The inspection took place on 26 February and 5 March 2018. The first day of the inspection was unannounced.

The last inspection took place in October 2015 and the service was rated ‘Good’ overall and in each individual domain. At this inspection we found the service had maintained its overall rating of ‘Good’.

HF Trust – The Elms is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

HF Trust – The Elms accommodates up to eight people in one adapted building. The building is located in Dore on the outskirts of Sheffield.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had two registered managers in place. One of these was in day to day control of the service and the other was a senior manager within the provider group. Throughout this report, the manager in day to day control will be identified as the registered manager and the senior manager as the operations manager. 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 an extremely caring service. Without exception, people receiving support and their relatives spoke positively about the staff that supported them. Staff knew people very well and had developed very strong relationships with them. Care and support was focused on each individual and maximising their care experience. Staff were extremely dedicated in ensuring people were kept happy, occupied and lived fulfilling lives. The service was dedicated to increasing people’s independence and confidence to help them achieve their goals.

People said they felt safe and secure living in the home. Systems were in place to protect people from harm and staff understood how these operated. People received their medicines as prescribed and appropriate records were kept. When things went wrong, investigations were undertaken and the service learnt from adverse events to improve its safety.

There were enough staff deployed to ensure people received prompt care and support when they needed it. Safe recruitment procedures were in place to help ensure staff were of suitable character to work with vulnerable people. Staff received training which was appropriate to their role. This was tailored to the individual needs of the people they were supporting.

The service was compliant with the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The service involved people in decision making to the maximum extent possible and where people lacked capacity, best interest decisions were made.

The service worked effectively with a range of health professionals to help ensure good care outcomes. Care plans were detailed and demonstrated people’s needs had been assessed. People and relatives told us the care provided met people’s individual needs.

There was a clear, visible person centred culture within the home. People knew the staff and management very well and spoke highly of them. Staff said morale was good and they felt well supported. Governance systems were operated by the management team to ensure risks were monitored and improvements were continuously made.

People’s views and opinions were valued and sought through a variety of mechanisms. These were used to make improvements to plans of care and how the ser

HF Trust The Elms is registered to provide accommodation and personal care for up to eight adults with a learning disability. The home is situated in Sheffield on the outskirts of Dore village. Communal living space and single bedrooms are provided.

The manager for the service was registered with CQC. 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 and associated regulations about how the service is run. The registered manager was based at the HF Trust office in the S8 area of Sheffield, and is also registered manager for HF Trust - Sheffield & Derbyshire DCA. The registered manager regularly visited HF Trust The Elms. There was a service manager based at the location who was responsible for the day to day running of the home.

Our last inspection at HF Trust The Elms took place on 23 September 2013. The service was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 12 October 2015 and short notice was given. We told the registered manager one working day before our visit that we would be coming. We did this because the registered manager is not always present at HF Trust The Elms and people living there may have been out. We needed to be sure the registered manager, service manager and some people living at HF Trust The Elms would be available for us to speak with. On the day of our inspection there were eight people living at the home.

People living at HF Trust The Elms and their relatives spoken with made positive comments about the support provided. People said “I love it here” and “I have a good life, I am happy. I will be here a long time.” People had a good rapport with staff.

Relative’s comments included, “The staff there are wonderful” and “We have no worries at all, my [relative] is happy there.”

We found systems were in place to make sure people received their medicines safely.

Staff recruitment procedures were thorough and ensured people’s safety was promoted.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. Staff understood their role and what was expected of them. They were happy in their work, motivated and proud to work at the service. Staff were confident in the way the service was managed. The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and the principles of the Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.

The support provided was person centred and flexible to suit the needs of the person supported.

People supported and relatives spoken with said they could speak with staff if they had any worries or concerns and they would be listened to.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. People using the service and their relatives had been asked their opinion via surveys, the results of these had been audited to identify any areas for improvement.

Eight people were living at The Elms at the time of our inspection. During the inspection one person showed us around the house and introduced us to other people living there. We spoke with four people and they told us that they were treated with respect. They also told us that their opinions were sought so that they were involved in decisions and that they had choice. Their comments included: “we choose what we want, we live here, not the staff, this is our home”, “I decide what I want to spend my money on” and “we choose all our meals”.

Staff spoken with told us that they really enjoyed working at the service and that they promoted people to be as independent as possible. Their comments included: “people choose how they want to be supported” and “we promote people to be as independent as possible”.

All the people we spoke with were satisfied with the support they had received from staff and made positive comments about the staff. Their comments included: “they (staff) listen to us”, “we are not treated like babies, we are treated like adults”, “my key worker is brilliant” and “I really love living here”.

All staff spoken with were clear about what their roles and responsibilities were and the action they would take if they saw or suspected any abuse.

We spoke with two members of staff, they told us that they did not have any concerns and felt “supported” by the service manager.

There was an effective complaints system available.

We used a number of different methods to help us understand the experiences of people living at The Elms. During our inspection we sat and spent time talking with people who used the service in the kitchen and lounge areas of the home. Some people who used the service had communication difficulties and were unable to verbally tell us about their experience of living at The Elms. In order to capture their experiences we also undertook informal observations in order to see how staff interacted with them and see how care was provided.

Throughout our observations we saw that staff at The Elms treated people with dignity and respect. We saw that staff clearly knew people and their individual likes and ways of communicating. Staff spent one-to-one time talking to people and supporting people with their chosen activities, for example doing jigsaws or playing board games. People responded positively to the person centred approach of staff and demonstrated this by their positive interactions with staff, smiles and laughter.

We spoke with three people who were able to tell us their experience of living at The Elms. One person said, “it’s lovely living here, the staff are super to me.” The same person told us that they took medication each day and always got this on time. Another person stated, “I love it here, the staff are ever so kind to me if I’m poorly.” This person also told us of their goal of having a job and the way in which staff were supporting them to achieve this.

From our conversations, it was clear that people who used the service were at the centre of their support plans and the information within them. One person proudly stated, “it’s my plan, it’s my story and I can speak up for myself.” It was evident that this person had been fully involved in developing their plan and ensuring that this reflected their individual needs and goals.

It was also evident that people living at The Elms were involved in a range of decisions. One person told us that, together with other people living at The Elms, they had chosen, “nice new modern worktops, units and a floor,” for the kitchen of the home. People also told us that they were involved in the menu choices for the home and were supported by staff to make their favourite meals each week.

We spoke with people about staffing at The Elms. One person described their key worker as, “absolutely marvellous.” They said that their key worker knew them well and told us that their key worker had arranged, “a lovely party” to celebrate a recent milestone birthday. Another person stated, “you’ve only got to ask and staff will help you, they are so lovely to me.”

People also told us that their views and experiences of the service were sought within the monthly tenants meeting and were clear about how the provider had acted upon issues suggested within this meeting. For example, the provider had purchased safes for people’s rooms following people requesting these within a recent tenants meeting. A number of people also attended, “One Voice”, the provider’s monthly advocacy group.