About the service: Elm Tree House is a residential care home that was providing personal and care for 15 older people at the time of the inspection.

People’s experience of using this service:

¿The provider had not ensured enough staff were deployed to meet people's needs throughout the day. Staff did not always have time to support people with meaningful and fulfilling activities. When they had time, the activities were meaningful and stimulating.

¿People did not have personal emergency evacuation plans that would be used in the event of an emergency, such as a fire. These were completed after our inspection.

¿People were happy living at Elm Tree House. They felt safe and liked the staff who looked after them. Relatives were satisfied with the service the staff gave to their family members and they felt welcomed at the home.

¿Staff enjoyed working at the home and felt supported by the manager. They understood people's needs their needs and had received the relevant training.

¿Staff were caring and supported people in ways to make people feel they mattered to them. Staff respected people’s privacy. People were involved in decisions about their care and support.

¿Staff followed infection prevention and control procedures. However, during our inspection we saw a mouse in the manager’s office. The manager arranged for a pest control person to come to the home. We reported this to the appropriate local authority environmental health department.

¿Staff supported people to access health services when they needed them. External healthcare professionals supported staff to help people maintain or improve their health.

¿Staff supported people to have enough to eat and drink. Staff cooked a variety of nutritious meals, based on people’s choices and including special diets for those who needed them.

¿Staff did not always weigh people when they should. Two were weighed a month after they were last weighed instead of a fortnight later.

¿Staff supported people to have the 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. However, not all staff understood the purpose of the Mental Capacity Act 2005. We have made a recommendation about staff training on the subject of the Mental Capacity Act 2005.

¿The provider was working to improve the décor of the premises to make them ‘dementia friendly’.

¿When staff had time they supported people to participate in activities they enjoyed. Staff had creative ideas about activities but did not always have the time to support people with these.

¿The provider had not ensured that the Care Quality Commission (CQC) were notified of events or changes at the service.

¿ The service did not have a registered manager. The provider had not supported the manager to understand and meet the responsibilities of a registered manager.

¿The provider wanted to improve the service but there was no plan of how they would do this.

¿We found there were breaches of regulations. Action we told the provider to take is at the end of the report.

Rating at last inspection:

At the last inspection we rated the service Good (Report published 16 July 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At this inspection we found the service had dropped to Requires Improvement. We found that the provider was in breach of two regulations. Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We have required the provider to submit an action plan of how they intend to improve the service. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We carried out an unannounced inspection of the service on 27 April 2016.

Elm Tree House provides accommodation to older people. It is registered for a maximum of 17 people. There were 11 people receiving care and support at the home at the time of our visit.

On the day of our inspection there was a registered manager in place. 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.

People felt safe and the home offered a safe environment for people to live. People were supported by staff who understood how to protect and keep people safe. Appropriate processes were in place to support staff to report allegations of abuse if required. Risk assessments were in place to identify and reduce the risk to people’s safety. Sufficient numbers of staff were in place to keep people safe and the provider followed safe recruitment processes. Medicines were stored and handled safely.

People were supported by staff who had completed an induction and relevant training to help them carry out their role. Staff were knowledgeable about the people they cared for and how to best meet their needs.

People’s rights were protected under the Mental Capacity Act 2005. People were supported to have sufficient to eat and drink. People received effective care relevant to their needs. They had access to relevant health care professionals to maintain their health and wellbeing.

People were cared for by kind and compassionate staff. Staff interacted with people in a caring and friendly manner. People were able to contribute to their care and support. People’s privacy and dignity was protected. Arrangements were in place to share information to support people with independent advocates if and when required.

Care plans were personalised to meet people’s relevant needs and what was important to them. The staff encouraged people to participate in activities that were available in the home. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were complimentary about the management team. The registered manager actively sought people’s views and acted on them. There were systems in place to monitor and improve the quality of the service provided. The service was led by a registered manager who had a clear understanding of their role and how to improve the lives of people at the service.

The inspection team who carried out this inspection consisted of one inspector to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Prior to our inspection we reviewed all the information we had received from the provider. We used a number of different methods to help us understand the experiences of people who used the service. We held conversations with people who used the service. We spoke with the manager and two staff. We also looked at some of the records held at the service which included people’s care plans.

Is the service safe?

People told us they felt they received their care and support in a safe and considerate manner. One person told us, “I feel safe, all the staff are wonderful. We have a good laugh and joke,” whilst another said, “As far as I am concerned I am very safe and could not be in a better home.”

People told us they were aware of the complaints procedure and felt confident that the manager would address any issues of concern in a timely manner. One person told us, “I have never complained about anything, if I did I’m sure the manager would sort it out.”

We found that an on call system was in operation to ensure a member of the management team or the proprietor would be available at all times should an emergency situation arise.

Is the service effective?

Systems were in place to ensure that people’s individual support needs could be identified and met. We found that people’s care packages were delivered in such a way that met their individual needs. We also established that staff had a good understanding of people’s individual needs and preferences and how they were to be met.

Is the service caring?

People told us that staff were respectful and caring at all times. One person told us, “I would give the home ten out of ten,” whilst another person said, “I couldn’t be in a better place, all the staff are excellent, so cheery and caring.”

We asked a visiting professional to provide their views on the quality of service provision. They told us, “I think the home looks after the residents very well. The staff have a very good rapport with the residents and they appear to be very well cared for.”

Is the service responsive?

We found that systems were in place to ensure that needs assessments were performed when people expressed a desire to use the service. We also found that information from people’s relatives and professionals, such as social workers were incorporated into the assessment process. This was to ensure a comprehensive picture of people’s individual support needs could be identified. We found the reviewing procedures at the service had been amended since our previous inspection to ensure that care plans were up to date and reflected people’s individual needs.

Is the service well-led?

We found the manager to be fully aware of their roles and responsibilities and what was expected of them. We found that they had initiated procedures and amended practices following our previous inspection to ensure they were compliant with essential standards.

We found that the manager had undertaken staff supervision to ensure the care staff received appropriate training, support and direction. Staff spoken with said they felt fully supported by the manager and felt they were valued and respected.

Records showed that people residing at the home, and their relatives, had been supplied with a satisfaction survey so they could make comments about the quality of the service they received. Furthermore we found that the information gleaned from the consultation process was analysed by the manager to develop the quality of the service whilst recognising where improvements could be made.

There were sixteen people living at the home at the time of our inspection. During our visit we spoke with two people who were living at the home, two members of staff and one relative. We also reviewed three sets of care records.

Both people we spoke with told us that they were happy with the care they received. Staff members said that they liked working at the home. One member of staff said “It’s good working here, I have time to give a good standard of care.”

During our visit we found that the provider’s arrangements for the management of infection control were not adequate.

We spoke with four people who used the service. People’s comments were positive and included: “they’re very good”, “I’m happy here” and “carers are kind and helpful”.

Comments from the last satisfaction survey included ‘[X] has been in Elm Tree House over 2 years now and I have no cause to complain about anything. They treat everyone with dignity and respect and the carers are very proficient’ and, ‘would recommend the home to others’.

We looked at the care plans and records of four people who used the service. We found people’s needs were assessed and care was planned and delivered in line with their individual plan.

We found people were cared for in a clean and hygienic environment and that staff had received appropriate professional development.

The provider had an effective quality assurance system.

The service was compliant with the essential standards of quality and safety that we inspected.