 October 2017. The first day of the inspection was unannounced and we informed the registered manager of our intention to return on the second day. Following these two inspection visits we received information of concern from health and social care professionals in relation to the quality of care and support provided to people who used the service. The third day of this inspection was unannounced and was scheduled in order to gather further evidence. At our previous inspection on 14 and 16 July 2015 the service was rated ‘Good’. At this inspection we have rated the service as ‘Requires Improvement.’

1-2 Elmfield Way is a six bedded care home for men and women with a learning disability or autistic spectrum disorder. It is a bungalow with single occupancy bedrooms, a combined dining and lounge area, a small sitting room and a rear garden. None of the bedrooms are en-suite; there are shared toilets and bathrooms in the communal areas. At the time of this inspection there were four people living at the service.

There was a registered manager in post, who had managed the service for several years. 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. The registered manager was present at the inspection.

The systems in place to identify and manage risks to people’s safety and wellbeing were not sufficiently rigorous. Staff understood how to protect people from the risks of abuse and how to report any concerns about people’s safety and welfare.

There were sufficient staff deployed to support people with their personal care and their preferred activities at home and in the wider community. Thorough recruitment practices were followed by the provider to ensure that people were supported by staff with appropriate experience and knowledge.

The premises were being safely maintained in regards to areas such as fire safety and the professional maintenance and servicing of equipment and installations. Medicines were managed in a safe way and staff received medicines training.

Health and social care professionals told us that people were not always supported to meet their needs. We found that some staff had experienced difficulties in completing monitoring charts required by external professionals.

Staff received ongoing training, one to one formal supervision and an annual appraisal of their performance. Staff received mandatory training, such as moving and handling people and fire safety. Training was being provided to enable staff to effectively support people by providing positive behaviour support.

Staff had received training about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), and they understood how to protect people’s rights.

Processes were in place to support people to meet their nutritional needs and to report concerns to relevant professionals if people needed more intensive support.

There were positive interactions observed between people who use the service and staff. People were treated with respect and their privacy was protected when they received personal care.

We received some negative comments about how people were supported to engage in meaningful activities. During the inspection we saw that people were actively using community resources and returned home pleased with their visits to places and activities of their choice.

Systems had been established to enable people and their supporters to make a complaint.

People were provided with a pictorial complaints leaflet and other more detailed pictorial materials were used to help people express their concerns and views.

Staff told us they felt well supported by the registered manager. H

We spoke to staff, people who used the service and relatives. Relatives and people who used the service were very positive about the care they received. One person told us the home was ‘Amazing’.

We found that staff asked people for their consent prior to providing care and that people using the service were able to withdraw their consent at any time.

We found that care was delivered in an individualised way that ensured that people’s rights were protected. We also found that the provider documented care appropriately and could respond to foreseeable emergencies in an organised way.

People using the service were cared for in a building that suited their needs and that the provider ensured that the care provided was of a consistently high quality.

Staff sought people's permission before carrying out care and gave them a choice of activities to be involved with. Relatives we spoke with said that staff always sought their opinion and consent and "respected their rights" .The entrance to the home was restricted to authorised persons only and people could not leave unless staff opened the door for them using a passcode.

Each person had a person-centred plan that was available in easy-read format with images and pictures. One relative said that staff had a "respectful attitude" and another said that they knew who the key worker for the family member was.

Staff knew how to recognise the signs of abuse and said that they would report all forms of abuse to their line manager. Staff were trained in specific techniques to deal with difficult situations for example, aggression and violence. Relatives told us that their family member was safe at the home and if they had any concerns they would report it to the manager and their social worker.

Staff had attended various training courses including safeguarding vulnerable adults, fire safety, medication and Makaton. Staff were supervised by their line managers and records were kept. Annual appraisals of staff performance was carried and recorded.

Staff documented people's care in their personal diaries. These were clear and concise. Staff records were kept in the staff office in a locked cabinet and the manager kept the keys.

On this occasion it was not possible to speak to people who use the services about their experiences as the people that use this service have many complex and challenging behaviours and are unable to fully understand and communicate without specialist support.

This inspection took place on 14 and 16 July 2015. The first day of the inspection was unannounced and we informed the registered manager we were returning on the second day. At our last inspection on 28 January 2014 we found the provider was meeting regulations in relation to the outcomes we inspected.

1-2 Elmfield Way is a six bedded care home for men and women with a learning disability. It is a single storey building with single occupancy bedrooms, a combined dining and lounge area, and a large rear garden with a summer house. None of the bedrooms are en-suite; there are shared toilets and bathrooms in the communal areas.

There was a registered manager in post, who had managed the service for several years. 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.

The relative of one person told us they felt appropriate actions were being taken to promote the safety of their family member and protect them from the risk of abuse. Staff told us about the actions they would take to protect people from abuse and records showed they had attended safeguarding training.

The management and staff team demonstrated a positive approach towards managing risk and keeping people safe. Potential risks of harm to people or others in their daily lives were assessed and identified. Strategies were in place to provide guidance for staff, in order to mitigate risks and enable people to take part in their preferred activities and safely access community amenities.

There were sufficient staff deployed to support people with their personal care and their preferred activities at home and in the community. Recruitment records demonstrated that the provider’s policies and procedures were followed to ensure that suitable staff were selected and appointed to work with people using the service.

The internal premises were tidy and clean. Records showed that the property was being safely maintained in regards to areas such as fire safety, and the professional maintenance and servicing of equipment and installations.

Medicines were stored, administered and disposed of safely. Staff had received medicines training and their competency was regularly assessed.

Staff received ongoing training, bi-monthly supervision and an annual appraisal of their performance. Staff received mandatory training, such as moving and handling people and fire safety. There was also training focused upon how to meet the individual needs of people using the service, for example training to support people with behaviour that challenged the service.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way, to protect themselves or others. Staff had received training and understood how to protect people’s rights.

People were supported to have a nutritious and enjoyable diet, which took into account personal preferences, and any cultural and dietary needs. They were encouraged to get involved with menu planning, food preparation and kitchen chores, in accordance to individual interests.

Staff supported people to access and follow guidance from relevant healthcare professionals. Focused work was carried out by staff to support people to understand medical interventions such as blood tests and ‘well woman’ screening procedures. Each person had a health action plan which contained information about how they were being supported to meet their identified health care needs, which included advanced planning for routine and elective surgery hospital admissions whenever possible.

A relative described staff as being “brilliant with the residents, they are all so kind, patient and genuine.” During the inspection we saw that staff interacted with people in a thoughtful and caring manner. We received positive comments from external health and socialcare professionals in regards to the conduct and approach of staff.

We saw that people were consulted about their wishes and preferences. For example, some people expressed that they wanted to have supported employment opportunities and the service had arranged this. Another person told us they liked swimming and we saw that this activity featured every week on their individual schedule. People were supported to use computers and electronic tablets for communication and social purposes.

A relative informed us they had been given information about how to make a complaint and felt confident the provider would respond in an open and helpful way in the event of a complaint. People were provided with a pictorial complaints leaflet and other more detailed pictorial materials were used to help people express their concerns and views.

A relative described the registered manager as “a wonderful head of the home, approachable and leads the staff well.” Appropriate quality assurance systems were in place to check the quality of the service and identify ways to improve.