Elm House 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 House provides care and support for up to four people with complex neurological needs following a traumatic or acquired brain injury. The service aims to provide short-term and long-term rehabilitation service to enable people to maximise their lives. At the time of our inspection there were three people using 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. At this inspection we found the service remained Good.

The service was Safe. People their medicines on time and in the right way. Systems were in place to keep people safe and risks had been assessed and considered. Recruitment processes were in place which made sure that staff were recruited safely.

The service was Effective. Staff were given a robust induction when they started and had been trained to meet people’s needs. They received regular supervision and appraisals. People had access 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; the policies and systems in the service supported this practice.

The service was Caring. 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. A range of activities was on offer and people were supported to live day to day lives such as socialising and working. We have made a recommendation about the accessible communications standards.

The service was Well-Led. Audits were carried out on a regular basis, and surveys had ben carried out which looked at the quality of the service people received. The registered manager had a clear oversight of the service.

Further information is in the detailed findings below.

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

Elm House is a residential care home that provides care and support for up to four people. The service aims to provide short-term and long-term rehabilitation service and enable people who have an acquired brain injury to continue to maximise their potential for improvement. At the time of our inspection there was one person 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 Cottage, provided by Partnerships in Care, the same provider and located a short distance away.

The service was last inspected 25 October 2013 and at that time requirements in the health and Social Care Act 2008 and associated Regulations were met.

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. They also provided 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 whilst 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 people living at Elm House were well supported. One person told us: “It is very good. I have no problems at all.” Another said: “The staff are kind and caring.” A relative we spoke to also spoke positively: “Elm House is a fantastic place. Staff are very caring.”

Care plans we reviewed were relevant and up to date. It was clear that staff supported people in a way that met their needs and preferences.

We found that there were enough skilled staff to meet people’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 also 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. Staff worked across both sites; and policies, procedures and operational practice were also the same.

We were not able to speak to all the people using the service because some had complex needs which meant they were not able to tell us their experiences. We gathered evidence of people's experiences of the service by observing care to help us understand the experience of people. We also reviewed surveys, the provider's monthly visit reports and complaints log.

We saw that staff and management had a good rapport with people living in Elm House. Staff were supportive and interacted well with people living in the service.

One person we spoke with told us they were very happy at Elm House and staff were very supportive, helpful and caring. They would feel comfortable to raise any concerns they may have with staff and management.

This person told us that they were very much involved in the running of the home and that they were treated with dignity and respect. They chaired the monthly resident meeting held jointly with the residents of the sister home Elm Cottage and were actively involved helping staff with health and safety checks and fire safety in the home.

This person also told us about how they had been supported to get volunteer jobs in the community.

Some of the people using this service have difficulty in understanding and responding to verbal communication. During our visit on 18 November 2011 there were two residents living at the home. One was at work at a local farm and the second person was unable to hold a conversation with us. Most of the information about people's experiences of Elm House was gathered through our observations and speaking with relatives. One person we spoke with told us “X has got on very well at Elm House. There is a family atmosphere and X gets on well with all of the staff. We have no concerns whatsoever. X is happy and we are happy.” We saw that the one person at the home at the time of our visit on 18 November 2011 was well supported and well supervised by care staff. A relative told us that they found the service ‘fantastic’. They told us that “X used to be worried and insecure and X is now calmer, methodical and organised." They also told us that “Elm House is nice and secure. X is very safe there.”

We saw that staff spent time with people and gave them reassurance about their care and daily routines or concerns they had. We saw that staff spoke with people in a friendly and respectful way, supporting them and spending time with them.