We carried out this inspection on 26 September 2018. The inspection was unannounced.

Elliot House 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. Elliot House provides accommodation and personal care for up to six people. At the time of the inspection there were six people living at the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a manager at the service who was registered with the CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 used the service told us they felt safe. Staff knew how to identify and report suspected abuse and had clear systems in place which ensured safety and legal standards were met. We found systems were in place to make sure people received their medicines safely so their health needs were met. Additional safeguards were in place for people who were on psychotropic medicines to reduce the risk of people being medicated unnecessarily. We found people received support from the same staff which promoted good continuity of care. It was evident there were enough staff on duty so people’s needs were met in a timely way and by staff who were well-trained and properly recruited. Specialist training was also provided so staff knew how to safely respond to behaviour that can challenge.

People’s care records contained detailed information and reflected the care and support being given. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the registered provider’s policies and systems supported this practice.

We observed staff were exceptionally caring and always listened. We saw care records contained details about people’s likes and dislikes so their personhood was promoted and respected. Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and they were involved in decisions about their care. People’s privacy and dignity was respected and promoted.

The service provided a programme of activities to suit people’s preferences. We observed people had regular opportunities to access the community and support staff had access to an adapted vehicle to facilitate trips outside of the service.

All staff we spoke to told us the service was well-run and the management team were approachable and friendly. We found the registered provider’s systems or processes were well-established and operated effectively to ensure compliance with the requirements of regulations.

Elliott House is a care home registered to provide accommodation and personal care for up to 6 people with learning disabilities. Each person has their own bedroom with en-suite facilities. The home is situated within the village of Great Houghton, near Barnsley. The home is owned by Voyage 1 Limited.

This inspection was carried out on 23 March 2016 and was unannounced. We previously visited the service on 01 May 2014. We found that the registered provider did not meet all of the regulations we assessed. We carried out a follow up inspection on 23 July 2014 and found that the registered provider had met the regulations.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager in post who was registered with the Care Quality Commission (CQC).. 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 also registered to manage another of the registered provider's services. They divided their time equally between the two services.

We found that the recording of accidents and incidents was inconsistent and did not always provide sufficient detail about the incident and what action had been taken following the incident to prevent a reoccurrence. We made a recommendation about this in the report.

We saw that medicines were obtained in a timely way so that people did not run out of them, stored securely, administered on time, and disposed of appropriately. However, we found that the recording of medication was inconsistent and medication audits did not occur as scheduled. We made a recommendation about this in the report.

We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people's assessed needs. Staff had been employed following appropriate recruitment and selection processes.

We found assessments of risk had been completed for each person and plans had been put in place to minimise risk.

We saw that staff completed an induction process and they had received a wide range of training, which covered courses the service deemed essential such as safeguarding, infection control, safe handling of medication, manual handling and the management of actual or potential aggression (MAPA).

The registered manager understood the Deprivation of Liberty Safeguards (DoLS) and we found that the Mental Capacity Act 2005 (MCA) guidelines had been followed. Emotional or behavioural support plans were in place for most people using the service.

People's nutritional needs were met. We saw people enjoyed a good choice of food and drink and were provided with snacks and refreshments throughout the day.

People were well cared for and we saw people were supported to maintain good health and had access to services from healthcare professionals. People had health action plans in place to help ensure their health needs were met.

We found that staff were knowledgeable about the people they cared for and saw they interacted positively with people living in the home. People were supported to make choices and decisions regarding their care.

People had their health and social care needs assessed and care and support was planned and delivered in line with their individual care needs. Care plans were individualised to include preferences and likes and dislikes, and contained detailed information about how each person should be supported.

People were offered a variety of different activities to be involved in. People were also supported to go out of the home to access facilities in the local community.

The registered provider had a complaints policy and procedure in place and there were systems in place to seek feedback from

This was a follow up inspection to check that improvements had been made following concerns raised during our inspection on 1 May 2014. During our inspection on 1 May 2014 we identified concerns that people were not fully protected against the risks associated with medicines that were prescribed to be used ‘as required.’ This was because the systems and processes in place to manage those medicines were ineffective in practice.

During the inspection we observed the registered manager administer medicines to people, spoke with the registered manager about improvements that had been made, as well as reviewing relevant documentation.

We considered all the evidence we had gathered under the outcome we inspected. We used the information to answer the five questions we always ask: Is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found.

Is the service safe?

The home had a medication policy and procedure in place that was available for staff, so they had guidance to follow.

Systems were in place to make sure that the manager and staff learned from any medication errors, which meant risks to people were identified and acted on to minimise any further risks and help the service to continually improve.

Is the service effective?

Staff received training in respect of their responsibilities in the management of medicines. An observation of practice took place, to ensure staff effectively implemented the knowledge and skills they had acquired during training.

People were protected against the risks associated with medicines that were prescribed for them. This was because the systems and processes in place to manage those medicines were now effective in practice.

Is the service caring?

We saw that the registered manager showed patience and gave encouragement when supporting people to take their medication. We saw him sit down and explain to the person the medicines they were giving them and what they were for. They offered the person a drink to help them swallow their medication. The person refused one of their medicines. The manager returned with their medication explaining the benefit of them taking the medication.

Is the service responsive?

The service had demonstrated they were responsive to people’s needs, both in the systems and processes they had improved to minimise risks to people and listening to what people said about their medication.

Is the service well-led?

The leadership, management and governance of the organisation was focused on the delivery of person-centred care.

The service had quality assurance systems in place to identify, assess and manage risk to people in regard to their medicines. We saw that identified actions were addressed within reasonable timescales.

If you want to see the evidence supporting our summary please read the full report.

This was a scheduled inspection in addition to checking that improvements had been made following concerns raised during our inspection of 8 November 2013. During our inspection of 8 November 2013 we identified concerns that the delivery of care did not always ensure that people’s individual needs, in regard to their welfare, were met.

At the time of this inspection, six people were living at Elliott House. We observed the care those people received, spoke with two people who used the service, the registered manager and three members of staff, as well as reviewing relevant documentation.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found.

Is the service safe?

There were risk assessments in place where required for people using the service in relation to their support and care provision. People were not put at unnecessary risk, but had choice and remained in control of their own decisions where they had the capacity to make those decisions. This meant that people’s independence was promoted and they were not restricted from engaging in and accessing the wider community.

Systems were in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This meant risks to people were reviewed and monitored to minimise any further risks and help the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Where necessary, applications had been submitted to authorise that any restrictions were in the best interests of the person. Some applications were in the process of being assessed. This meant that appropriate safeguards were in place to protect people.

People received care in surroundings that were safe and accessible and supported their health and welfare. Some refurbishment had taken place since the last inspection including the lounge, kitchen/dining room and a bedroom.

People were not fully protected against the risks associated with medicines that were prescribed to be used ‘as required’, because the systems and processes in place to manage those medicines were ineffective in practice.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to the management of medicines.

Is the service effective?

People’s health and care needs were assessed with them and they were involved in the formulation of their support plan.

People had food and drink support plans in place where needed, so that people were protected from inadequate nutrition and dehydration.

Discussions with people who used the service and staff told us that in the main, people made independent choices about their breakfast and lunch. Each person chose a meal, for the main meal of the day in agreement with other people using the service at a weekly house meeting they attended. Our observations evidenced that where the agreed meal was not wanted an alternative was offered. People were not rushed with their meal and staff tried to make the mealtime a social occasion for people, engaging them in conversation about their day. We saw that where people needed assistance, they were provided with this by staff

Is the service caring?

We saw that care workers showed patience and gave encouragement when supporting people. We heard staff engaging with people who used the service and this demonstrated positive relationships had developed. We heard staff treat people with kindness and compassion when providing their day to day care and responding in a caring way to people’s needs. Our observations of when staff spoke with people were that staff had a clear knowledge of people’s individual likes and preferences.

We observed that people went about their daily lives and moved around the home as they wished. We saw that people looked well presented, for example, their hair had been brushed/styled and people looked clean and were wearing clothes that were clean.

Is the service responsive?

Services were organised so that they met people’s needs. People completed a range of activities in and outside the service regularly and were assisted to access the community and maintain relationships with family members.

Is the service well-led?

The leadership, management and governance of the organisation was focused on the delivery of person-centred care. The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service encouraged an open and transparent culture, promoting communication with people, staff and other stakeholders.

Staff felt supported by the manager and felt they were able to raise any concerns with him.

Discussions with staff told us they were clear about their roles and responsibilities. Discussions on best practice, improved ways of working and incident reviews were common throughout formal team meetings and informal discussions.

The service had a quality assurance system in place and records seen by us showed that identified actions, in the main were addressed within reasonable timescales.

If you want to see the evidence supporting our summary please read the full report.

People were asked for their consent before care or support was provided and staff acted in accordance with people’s wishes.

We found the care provided to people did not meet their care and welfare needs. For example, there was little evidence of structured, stimulating activities for people and some people looked unkempt. People we spoke with said they were happy living at Elliott House and they told us, “I like it here. I like my 1:1 staff” and “I like living here with my friends.” There were contrasting views from the two family members we spoke with. One family member said, “We’re really pleased with the care [our family member’s] receiving. They’ve come on leaps and bounds since being in there [Elliott House]. They let [my family member] phone me. It’s better than the last place. They’re not neglected. All the staff have patience.” Another family member said, “[Family member] seems quite happy and the care seems fine, but when we visit they aren’t always clean and presentable and their clothes have spillages from meals down them.”

On the whole, people were cared for in a clean, hygienic environment.

The service operated an effective recruitment procedure.

There was a complaints system available. People and family members we spoke with said they would raise concerns if they needed to.

People with learning disabilities are not always able to tell us about their experiences. We used informal observation during our inspection visit and found staff members treated people with respect, dignity and maintained their privacy. We found people looked clean, tidy and had their personal care and welfare needs met.

During our inspection visit we talked to two people. People liked their bedrooms, the food and the various activities they were involved in. One person explained how they had enjoyed their recent holiday to Skegness with two members of staff. We talked to one relative who used the service by telephone during our inspection. Some comments captured included, “they’re brilliant [staff] and lovely people”, “I can’t praise them (Elliott House) enough” and “I’ve put my trust in all of them (staff)”.