About the service: The Elms is a residential care home set within a local community. The home is registered to provide support for up to six people with a learning disability and associated mental health needs.

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.

People’s experience of using this service:

• Improvements had been made to the service since our last inspection. Issues relating to staffing training and quality assurance had been addressed.

• People told us they were happy living at the home and people got on well together. People told us they felt safe and well looked after.

• We saw that the property was clean, comfortable and homely. We saw that new carpets and curtains had been purchased since our last inspection. However, the home was tired in parts.

• People who used the service had the capacity to make decisions about their day to day lives and what they did with their time. The registered providers were aware of their responsibilities in relation to the Mental Capacity Act 2005.

• People told us that they enjoyed the food provided.

• People said they were treated with respect and felt well cared for. They spoke positively about the staff who supported them, who knew them and their support needs well.

• The atmosphere was relaxed and friendly and people who lived at The Elms told us they got on well together as a group.

• People had active lifestyles. They accessed a range of community facilities, used public transport and their independence was promoted wherever possible.

• We found there were adequate systems in place to monitor the quality of the service provided to people.

• The service met the characteristics for a rating of "good" in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was "good".

Rating at last inspection: The rating at our last inspection was ‘requires improvement’ as we made two recommendations. The registered providers had fallen behind with providing staff training and some aspects of quality assurance, which they openly told us about. This was due to the closure of one of their homes and resettling people into the Elms or finding alternative care homes had been their priority. We recommended that any outstanding staff training and quality assurance shortfalls were addressed as soon as possible.

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Follow up: We will continue to monitor the service through information we receive and future inspections.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection was unannounced and started on the 23 November and we returned to the home on 29 November 2017 to speak with the registered providers, people who used the service and a support worker.

At our last unannounced inspection which took place on 7 October 2015 we rated the service as GOOD.

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.

The Elms is registered to provide accommodation for up to six people who have a learning disability and mental health needs and require support with personal care. There were six people living at the home on the day of our inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. There were two registered managers for the home who shared the role, one of whom was the provider.

During the inspection we spoke with five people who used the service either individually or as part of a group and a support worker. We also spoke with the registered manager and both providers responsible for the home.

We were aware that three people had recently moved into the home following the closure of one of the providers other two homes. The home closed due to financial constraints caused by changes in payments relating to sleep in allowance so as to secure the future of The Elms and another home nearby.

People who had moved told us or indicated that they were happy with the new arrangements and that they were still being supported by people who knew them well in a place they were familiar with.

Resettling people to The Elms or finding alternative care homes for people who used that service and resolving issues with staff had been the registered providers priority. This meant the registered providers had fallen behind with providing staff training and some aspects of quality assurance, which they openly told us about. We recommend that any outstanding training and quality assurance shortfalls are addressed as soon as possible.

We saw that the property though comfortable and homely was tired in parts. We were told that some upgrade of the property would be carried out once the sale of their former home had been completed.

We saw there had been significant improvements in the detail in people’s new support plans and risk assessments. Records provided good information about how people wished to be supported.

People who used the service and the support worker told us that they felt safe at the home.

We saw that there were recruitment and selection procedures in place to help protect people who used the service from coming into contact with potential staff who were unsuitable to work with vulnerable people.

People’s medicines were managed well and the home was seen to be clean and tidy throughout. Some maintenance concerns were seen on the day of our inspection, for example, exposed water pipes in the rear yard. Action was taken by the appropriate utilities service to address this longstanding matter following our inspection.

People who used the service had the capacity to make decisions about their day to day lives and what they did with their time. The registered providers’ were aware of their responsibilities in relation to the Mental Capacity Act 2005.

People could make choices about their food and drink and alternatives were offered if requested.

Arrangements were in place to request health and social care services to help keep people well and advice was sought when needed.

Feedback we received from community based professionals was seen to be highly positive. The relationships we saw between people who used the service and the staff supporting them were warm and friendly. The atmosphere at th

This inspection was unannounced and took place on 7 October 2015. The last inspection of The Elms took place on 5 and 11 November 2014 when it was found not be meeting two of the regulatory requirements we looked at in medicines management and systems were not in place to regularly assess and monitor the service provided. At this inspection we found that action had been taken by the providers to improve these areas of service and all the regulatory requirements had been met.

The Elms is registered to provide accommodation for up to six people who have a learning disability and mental health needs and require support with personal care. There were five people living at the home on the day of our inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. There were two registered managers for the home who shared the role, one of whom was the provider.

During the inspection we spoke with four people who used the service individually and a support worker. We also spoke with the registered manager and both providers responsible for the home and the improvements they had made since our last visit, for example, introducing an electronic computer system that linked the three homes, reviewing the homes policies and procedures and a new carpet fitted to the hall, stairs and landings.

People who used the service told us that they felt safe. People we spoke with said, “I am settled, safe and happy here.” “I don’t have any worries.” “I feel safe here. Yes and I am quite happy.” And “I have got used to it here and I want to stay.” We saw they had access to information about who they could contact if they had concerns that they had been harmed or were at risk of being harmed.

We saw that there were recruitment and selection procedures in place to protect people who used the service from coming into contact with potential staff who were unsuitable to work with vulnerable people.

People’s medicines were managed well and the home was seen to be clean and tidy throughout. Some maintenance concerns were seen on the day of our inspection visit relating to plumbing and we were told these issues would be resolved as soon as the plumber was available.

People who used the service had the capacity to make decisions about their day to day lives and what they did with their time. The provider and manager we spoke demonstrated they had an awareness and knowledge of the Mental Capacity Act 2005, which meant they could support people appropriately to make choices and decisions.

People could make choices about their food and drink and alternatives were offered if requested.

Arrangements were in place to request health and social care services to help keep people well and advice was sought when needed.

The relationships we saw between people who used the service and the staff supporting them were warm and friendly. The atmosphere was calm and relaxed.

We saw that to ensure people’s right to privacy they had keys to their bedrooms and opened any letters that came to the home that were addressed to them.

People told us they had a range of individual activities that they participated in at the home and in the local community; these included, for example, attending outreach centres, a computer course at college, as well as visiting family and friends. People told us, “I like to meet [my relative] in a café in Bury.” “I have been to the set of Coronation Street. I had my picture taken on the bench.” “It is my birthday on Friday and I am having a party and going out for a Chinese buffet.” “I am looking forward to going to Blackpool Illuminations.”

We found people who used the service were encouraged to maintain their independence, wherever possible. People took responsibility for household tasks such as preparing meals, washing and drying after meals, washing their clothes, vacuuming and general cleaning. A person told us, “I do my jobs every day. I like to keep my room spotless and tidy.”

Systems were now in place to regularly assess and monitor the service provided and the provider had notified us of any incidents that occurred as required.

People who used the service and staff reported the registered manager and the providers were approachable and supportive.

Before our inspection visit we contacted the local authority commissioning and safeguarding teams. They informed us they had no concerns about the service provided.

This inspection was unannounced and took place on 5 and 11 November 2014. The last inspection of The Elms took place on 18 July 2013 when it was found to be meeting all the regulatory requirements we looked at.

The Elms is registered to provide accommodation for up to six people who have a learning disability and mental health needs and require support with personal care. There were five people living at the home on the day of our inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. There were two registered managers for the home who shared the role, one of whom was the provider.

During the first day of the inspection we spoke with four people who used the service individually and as a group as well as two support workers. We also spoke briefly with the registered manager and the provider responsible for managing the administration of the home.

On 11 November we spent time with both the owners. We talked with the providers about their plans to make improvements to all three services that they were responsible for and looked at maintenance, recruitment and other records relating to the running of them.

We were made to feel welcome by both people who lived at the service and the staff supporting them throughout the inspection.

The relationships we saw between people who used the service and support workers were warm and friendly. The atmosphere was calm and relaxed.

People who used the service had the capacity to make decisions about what they did with their time. They chose which individual activities they wanted to be involved in and were able to take part in group activities if they wanted to both in the home and in the community.

People who used the service had access to information about who they could contact if they had concerns that they had been harmed or were at risk of being harmed. We saw that safeguarding had been discussed with people at a residents meeting.

Overall medication was well managed, however a number of minor improvements were needed such as ensuring homely remedies (over the counter medication) had not expired and that there was a need for a clearer risk assessment to be in place where a person, with capacity, regularly refused to take their medication.

We saw that the house was comfortable, homely, clean and tidy. The provider was aware that the home appeared tired in parts and was in need of decoration and that some carpets needed to be replaced as they posed a potential trip hazard.

The staff we spoke with had a good understanding of people’s risks, individual needs and personal preferences so that they could support people effectively.

We saw that to ensure people’s right to privacy they had keys to their bedrooms and opened any letters that came to the home that were addressed to them.

We spent time looking at the care and support records with a person who used the service. They confirmed they had been involved in developing the records.

Staff told us they had received a range of training and had the support they needed from the registered manager and providers to enable them to deliver effective care.

Staff members we spoke with said that the registered manager and the providers were very approachable and supportive.

We saw that quality assurance questionnaires had been sent out to people living at the home in September 2014 asking for their views and opinions of the service. Feedback from staff who worked at the home had also been received.

Systems were in place to record and review complaints. People were encouraged to express their views about the service they received and discussion about how to make a complaint had been undertaken at recent resident’s meetings. No complaints had been received at the home.

The provider was aware that they did not have all the systems they needed in place to regularly monitor and audit the quality of care provided at The Elms. The provider was working with a local quality assurance officer and good progress had been made in addressing the outstanding issues.

People’s needs were assessed and care and support was planned and delivered in line with their individual care plan. We saw that where necessary people had access to an Independent Mental Capacity Advocate (IMCA) to help them make decisions about their life.

There was fruit on the dining table and a large jug of fruit juice available for people with additional ice cubes in the freezer to prevent people from dehydrating in the exceptionally hot weather.

We looked around some parts of the home. We saw that the house was comfortable and homely and maintained to a satisfactory standard.

We saw that there were infection control measures in place. For example we saw that there were different coloured coded mops for use in the kitchen, bathroom and the hallway.

We saw that there were frequent and friendly interactions with the support worker on duty and the atmosphere was calm and relaxed. The support worker said the staff team worked well together and communication was good.

Before our visit we contacted the local commissioning and safeguarding teams. They informed us that they had no concerns about The Elms at this time.

People experienced care and support that met their individual needs.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People told us that they knew the staff well because most had worked at the home for a long time. They said that they got on well with the staff.

People we spoke with told us that they could speak to the manager or a staff member if they had any problems or concerns. They said that they were confident that they would be taken seriously and they would do their best to sort the problem out.

Prior to our visit we contacted the local safeguarding and commissioning teams about the service. They informed us that they had no concerns about The Elms.

We spoke with three people living at the home. They confirmed that they had been involved in developing their person centred plans and had signed that they had agreed with them. They told us that they were not really bothered about the paperwork about them but they could read it if they wanted to.

We did not speak with people using the service as part of this inspection visit.

We visited the home on 11 January 2012 at 4pm. When we arrived two people living at the home were chatting in the dining room. One person arrived home later from college and another was out attending a personal development course. One staff member was on duty and they were busy making tea. They all made us feel very welcome.

We spoke with three of the people living at the home. Some people said that they had lived at the home for a long time. We talked with the staff member who had also worked at the home for many years.

The organisation has three care homes covered by two registered managers, one of whom is the provider. One of the registered manager’s was present during our visit to the home.

We also asked the local adult care commissioning and safeguarding teams whether they had any concerns about The Elms. They confirmed that at this time they had not.