This inspection took place on 18 and 30 October 2018 and was unannounced.

Elmsmead is a residential home for up to 12 people with learning disabilities, including autism. At the time of the inspection 10 people were living at the home. The home specialised in supporting people who may become challenging to themselves or others if their anxiety was heightened. There were bedrooms on both floors of the building and a range of communal spaces. Each bedroom was personalised by the person and no one shared although there was an option to share if people wanted to.

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.

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At this inspection we found the service remained Good.

Why the service is rated …

Since the last inspection the management and provider had worked hard to ensure there were continual improvements at the home. There had been redecoration and a reduction in incidents occurring at the home. People, relatives and staff were positive about the registered manager. The registered manager and provider continually monitored the quality of the service and made improvements in accordance with people’s changing needs.

People received care from staff who knew them incredibly well. People were involved in decisions about their care and the staff continuously were finding ways to share the information with people. Feedback from people and relatives to the home informed us about how well cared for they felt.

Care and support was personalised to each person, which ensured they could make choices about their day to day lives in line with their needs, hobbies and interests. Information about people's preferences were gathered in detail by members of staff. Time was provided for new staff to learn about people’s care through the care plans.

People were supported to have a dignified death and support was provided for those who lost people they lived with. People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. People, or their representatives, were involved in decisions about the care and support they received.

The service was responsive to people’s individual needs. Activities were personalised to each person’s preferences and hobbies. Staffing levels reflected the ethos that all staff were encouraged to support people with activities and in all aspects of their care. There was a range of opportunities for people and their families to participate in.

There was a system in place to manage complaints and people felt listened to. Plans were in place to further develop opportunities to learn from people. The provider had developed ways of promoting employment for people. There were opportunities for people to drive improvements within the home.

There were suitable numbers of staff to meet people’s needs and to spend time socialising with them. Interactions were kind and caring. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People received their medicines safely. People were protected from abuse because staff understood how to keep them safe and were sure action would be taken if any concerns were raised.

The home continued to ensure people received effective care. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People who required special diets had their needs met and healthy eating was promoted. Staff had the skills and knowledge required to effectively support people. People told us their healthcare needs were met and staff supported them to attend appointm

Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s).

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

We looked at the personal care or treatment records of people who use the service, carried out a visit on the 10 September 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members and talked with staff.

We considered all the evidence we had gathered under the outcomes we inspected. We used information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is the summary of what we found:

On the day of our inspection at Elmsmead there were eight people living there. We spoke to three people living at the home and eight staff.

Is the service safe?

We observed people were cared for in an environment that was clean safe and hygienic. Two people were able to tell us they felt "safe" and knew they could "trust" the staff to care for them at the home. One person said "The staff are always kind to me and my partner and I know I can always talk to them about anything that is worrying me". We noted that appropriate safeguarding arrangements were in place in the form of safeguarding and whistleblowing policies. Staff had attended training in the Mental Health Act 2005 and Deprivation of Liberties. We saw evidence of this in staff files.

CQC monitors the operation of Deprivation of Liberties which applies to all care homes. We noted six Deprivation of Liberties applications had ben submitted by the home in line with the appropriate policies and procedures.

We observed there were sufficient staff on duty to meet the needs of people living at the home. The operational manager was on call in case of emergencies. We noted that staff records were accurate and complete. We saw evidence that staff had the experience and skills needed to support people in their care at the home. We observed emergency procedures were in place in the event of fire. We noted the fire evacuation training was up to date and documented in staff files.

Is the service effective?

We found the service was effective at meeting people's needs. We observed staff at Elmsmead were skilled in communicating with people in a variety of ways. We noted staff were well known to people at the home and relationships with people were friendly kind and open. One person told us "We are able to plan our meals with the staff and I really enjoy the food as it is what I want to eat". Another person said "I have been taught how to cook for me and my partner as we hope to move to supported living in the future and we need to know how to cook for ourselves".

Is the service caring.

Two people told us how happy they were at the home and were cared for by staff who always "listened" to them. One person told us "I know what was written in the last CQC report about the home and the manager and staff have been working really hard to make the care plans better". Another person said "A new manager is in post who was very approachable and made sure all the staff were delivering a high standard of care". We reviewed eight care plans. Each care plan contained a comprehensive assessment of each person's care and support needs including risk assessments and crisis intervention information. We saw the care plans included known triggers and behaviours which would indicate to staff if a person was becoming unwell. One person said "I feel part of my own care and I know I am always consulted about my care by the staff who care for me. I write my own daily and monthly reviews and the staff help me if I need them to".

Is the service responsive?

Staff told us it was essential to the care and wellbeing of people living at the home to be responsive to their care and support needs. We noted the home supported people to be as independent as they were able to be. People who lived at the home had complex care needs and were supported by various care professionals. We saw in people's care records people saw their GP when they needed to and had regular appointments with the dentist and optician. One person told us "If I need to go to the doctor the staff help me to make an appointment and make sure that I get there safely". There was a comfortable and relaxed atmosphere in the home and it was evident people were able to choose how they spent their time and were well supported with activities of daily living. On the day of our inspection three people went our shopping with the care staff. Another person chose to stay at home and was helped by their keyworker to make cheese straws and do their laundry.

Is the service well-led?

The operational manager told us they were supporting the home as part of the interim arrangements put in place by the provider as the registered manager had recently left the home. The operational manager visited the home at least weekly and was supported by an interim and deputy manager. The recruitment process for the vacant registered manager's post had commenced. We spoke to five staff who all talked positively about the interim arrangements for the home. Staff told us how proud they were to work at the home despite the loss of the registered manager. We observed staff had a good understanding of the ethos of the home. Staff demonstrated throughout the visit that people were supported to live full and independent lives within their medical condition. We reviewed the feedback from quality assurance surveys completed by people living at the home and their relatives. We noted people had commented favourably on the care, support and management of the service. Relatives said "Their family members always came first in the management of the home and nothing was ever too much trouble for the staff". A person living at the home said "I know if I have a problem I can always talk to my key worker or the manager about it".

We noted that staff received regular supervision, appraisal and in-service training. This was recorded in staff files and in the central training records held by the deputy manager. This demonstrated that staff were supported to give quality care to people at the home.