Elm Farm Residential Home provides residential support and care for up to 12 older people. At the time of our inspection there were 12 people living at the home. At the last inspection, in February 2015, the service was rated Good. At this inspection we found that the service remained Good.

People continued to receive safe care and there were enough staff to provide support people’s needs. People were protected from the risk of harm. People received their medicines as prescribed. Staff were suitably recruited to ensure they were able to work with people who lived at the home.

People made decisions about their care and staff sought people’s consent. Where people lacked capacity they were helped to make decisions. Where their liberty was restricted, this had been identified and action taken to ensure this was lawful. People received supported to stay well and had access to health care services. They were able to choose what to eat. Staff received training to meet the specific needs of people who used the service.

People were treated with dignity and respect. People were asked their preferences about how they wanted to be supported and cared for. These details were recorded in people’s care plans including their end of life wishes.

People and their family members were involved in the planning and review of care and support provided. People knew how to make a complaint or raise a concern.

Systems were in place to assess and monitor the quality of the service. People and staff were encouraged to raise any views about the service on how improvements could be made. The registered manager promoted an open culture which put people at the centre of the service.

We carried out this inspection on 16 December 2014. The inspection was unannounced.

The home is registered for a maximum of twelve people offering personal care and accommodation to older people and to older people with dementia. The service has a registered manager. The 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. On the day of our inspection the registered manager was on leave. The assistant manager was managing the home that day.

Elm Farm is an older style property over two floors with a large conservatory ‘courtyard’ in the centre. At the time of our inspection 12 people lived at the home. Two of the rooms were shared rooms. The home also offers respite facilities. The registered manager lives on site.

At our last inspection in June 2014, we identified breaches of the Health and Social Care Act 2008. (Regulated Activities) Regulations 2010 in relation to Regulation 10, Assessing and monitoring the quality of service provision. We found that the manager did not carry out regular audits of the service and that risks were not assessed, identified and managed. Following this the provider sent us an action plan which told us about the improvements they intended to make. At this inspection we found improvements had been made. The assistant manager was able to show us many changes which had benefited them in managing the service.

People who lived at the home, relatives and staff told us people were safe. There were systems in place to protect people from the risk of harm. These included comprehensive staff recruitment and training practices. Procedures were in place to effectively protect people against risks of abuse.

We saw that staff were respectful in their approach to people and people told us staff were caring. Staff understood the need to ensure privacy and dignity when providing care and could give examples of how they did this. People told us there were enough staff to care for them.

The provider was meeting the requirements set out in the Deprivation of Liberty Safeguards (DoLS). At the time of this inspection, no applications had been authorised under DoLS for people’s freedoms and liberties to be restricted. The assistant manager was aware of recent changes in legislation.

Records showed people’s health and social care needs had been appropriately assessed. Care plans provided detailed information for staff to help them provide the individual care people required. These showed they had considered people’s backgrounds, interests and preferences so social activities could be personalised. Risks had been assessed and plans were in place to minimise these.

There was a system in place for managing and storing people’s medications safely. This had recently been reviewed by the Clinical Commissioning Group and some further improvements were being made by management.

This inspection was completed by one inspector. Due to their complex health conditions we were unable to speak with some people who used the service. We observed their experiences to support our inspection. We spoke with four people who used the service, the manager and three care staff. We also spoke with the activities coordinator and the cook.

Below is a summary of what we found. The summary describes what people told us, what we observed, the records we looked at and what staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff were aware of the provider's whistleblowing policy.

Staff knew about people's risk management plans and we saw they were supported in line with those plans. This meant people were cared for in a way that protected them from harm.

The provider worked well with health care providers to ensure people's health needs were met and they were protected against harm.

Systems were not in place to make sure the manager and staff learned from events such as accidents and incidents, complaints and checks made on the service. This increased the risk to people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People’s care needs were assessed with them. We saw evidence that people were involved in their care planning and reviews. We saw care plans were regularly updated. One person told us, "The staff always ask what I need."

Where people had complex needs that required the input of specialist health care services, assessments had been made by the appropriate professionals. Their recommendations were carried out by staff. This meant the provider worked well with other services to ensure people's health care needs were met.

Staff were appropriately supported and trained to ensure they effectively met people's needs.

People were cared for in a clean, comfortable and appropriate environment which afforded them privacy.

Is the service caring?

People were supported by kind and caring staff. We saw staff were patient and encouraged people to be independent. One person told us, "The staff are wonderful, very caring and kind."

People’s preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people’s wishes.

Is the service responsive?

People had the opportunity to plan and engage in a range of different activities each day.

People were asked their views about the service and the provider acted on comments that people made.

Where care staff had noticed people's changing needs, their care plans were updated to reflect this. We found staff discussed people's care needs with them on a regular basis.

Is the service well led?

The provider did not have risk management systems in place. We found the provider had not checked that risks were managed effectively.

The provider sought the views of people who used the service. Records seen by us indicated that people were not asked about all aspects of the service. For example, people were not asked what meals they would like to see on the menu.

Staff told us they were clear about their roles and responsibilities. Staff told us the service was well organised and they felt supported by their manager.

During our visit to Elm Farm we spoke with five people living in the home and four staff.

People living at Elm Farm told us,

Staff were, “Very nice.”

The food was, “Very good, like home, and you get plenty.”

“I love it…I’m happy here, the girls are very nice and the food is nice...no complaints.”

We observed a very good rapport between people living at Elm Farm and staff supporting them.

We looked at the care provided to people living at Elm Farm. We were satisfied that people were having their care needs met by staff who knew them well.

We looked at cleanliness and infection control. The home was very clean and had good systems in place to minimise the spread of infection.

We looked at how people living at Elm Farm were safeguarded from abuse. We were satisfied that staff and management knew what to do if they had any safeguarding concerns. People living at Elm Farm told us they felt safe living at the home.

We looked at the level of staffing and the skills staff had to undertake their role. We were satisfied there were sufficient staff to meet the needs of people living at the home. Staff had received appropriate training to help them undertake care effectively.

We spoke with people living at Elm Farm. People were happy with their care. A typical view was "Staff are wonderful."

We observed staff being kind and considerate to people. We saw people being treated with dignity and respect. People were seen to have developed good relationships with each other, and with staff.

We looked at the care records of three people. These demonstrated the care needs of people were appropriately assessed and updated as soon as care needs changed. The service worked well with other health care professionals.

We looked at menus. We saw that people were provided with a good range of meals which met their dietary needs. During our visit we observed people having breakfast and their main lunch time meal. They were seen enjoying the food provided and the experience of sitting and eating together.

We checked the administration and management of medicines. We were satisfied the service administered medicines safely to people living at the home.

We noted the service had a good activities programme. On the day of our visit people were seen joining in with a visiting singer and accordion player. They enjoyed singing and dancing along with him.

We checked staff recruitment processes and were satisfied that relevant checks were made to keep people safe.

We looked at the formal and informal complaint processes and were satisfied that people felt able to tell staff if they had any concerns, and these would be acted upon.

People told us that they were happy with the care they receive. They commented that the staff team were “very nice” and “very friendly”. Some people were not able to express their views about the service; however observation of their interaction with staff indicated that they had made positive relationships with them.