We inspected this home on 2 February 18. At our last inspection we found the provider was meeting the regulations and we rated the home as ‘Good’ overall. However for the key section of caring we rated them as ‘Requires improvement’ and asked them to make improvements to achieve a minimum rating of ‘Good’. The care service supports people with learning disabilities and autism to support them to live as ordinary a life as any citizen. This service is delivered in a large complex and was registered with us before the introduction of ‘Building the Right Support and Registering the Right Support guidance.’ However the home aims to work towards the guidance with the values that underpin this practice.

These values include choice, promotion of independence and inclusion. Elmwood is in the village of Hollingwood. The accommodation is provided in a large building divided into four units. Each unit is independent with their own kitchen, living space and bedrooms. Elmwood accommodates 32 people, at the time of our inspection there were 31 people using the service.

The service had 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.

The provider had not always completed audits and those which had been completed had not been used to reflect trends and drive improvements. Peoples views had been considered, however a formal survey had not been completed or an improvement plan completed to reflect the direction of the home.

The home offered a homely atmosphere and people felt the management team were visible. There were sufficient staff to support people’s needs who were aware of how to keep them safe from harm. People had their risks assessed and measures taken to reduce any risks. The medicines were managed to meet peoples prescribed needs.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Health care professionals had been consulted and when guidance was provided this was implemented. People enjoyed the meals and had a choice which reflected their preference and dietary needs. Individual’s independence levels were promoted and life styles were being developed. People were protected from having sore skin and their weights had been monitored to ensure they received the required nutritional support to maintain good health.

Staff had established positive relationships which enabled them to personalise the care they delivered. Care plans were person centred and identified people’s preferences and their lifestyle choices. Information was offered in a range of methods, pictorial, visual and written. Other methods were being considered to supported understanding and choice. People and relatives all identified that staff offered respect and when they delivered care it was in a dignified way.

The home had a complaints procedure; however the home had not received any complaints since our last inspection. Staff felt supported in their role and had received training and inductions to enhance their skills. When staff joined the home they were checked to ensure they were suitable to work with people.

The registered manager understood their registration and had notified us of events. They had displayed the previous rating in the home and on the provider’s website. We saw that the previous rating was displayed in the reception of the home as required. The manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.

There were 37 people living at Elmwood House on the day we visited. We spoke with three people who lived there who told us they were involved in activities at Elmwood like the farm, the Sunny Shine Club and bowling.

People we spoke with told us that they liked living at Elmwood House and that they were happy with the care they received.

We looked at one person's bedroom which had recently been decorated.

We found that although people's consent was being obtained for some aspects of people’s care. However we also found that where people did not have the capacity to consent, for example due to their learning disability, the provider did not use the appropriate procedures in line with legal requirements.

We found that some areas of the home, including people’s bedrooms, were comfortable and personalised. However the provider needs to continue with the improvements to ensure that the premises were safe and people are protected against unsafe and unsuitable premises.

We found that systems for monitoring the quality of the service were not fully ensuring that risks were identified and managed appropriately.

We found that peoples care files and other records were not always accurate and up to date. We found that records were now stored securely.

People told us they went for a visit with their social worker before they moved in and it felt right so they moved in.

People we spoke with told us “they had a care plan and that they know what was on it.”

We were told that it includes the activities they liked, how they wished to be care for, about healthy eating, exercise and maintaining contact with their family.

People we spoke with told us they were happy at Elmwood and liked living there.

This inspection took place on 4 and 9 December 2014. The first day was unannounced.

Elmwood House is a home for up to 32 people with learning disabilities. There were 28 people using the service at the time of this inspection. It is located on the outskirts of Chesterfield, which has social and cultural amenities and good transport links.

There was a registered manager at the service at the time of our inspection. 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.

At the last inspection on 28 November and 12 December 2013, we asked the provider to take action to make improvements. This was in relation to care planning, the management of medicines and staff training. The provider sent us an action plan outlining how they would make improvements.

At this inspection we found that action had been taken and improvements had been made.

People using the service were protected from abuse because the provider had taken steps to minimise the risk of abuse. Decisions related to peoples care were taken in consultation with people using the service, their representative and other healthcare professionals, which ensured their rights were protected.

Where people using the service lacked capacity to understand certain decisions related to their care and treatment, best interest meetings were held which involved family members, independent mental capacity advocates, and social workers. This process had recently started and the manager was prioritising which people required the most urgent assessments.

Staff were available at the times that people needed them to provide care and support.

Medicines were safely managed and administered and people received medicines when they needed them.

Staff received training that was relevant in supporting people with learning disabilities. Staff were supported through links to specialist health advisors such as physiotherapists, community nurses, doctors and psychology services.

People told us they enjoyed living at Elmwood House and their relatives told us that staff were caring and compassionate.

People were able to take part in activities of their choice but some options were not age appropriate.

People using the service were able to go to visit family and friends or receive visitors. Staff supported people in maintaining relationships with family members.

The registered manager at the home was familiar with all of the people living there and staff felt supported by the management team. The service had a clear aim to be open and transparent and people were able to contribute to plans to develop the service. Regular staff and residents meetings were held to ensure people were involved and could have their say in the running of the service.