About the service: The Elms is a residential care home. It provides personal care and support and/or nursing care for up to 86 older people, people living with dementia, a sensory impairment or a physical disability. The home has three separate units; Larchwood, residential care for people living with dementia; Woodlands for people with nursing needs and Oakwood, for people in the later stages of dementia who require nursing care. On the day of our inspection 73 people were living at The Elms.

People’s experience of using this service:

• The provider met the characteristics of ‘Good’ in all areas. This has improved from a rating of ‘Requires Improvement’ at the last inspection in June 2017. More information about this is in the full report.

• People were cared for by competent, skilled and experienced staff who knew how to keep them safe from harm and abuse. People’s rights were maintained and staff followed the principles of the Mental Capacity Act 2005.

• Staff were provided with a comprehensive induction and received ongoing training to support their professional development and provide care in line with national guidance.

• People lived in a clean and homely environment. Staff followed good infection control practices. The design and decoration of the home environment met the sensory, cognitive, mobility and social needs of the people who lived there.

• Lessons were learnt when things went wrong. The registered manager and staff worked together to make improvements to the service. Good working practices had been developed within the service and across organisational boundaries to support peoples’ health and wellbeing.

• People have their care needs and preferences assessed and were enabled to have choice and control over their lives and were encouraged to maintain their independence. There were enough staff to provide care and support to people to meet their individual needs.

• People were provided with a nutritious, varied and balanced diet. Their risk of dehydration, malnutrition and obesity were closely monitored by staff.

• People were supported to follow interest and hobbies of their choice and maintain links with the local community.

• People were treated with dignity, respect and compassion by kind, caring and supportive staff. People were enabled to share their wishes and preferences for their end of life care. Staff supported people to have a pain free and dignified death.

• People and their relatives could share their experience of the service; both positive and negative. Any issues or complaints shared were investigated, resolved and responded to in a timely manner.

• The manager was an approachable and visible leader. The manager and their team were committed to improving the quality and standards of care people received. Links were being built with the local community and partner agencies. There is a good governance framework, leading to improvements in the service.

The service met the characteristics of Good in all areas that we inspected. More information is in the full report.

Rating at last inspection: The Elms was last inspected on 24 and 25 April 2017 (report published 23 June 2017) and was rated as requires improvement overall.

Why we inspected: This was a scheduled inspection based on previous rating of requires improvement.

Follow up: We will continue to monitor intelligence we receive about The Elms until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We inspected The Elms Care Home on the 24 and 25 April 2017. This was an unannounced inspection. The service provides care and support for up to 86 people. When we undertook our inspection there were 77 people living at the home.

People living at the home were of mixed ages. Some people required more assistance either because of physical illnesses, mental health needs or because they were experiencing difficulties coping with everyday tasks, with some living with dementia.

There was 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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection we looked at the records of three people who were subject to such an authorisation. Some staff were unsure of the practicalities of implementing MCA legislation.

We found that people’s health care needs were assessed. However, the recording in the care plans was not consistent. People and their relatives (where appropriate) were not always involved in the planning of their care. The information and guidance provided to staff in the care plans was unclear and staff did not always complete charts as they were supposed to. Risks associated with people’s care needs were assessed, but plans were not put always in place to minimise risk in order to keep people safe. Forward planning for those living with dementia was poor. Staff had received training in how to protect people from harm, but were unaware of how other agencies such as the local authority could be involved in the decision making process.

People had been consulted about the development of the home and quality checks had been completed to ensure the home could meet people’s requirements. There was an analysis of quality checks and lessons learnt were passed on to staff. The premises were well kept. There was a maintenance team to ensure areas were kept refurbished and redecorated. A garden team kept the grounds tidy and ensured pathways were free from hazards.

The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period. The home was divided into three different units and a core staff worked in each unit, with some staff working across units depending on people’s needs. There was a unit manager in charge of each unit. This ensured there were sufficient staff to ensure the needs of people could be met.

Staff had received training in administering medicines. Medicines were stored safely. However, staff needed to ensure they accurately recorded when medicines, such as creams, had been applied.

People were treated with kindness and respect. Staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

People had a choice of meals, snacks and drinks. Meals could be taken in dining rooms, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it. In two units there were menus on display so people could remind themselves of the choices they had made. In the unit where the majority of people were who were living wi