13 Elm Road is a residential care home for up to 3 people with learning disabilities and/or mental health needs. The home is a large terraced house in a residential area, with community facilities including shops, cafes and good access to local transport .

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 on-going 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.

At this inspection we found the service remained Good.

Why the service is rated Good.

Risk assessments were in place specific to people's individual needs.

Medicines were managed safely and people received their medicines as prescribed.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. There was sufficient staff on duty to meet people's needs. The staff team provided consistent support to people, as most had worked in the home for a few years and they provided cover for each other for holidays and sick leave.

The home was well maintained and in good decorative order. Measures were in place to ensure the environment was safe and suitable for the people who lived there. Repairs to the building were reported to the landlord and attended to in a timely way.

People's needs were assessed and care plans were completed to demonstrate the support required. People's health care needs were addressed. People saw their local health care professional when they needed to.

Staff received a programme of mandatory and optional training relevant to the people they supported. Regular supervision and annual appraisals took place. Staff meetings were held to keep staff informed and support them in their role.

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. People made decisions and choices in relation to their care, support received and daily activities.

Staff knew the people in the home well, particularly their needs and choices and how they preferred to be supported. This information was well documented to assist new staff.

Staff knew people's dietary needs and preferences. They supported people to eat and drink enough to maintain a balanced diet.

Staff showed kindness towards the people in the home. People were supported to maintain their independence with activities of daily living. People went out when they chose to and were supported by staff to attend health appointments.

Care plans were written for the individual and informed staff of their preferences and wishes. These documents were regularly updated to reflect people's change in need or preference.

People enjoyed a range of activities, including their hobbies. Staff made sure they had what they needed to complete the activity, such as flowers, paper, crayons and books.

A complaints policy was in place and displayed in the home. No complaints had been received since the last inspection in 2015.

There was a person-centred and open culture in the home. Staff reported that registered manager was supportive and made themselves available to support staff when they needed it. Staff worked as a team and supported each other. Absence and annual leave was covered by the staff team. This ensured there was a consistent staff team that people in the home knew and staff were familiar with their support needs.

Quality assurance and governance systems were in place to help the registered manager and provider to monitor standards and drive forward improvements.

The registered manager and provider met their legal requirements with the Care Quality Commission (CQC). They had submitted notifications relating to incidents and the rating fro

The inspection took place on 11 November 2015 and was announced.

13 Elm Road is registered to provide accommodation for up to three adults, who require personal care. It is a large four bedroom terraced property, situated in a residential area, close to local amenities and transport links. There were three people living in the home on the day of the inspection.

There is a registered manager in post at the service. 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.

We found that people who used the service were protected from avoidable harm and potential abuse because the provider had taken steps to minimise the risk of abuse. Procedures for preventing abuse and for responding to allegations of abuse were in place. Staff told us they were confident about recognising and reporting suspected abuse and the manager was aware of their responsibilities to report abuse to relevant agencies.

Medicines were safely administered by suitably trained care workers. We found that medicines were stored safely and adequate stocks were maintained. Regular medicines audits were being carried out to ensure that medication practices were safe and to ensure that any medication errors could be promptly identified.

Staff supported people to make decisions about their daily life and care needs.

People’s nutritional needs were monitored by the staff. People’s dietary requirements and preferences were taken into account.

Each person who lived at the home had a person centred plan. The plans we looked at contained relevant and detailed information. This helped to ensure staff had the information they needed to support people in the correct way and respect their wishes, their likes and dislikes. A range of risk assessments had been undertaken depending on people’s individual needs to reduce the risk of harm. Risk assessments and behavioural management plans were in place for people who presented with behaviour that challenges. These risk assessments and behavioural management plans gave staff guidance to keep themselves and people who lived in the home safe, whilst in the home and when out in the community.

Sufficient numbers of staff were employed to provide care and support to help keep people safe and to offer support in accordance with individual need. This enabled people to take part in regular activities both at home and in the community when they wished to.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. Staff were only able to start work at the home when the provider had received satisfactory pre-employment checks.

Staff told us they felt supported in their work. They told us they had the training and experience they required to carry out their roles and responsibilities. The majority of staff held a relevant qualification and all staff had worked in the home for a number of years.

Staff received an induction and regular mandatory (required) training to update their practice and knowledge. Records showed us that staff were up-to-date with the training. This helped to ensure that they had the skills and knowledge to meet people’s needs.

Regular staff meetings were held and handovers took place twice a day. Systems were in place to provide supervision and appraisal to staff.

Staff had good knowledge of people’s likes and dislikes in respect of food and drinks and people’s routines in respect of meal times. We saw that people who lived in the home had plenty to eat and drink. People in the home were supported by the staff and external health care professionals to maintain their health and wellbeing.

People who lived in the home took part in activities both in the home and in the community.

During our visit we observed staff supported people in a caring manner and treat people with dignity and respect.

Staff understood people’s individual needs and how to meet them. We saw that there were good relationships between people living at the home and staff, with staff taking time to talk and interact with people.

A procedure was in place for managing complaints. We found that complaints had been managed in accordance with the home’s complaints procedure.

Systems were in place to check on the quality of the service and ensure improvements were made. This included carrying out regular audits on areas of practice.

We looked around the building. We found it was clean and well maintained. Staff had a rota in place to ensure cleaning was completed daily.

We used a number of different methods to help us understand the experiences of some of the people living at 13 Elm Road. This was because some of the people who lived at the home had complex needs, which meant they were not all able to verbally tell us about their experiences.

On the day of our inspection we met all three people who lived at the home. Two people were at home. The other person was attending a day centre. We carried out some short observations between staff and the people who lived in the home. We observed some examples of where staff supported people well, such as acknowledging anxieties and attempting to reassure them, encouraging people to be independent in their daily routine and using appropriate communication with people. We also spoke with a relative who was visiting the home at the time of our inspection. They told us, “I can only praise the staff. I am very happy with the care they provide.”

We looked at three people’s care records in the office. We found them to contain relevant and current information about the person's needs.

On checking medication management we found that people received their medicines as prescribed. Records regarding medication were completed correctly.

We spoke with three staff about how they supported the people who lived at the home, the activities they did and about the training provided for staff.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We observed staff assisting people when they requested support and accepting their decisions if they chose not to do something.

People's needs were assessed and care and treatment was planned and delivered in accordance with their individual care plan. We spoke with a person who told us how staff had supported them with what they needed.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We saw that people who lived at the house were very relaxed and confident around staff. This showed people felt safe in the home. Those spoken said they were listened to so that any concerns were addressed.

There were effective recruitment and selection processes in place to ensure staff could

work with vulnerable people. We received positive comments about staff and their approach. One person said, "The staff are very good." A relative we spoke with told us, "The staff know just how to support my mum."

People we spoke with told us that they were supported well by Expect Ltd and staff were always available to assist and help as needed.

People who used the service, their representatives and staff were asked for their views

about their care and treatment and they were acted on. All of the people we met with were living in accommodation that suited their needs. They told us they enjoyed living in the home.