At the last inspection in November 2015, the service was rated 'Good'. At this inspection, the service continued to be good.

Elmdon House provides care and accommodation for up to six people with a diagnosis of a learning disability or autistic spectrum disorder. There were five people living in the home in the time of our visit.

There was a registered manager in post at the home. 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 living at Elmdon House and there were enough staff to support people safely. Procedures were in place to protect people from harm and staff knew how to manage the risks associated with people’s care. Accidents and incidents were analysed and action had been taken to reduce the risk of reoccurrence.

The provider’s recruitment procedure minimised the risks to people’s safety. New staff were provided with effective support when they stated work at the home. Staff received on-going training to ensure they had the skills to care for people effectively.

The provider was working within the principles of the Mental Capacity Act (2005). Staff respected the decisions people made.

Staff were caring and knew people well. They approached people in a friendly way and we saw interactions between people and the staff were positive. People were happy with how the home was run and they were involved in planning and reviewing their care. They told us they felt listened to and they had opportunities to feedback on their service they received.

People were offered choices and supported to pursue their hobbies and interests. Staff were responsive to people’s needs and understood the way people preferred to communicate. People were supported to be independent and staff respected people’s right to privacy.

People’s medicines were stored and administered safely. People received the care and treated they required from health professionals. People had enough to eat and drink and staff were knowledgeable about people dietary needs.

People knew how to make a complaint and felt comfortable doing so. Staff felt supported by their managers and enjoyed working at the home Effective systems to monitor and the review the quality of the home were in place.

When we visited Elmdon House on 10 April 2014 we found medication management was not sufficiently robust to ensure medicines were always administered safely to people. Staff had not completed the required training to make sure they could carry out their role effectively and were not supported through regular supervision. We visited the home on 24 July 2014 and checked whether actions had been put in place to ensure improvements in these areas.

We found the service had appropriate arrangements in place for the management of medicines.

There were protocols in place for people who required their medication on an "as required" basis to support staff in administering that medication consistently.

Staff administering medication received appropriate training and had their competency to administer medicines assessed.

During this inspection we saw progress had been made to ensure staff received regular training. All staff had received formal supervision since our last visit. A central record of staff training and supervision was maintained.

We inspected Elmdon House and spoke with the deputy manager and three care staff about the support they gave to people who lived at the home. Speaking with these people helped answer our five questions. Is the service safe? Is the service effective? Is the service caring? Is the service responsive and is the service well led?

Below is a summary of what we found. This summary is based on our observations and evidence we found during the inspection. During our visit we were able to spend time and chat with the people who lived at the home.

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

Is the service safe?

Elmdon House was suitable, safe and accessible for the people who lived there. Bedrooms were large enough for staff to be able to assist those people who required the support of a hoist when being moved. We saw the home was clean and well maintained with no unpleasant odours.

We saw risk assessments had been carried out for the service as a whole and for individual risk areas in people lives. There were appropriate certificates in place to confirm external checks of electricity, gas and emergency equipment.

The service was aware of their obligations in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLs). For one person the appropriate healthcare professionals and an independent advocate had been involved in a meeting to ensure any decisions made about the person's care were made in their best interests.

We looked at how medicines were managed within the home. We found one person was on medication to manage their behaviours. There was no protocol in place to inform staff when this medicine should be administered. We found the amounts in stock of medicines administered directly from the packet or box did not always correspond with medication records. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.

Is the service effective?

Care records contained sufficient information to support staff in consistently meeting people's needs. The plans were person centred and reflected people’s individual needs. Where risks to health or well-being had been identified, risk assessments had been put in place to manage those risks. Where people had identified physical health needs there were guidelines in place for staff to follow to meet those needs.

We looked at staff training records. We found staff did not always receive the required training to support people effectively. We found some staff had not completed the necessary training which had the potential to place people at risk of receiving inappropriate care or support. We also found the provider did not have an effective system in place that made sure staff had regular supervisions to discuss any concerns, performance or training needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff and making sure all staff are trained to the appropriate level.

Is the service caring?

People living at Elmdon House showed interest in each other and what others had been doing. When new staff came on duty people reacted positively and appeared pleased to see them. People approached the staff as they wanted throughout the day. People we spoke with appeared relaxed and comfortable in their surroundings. One person told us, "I am happy. I like it here."

People were well presented and wearing clothes that reflected their individual choices, age and preferences.

People living in the home chose the meals they wanted at weekly meetings. At lunch time staff assisted people to make choices. For example, people were shown a box of crisps and were asked to choose which flavour they wanted. This meant people were able to understand the choices they were offered.

Is the service responsive?

Records showed that other health professionals were involved in people’s care. Staff told us they would contact the relevant health professional when needed and records confirmed this. Staff we spoke with were able to tell us about the individual needs and abilities of people and how they supported their mental health as well as their physical health.

Is the service well-led?

At the time of our visit the service had been without a registered manager since December 2013. The provider had put plans in place to provide managerial oversight during this period. A recently appointed deputy manager had been in post for two weeks and taken over some of the responsibilities of the registered manager. Staff we spoke with confirmed that after a difficult period, the service was now more settled. One staff member told us, "It is more relaxed." We have asked the provider to keep us informed of their progress in appointing a registered manager.

The service carried out a range of checks and audits to monitor the quality of the service provided. Staff meetings provided an opportunity for staff to discuss ideas for the benefit of people who lived in the home.

When we visited Elmdon House in May 2013 we identified that some people's care records did not have up to date risk assessments.

During this follow up inspection we looked at three people's care records. We saw that where risks to people had been identified, risk assessments had been put in place to support staff in managing that risk.

We found that records were kept securely and were located promptly when required.

We saw records were in good order and well maintained.

On the day of our visit there were six people living at Elmdon House. We spoke with all the people living there. As some people had very limited communication we spent time observing how staff supported people throughout the day. We also spoke with three members of staff and the manager.

On the day of our visit we observed staff being sensitive to people's needs and responding to requests. People appeared relaxed in their home and when approaching staff. We saw there were enough staff on duty to meet the needs of people. One person described the staff as 'kind'.

Care plans were in place detailing people's care needs. These provided staff with detailed information about what support they needed to provide. Records showed that people were referred to other health care professionals at regular intervals and if a change in health was identified.

Staff we spoke with demonstrated a good awareness of their responsibilities for keeping people safe and reporting any concerns about suspected abuse.

We saw there were systems in place to monitor the quality of the service provided.

We found some improvements were needed in relation to the management of records in the home. We saw risk assessments were not always being regularly reviewed. Risk assessments were not in place to manage some identified risks.

We carried out this inspection to check on the care and welfare of people using the service. We visited Elmdon House on 15 June 2012. There were six people living in the home at the time of this visit. No one knew we would be visiting. We spoke to four people who used the service, three members of staff and the manager.

There was a relaxed friendly atmosphere in the home which was clean and well maintained. Each person had their own bedroom with en-suite shower room and toilet.

We saw people moved comfortably around the home. Staff respected it was their home. We saw people being assisted to make choices and maintain independent living skills. One person told us, “I like living here.” Another said, “I am happy.” The manger told us, “This is generally a calm and loving home.”

People’s records provided detailed information that enabled staff to provide care in the way people preferred. Staff records were not maintained in such good order.

We saw medicines were stored safely and people received their medication in accordance with their care plans.

Whilst the home was clean and tidy, we saw infection control procedures in the laundry were not always followed. This compromised the health of people who lived in the home.

There were detailed recruitment and selection processes in place for new staff. Staff told us they felt supported by their manager. One staff member described the manager as, “Very much hands on. Great to work with.”

This inspection took place on 19 and 20 November 2015. The first day of our inspection was unannounced.

Elmdon House provides care and accommodation for up to six people with a diagnosis of a learning disability or autistic spectrum disorder. The communal areas of the home are on the ground floor, together with three bedrooms. The rest of the bedrooms are on the first floor. There were five people living in the home at the time of our visit.

There was a registered manager 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.

There were sufficient staff to meet the needs of people both inside and outside the home. There were ‘on-call’ arrangements to ensure night staff received extra support if there was an emergency. Staff received regular training and new staff were provided with a thorough induction to help them understand people’s needs and how to support people effectively. Additional training was provided when there was an identified change in people’s needs.

Staff had received training in keeping people safe and understood their responsibility to report any observed or suspected abuse. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks. Staff were knowledgeable about each person’s risks and need for support.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA). Where people had been assessed as lacking capacity, the registered manager had obtained the services of an advocate or arranged best interest meetings. Where people were able to make their own decisions, staff respected the decisions they made. Where people’s freedom was restricted, the provider had applied to have this authorised by the local authority.

Staff were kind and considerate to people, patient and attentive to their individual needs. Staff respected and understood people’s need for privacy and promoted their dignity when providing personal care.

People received a balanced diet, and were involved in menu choices. People were referred to external healthcare professionals to ensure their health and wellbeing was maintained. Medicines were managed safely so that people received their medication as prescribed.

The leadership team had a good understanding of their roles and responsibilities, and provided good support to staff and the people who lived at the home. People, relatives, staff and visiting healthcare professionals were asked their opinions about the service and there were processes to monitor the quality of care provided. Action had been taken when a need for improvement had been identified.