Elm Cottage is a ‘care service’. People in care services receive accommodation and personal care under a contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Elm Cottage provides care and support for up to three people with complex neurological needs following a traumatic or acquired brain injury. The service aims to provide short-term and long-term rehabilitation service and enable people to maximise their potential for improvement. At the time of our inspection there were three people using the service.

This inspection took place on 16 April 2018. The inspection was unannounced, this meant the staff and provider did not know we would be visiting. At the last inspection on 13 November 2015, the service was rated ‘Good’. At this inspection, we found that the service remained good.

A registered manager was 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.

The service was Safe. The service had appropriate systems in place to keep people safe and staff followed these guidelines when they supported people. There were a sufficient numbers of care staff available to meet people’s care needs and people received their medication as prescribed and on time. The provider had a robust recruitment process in place to protect people from the risk of avoidable harm. They had been recruited safely with the skills and knowledge to provide care and support to people.

The service was Effective. Staff received regular supervision and had been trained to meet people’s needs. Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice. A wide range of activities was provided, which included involvement and use of local and wider community based activities.

The service was Caring. People were cared for and supported by staff that understood their needs and knew them well. Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights. The care and support people received was individualised.

The service was Responsive. People’s health and emotional needs were assessed, monitored and met in order for them to live well. The policies and systems in the service support this practice. The service worked closely with relevant health care professionals and people received the support they needed to have a healthy diet that met their individual needs.

The service was Well-Led. There were systems in place to drive improvement and audits were carried out on a regular basis, which looked at the quality of the service people received. The registered manager had a clear oversight of the service.

This inspection was unannounced and carried out on 13 November 2015.

Elm Cottage is a residential care home that provides care and support for up to three people with complex neurological needs following a traumatic or acquired brain injury. The service aims to provide short-term and long-term rehabilitation service and enable people to maximise their potential for improvement. At the time of our inspection there were three people using the service.

A registered manager was in post at the service. 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 similar service, Elm House, provided by Partnerships in Care, the same provider and located a short distance away.

People were protected from avoidable harm and potential abuse. This was done consistently so that people were safe whether they were in the service itself or out in the community. Potential risks of harm to the individual or others in their daily lives were assessed and identified. Detailed management strategies were planned for to provide guidance to staff on what actions to take to minimise risk and provide appropriate and individualised support that enabled people to participate in activities of their choice and access the community safely. Management and staff had a positive attitude towards managing risk while balancing the need for preference and choice with safety and effectiveness.

The provider had a thorough recruitment and selection process in place to check that potential new staff were suitable to work with people who used the service. People were supported by sufficient numbers of staff. Staffing levels were flexible and supported people to follow their interests, receive care and therapy, take part in social activities and, where appropriate education or work.

Medication was stored safely and administered correctly. The provider had robust systems in place to ensure medication was managed safely and appropriately.

Staff had developed good relationships with people living at the service and respected their diverse needs. They were caring and respectful and had the required knowledge and skills they needed to meet people's needs appropriately and safely. Staff knew people's individual care and support needs well. People's privacy and dignity was respected and upheld and they were supported to express their views and choices.

Management and staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions in some areas of their care and support.

People received personalised care specific to their individual needs; their independence was encouraged and their hobbies and interests supported. They received continuing specialist help pertinent to their needs and healthcare needs. They had prompt access to healthcare professionals when they became unwell.

The provider had arrangements in place to routinely listen and learn from people's experiences, comments and views. There was a strong emphasis on promoting good practice in the service and there was a well-developed understanding of equality, diversity and human rights and management and staff put this into practice. The registered manager was knowledgeable and inspired confidence in the staff team, and led by example.

Quality assurance systems were robust and helped to ensure the service delivered was of a good quality and safe, and continued to improve.

We found that the person living at Elm Cottage was well supported. They told us: “It’s nice to live at Elm Cottage. I have no complaints.” We saw that Elm Cottage had recently been refurbished. The environment was clean, comfortable and well maintained.

The person’s care plan was relevant and up to date. It was clear that staff supported the person in a way that met their needs and preferences.

We found that there were enough skilled staff to meet the person’s needs. Staff told us they enjoyed their work and felt supported. However, supervision records were not consistently up to date and it was not always possible to locate appraisal records.

A number of different systems were in place to monitor the quality of care provided. We saw that the provider regularly sought the views of people who use the service and responded to feedback.

We reviewed a wide variety of records during our inspection. Overall, we found they were accurate, accessible and securely held.

We saw that Elm House worked closely with Elm Cottage, a similar community facility also managed by the provider. Staff worked across both sites; and policies, procedures and operational practice were the same.

During our visit we spoke with two people who were using the service. They both told us that the home was very nice and the staff were very kind, helpful and caring. One person said 'The staff are great'. The other person said 'It's not where I want to be, but they make it very nice'.

One person told us that they were not getting out as much as they would like to because of recent staff shortages. They told us that they had the opportunity through the resident meetings to give their views and express their choices in their day to day lives such as activities, social outings and meals.

They both told us that they were very much supported to be involved in decisions about their care and support. One person told us that they regularly saw an advocate and the other told us that they were supported by their family.

Some of the people using this service have difficulty in understanding and responding to verbal communication. During our visit on 18 November 2011 we were able to hold a conversation with one person and one relative. Most of the information about people's experiences of Elm Cottage was gathered through our observations. One person we spoke with told us “The home is very good, very nice. The staff are brilliant.” We spoke with a relative who told us “X is happy at Elm Cottage. The staff are marvelous. They always get in touch with me if anything happens. I am really happy with the home.” We saw that people were cared for in a relaxed and family type home where the focus was on their care needs and rehabilitation with the ultimate goal of returning to the community.