About the service:

Elmlea is a ‘care home’ for 10 people. Elmlea consists of a home for eight people and a separate bungalow for two people. The service supports adults living with a learning disability or complex behavioural needs.

To ensure this felt like people’s own home, there were no deliberate signs to indicate Elmlea was a care home. The home is in a residential area within Gloucester. Support staff wore their own clothes when working with people including when supporting people in the community. 10 people were living at Elmlea at the time of our inspection.

People’s experience of using this service:

The service was developed to reflect the principles and values that underpin Registering the Right Support and other best practice guidance. Registering the Right Support ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that was appropriate for them.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways:

• Staff understood how to communicate with people effectively to ascertain and respect their wishes.

• People’s independence was respected and promoted. Staff prompted people during household tasks and activities, to enable them to do things for themselves and learn new skills.

• People's support focused on them having opportunities to be part of their community, meet their wellbeing needs and maintain existing relationships.

• Health and social care professionals guided staff to support people with their healthcare needs and behaviours in accordance with national best practice guidelines.

• Risks to people had been assessed and plans were in place and followed by staff to keep people safe.

• Safe recruitment practices were followed to protect people from unsuitable staff. There was a stable staff team which promoted a high continuity of care and support.

• Staff were knowledgeable around safeguarding and understood provider policies and procedures in this regard. There were good links with local safeguarding bodies.

• Systems were in place to ensure people received appropriate support to take their medicines safely.

• Staff received supervision, felt supported in their role and received the training they needed to support people’s needs.

• Staff attitudes and behaviours were responsive, respectful and caring.

• People were supported to take positive risks and their goals and wishes were acknowledged and worked towards.

• Interactions between staff and people demonstrated personalised, collaborative, action-oriented care and support.

• There were processes in place to manage adverse incidents and complaints. There was evidence that learning from incidents was shared across the service and with healthcare professionals.

• Effective quality monitoring systems were in place and regular audits and checks supported the registered manager and deputy manager to identify concerns promptly, to take action to improve the service.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

We received positive feedback about the service and the care people received. The service met the characteristics of ‘Good’ in all areas. For more details, please see the full report which is at the CQC website at www.cqc.org.uk

Rating at last inspection: We last inspected Elmlea on 14 January 2016. This was a planned comprehensive inspection. At the last inspection the service was rated ‘Good’ (this report was published on 18 February 2016). At this inspection the service remained ‘Good.’

Why we inspected:

We inspected this service as part of our ongoing Adult Social Ca

This inspection took place on 14 January 2016 and was unannounced. Elmlea provides accommodation and personal care for up to ten people with a learning disability or autistic spectrum disorder. There were ten people living in the home at the time of our inspection. Elmlea consists of the main house which has a lounge, dining room, kitchen and eight bedrooms set over two floors. Two one-bedroomed bungalows were also set in the grounds of the main house. People had access to a secured outdoor space.

A registered manager was in place as required by the service’s conditions of registration. 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.

One of the showers in the communal bathroom of the main house had not been maintained which meant that it could not be effectively cleaned and therefore put people at risk of cross contamination.

Staff delivered compassionate care which was focused on people’s individual needs. They were knowledgeable about people’s wishes and preferred way to be supported. Staff respected people’s decisions and provided support when requested. Both people and their relatives complimented the caring nature of staff. We received many positive comments about the home.

A wide range of activities were provided for people in and out of the home. People were encouraged to partake in activities. They told us they enjoyed the meals and were encouraged to maintain a balanced diet. People’s bed rooms had been decorated to their taste. Staff supported people to maintain links with their families. Relatives were positive about the care people received.

People’s care plans were personalised and reflected their needs, choices and risks.

They were supported to maintain their health and well-being and to access health and social care services as required. The home had identified people’s risks. Records provided staff with guidance on how they should be supported if they became upset. Staff were knowledgeable about safeguarding people and recognising signs of abuse. People’s medicines were managed well. Systems were in place to ensure people’s medicines were ordered and given to them on time by competent staff.

Processes where in place to ensure there were suitable numbers of staff to meet people’s needs. The employment and criminal histories of new staff had been checked to ensure they were of good character. Staff demonstrated understanding about their responsibility to protect people’s human rights. They had been trained to support people with complex needs. People were supported by staff who regularly met with their line manager to discuss any concerns.

The home was well-led. The registered manager had a good understanding of their role and how to manage the quality of the care provided to people. People and those important to them had opportunities to feedback their views about the home and quality of the service they received. Monitoring systems were in place to ensure the service was operating effectively and safely. Internal and external audits were carried out to continually monitor the service provided.

The people who used the service all had differing communication needs. We observed that staff knew each of the people well and knew how to communicate with each person effectively. Each person had a plan of care in place that was up to date and reflected people’s individual needs. As an example people had specific guidance in place on how they expressed happiness, sadness, their likes and dislikes. We saw that people were well presented and were able to participate in a wide range of activities. Staff were supported in their professional development and received regular supervision. The manager confirmed that the last complaint had been received in October 2012.

The comments from staff included “It’s a brilliant company to work for”. “Staff remember that they are in someone’s home and not just where they come to work”. “We have a good team here”. We also saw comments from the local GP which said "The staff I see are well trained". The provider sent out yearly satisfaction surveys to people who used the service, their families and other health and social care professionals. We saw the results for the 2013 surveys which were sent out before our visit. Three relatives and a GP had completed surveys. All were very positive and all recommended the home. The comments from these surveys included “my family have always been very pleased with the help and support from the staff”. “The staff were very friendly and nothing is too much trouble for them”.

We looked at the care files for two people and observed the communication between staff and people who use the service. Overall we observed staff interacting very well with people in a warm and friendly manner. We observed staff knocking on people's doors before entering and we were introduced to people during our visit. People who used the service had their dignity respected and staff were respectful of their needs.

We looked at the care files for two people and overall found no cause for concern. Care plans and risk assessments were in place and appropriate to each individual. They had been reviewed on a regular basis and were person centred where appropriate. For one person their care plan for how they communicated was accurate and we observed staff following this.

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.