We carried out an unannounced inspection of The Elms on 28 February 2017. We had received information of concern prior to our inspection and considered this when reviewing the quality of the service.

The Elms is a care home for up to 26 people who require personal care, some of whom have dementia. On the day of the inspection, 25 people were using the service.

The service had a registered 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.

At our last inspection of the service on 18 March 2016, we found the provider was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing. The registered manager did not always support staff in their roles. Staff did not receive regular one to one supervisions or appraisals to reflect on their practice.

We undertook a comprehensive inspection on 28 February 2017 to check that the service now met the legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Elms’ on our website at www.cqc.org.uk. At this inspection, we found the action taken to address the breach was sufficient to make the required improvements.

The premises had staircases that could pose a risk to people using the service. Some people living with dementia could access parts of the building which would cause them harm if they were not supervised. However, the registered manager had assessed risks to people and put plans in place to minimise potential harm to people.

Risks to people were identified, reviewed and managed appropriately. Staff were aware of the risks to people and had guidance on how to minimise the prospect of harm. The registered manager had reviewed other risks associated with the safety of the premises and working practices to protect people from avoidable injury.

Staff were supported in their role by the registered manager and their colleagues had received supervisions and appraisals to review their performance and development needs. People received care from competent and skilled staff who had regular training.

Prior to the inspection, the CQC was made aware of an incident that had happened at the service. The issue had been investigated and resolved by a local authority safeguarding team. During the inspection, an inspector and inspection manager conducted a fact finding exercise on this specific incident. The CQC will review the evidence gathered to inform its view about an aspect of people’s care at the service in relation to the incident.

People were protected from the risk of potential abuse. Staff had received training on how to identify and report abuse to help keep people safe. The registered manager and staff understood and followed the provider’s safeguarding procedures to deal with concerns. The registered manager had worked with a local authority safeguarding team on concerns raised at the service and made changes where a shortfall was identified.

There were enough numbers of suitably skilled and competent staff deployed at the service to meet people’s individual needs. Appropriate recruitment procedures were followed to ensure staff were suitable for their roles. People received the support they required to take their medicines from staff trained and assessed as competent to do so. Medicines were administered and stored safely in line with the provider’s procedures.

People accessed healthcare services when needed to maintain good health and to have their dietary needs met. People were provided with a healthy diet and sufficient amounts of food and drink and their nutritional needs were met.

People consented to receiving care and support. The regis

The Elms is a care home for up to 26 people who require personal care. Some of the people live with dementia. On the day of the inspection, 25 people were using the service.

This unannounced inspection took place on 18 March 2016. We last inspected The Elms on 31 December 2014. The service met all the regulations we checked at that time.

The service has a registered 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.

At this inspection we found that the provider had breached Regulation 18 (2) (a) of the Health and Social Care 2008 (Regulated Activities) Regulations 2014. The breaches of the regulations relate to staffing. The registered manager had not always supported staff in their roles. Staff had not received one to one supervisions or annual appraisal to reflect on their practice. You can see what action we have told the provider to take at the back of the full version of this report.

People in the service received safe care and support. People received their medicines safely and as prescribed from staff assessed competent to do so. The registered manager assessed risks to people and ensured staff had guidance to keep them safe. Staff understood how to recognise and report any abuse to protect people from harm.

There were sufficient staff on duty to meet people’s individual needs and to support them with their interests. The service recruited suitable staff by using a robust recruitment procedure. Staff received appropriate training to undertake their role. Although we found staff felt supported by management, there were insufficient formal supervisions. Staff understood people’s communication needs and knew their choices and preferences.

People were happy with the care and support they received. People received support from skilled and competent staff. Staff spent time and were not hurried when they supported people. Staff knew people well and had developed positive relationships with them. The service supported people to maintain relationships with their friends and family. Staff respected people’s dignity and privacy. Staff understood how to treat people with respect.

Meetings were held with people to get their feedback about the service. The staff team worked effectively to ensure people had a positive experience of the service. Staff upheld people’s rights and supported them in line with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).These legal safeguards ensure that people who lack mental capacity are not unlawfully deprived of their liberty. The registered manager ensured staff protected and promoted people's human rights in line with current legislation.

The service was flexible and responded positively to people’s requests. Staff regularly reviewed people’s health and the support they required to reflect their current level of needs. The registered manager always sought people’s views and opinions about the service and acted on their feedback.

People’s cultural needs and personal preferences were met in relation to their diet. People enjoyed the freshly home cooked food provided at the service. Staff engaged people in activities of their choice and reduced the risk of isolation and boredom.

People accessed the healthcare services they required and staff monitored their wellbeing. Important decisions in relation to people’s health was subject to thorough professional oversight which ensured people received appropriate and timely health interventions. Staff knew what to do in case of emergencies to keep people safe.

People understood how to make a complaint and felt confident the registered manager would act on their concern. There were processes in place to monitor quality and un

This inspection was carried out to follow up on concerns identified at our last inspection on 9 July 2014, where we found that the service to be in breach of regulations 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 related to the management of medicines. We also found that the provider had not complied with the Care Quality Commission (CQC) registration requirements related to the notification of absence. The provider sent us an improvement plan on how they will comply with these standards.

At this inspection we checked if the provider had met with the required standard on the management of medicine. We answered the questions: Is the service safe? Is the service well-led?

We checked the medicine administration records (MAR) for 29 people living at the service, observed the administration of medicines and we spoke to staff.

Is the service safe?

Medicines were administered and handled safely. MAR were accurately completed. People’s medicines were stored securely. Unused medicines were returned to the pharmacy and a record was kept for these.

Is the service well-led?

The service was well-led. The service had sent notifications to us as required relating to the absence of a registered manager.

The provider had appointed an interim manager to run the home and we were notified of this.

This inspection was carried out by an inspector who gathered evidence to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, staff supporting them and from looking at records. We spoke to three of the 26 people using the service, two relatives of people using the service, two health professionals and three members of staff. We also reviewed five care records and five staff records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were trained to support people safely. Risks were assessed for people and actions were in place to address identified risk. Staffing level was adequate and staff were trained and competent in their roles. There was a plan for how staff should respond to emergencies. Medication was handled safely. The service had care staff on duty 24 hours a day. People told us they felt safe living at the service. Appropriate equipment was provided for people who had mobility needs and staff had received training in using these.

Is the service effective?

People’s care was planned and delivered in a way that met people’s individual needs. The provider involved other healthcare professionals in the planning and coordination of people’s care and treatment. Staff responded to alarm calls promptly and flexibly to meet the needs of people. One person using the service told us, “I only need to call and they [staff] will all come running.” People were supported to take part in activities taking place at the service and in the community.

Is the service caring?

Staff understood the needs of people they supported. People using the service told us that they were treated with dignity and respect. One person said, “Staff are nice and they look after me well.” A relative told us, “staff are good and interested in the people they look after.” We observed staff interacted and responded to people in an open and positive manner. We observed that staff knocked on people’s doors before entering. Staff communicated with people in the way they understood.

Is the service responsive?

Care plans and risk assessments were reviewed monthly to reflect people’s changing needs. People got the assistance they required to eat and drink. The provider liaised with other health and social care professionals to address any concerns to a person’s care and welfare. We saw staff attending to people and responding to call bells.

Is the service well-led?

The provider worked with other agencies in meeting the needs of people using the service. There were quality assurance systems in place to identify, assess and monitor the quality of service provided. We saw records of complaints and actions taken to address them. People using the service and their relatives told us that senior members of staff took complaints and comments seriously and they sort things out quickly. People told us that the manager carried out spot checks to find out how people were doing. We found that people’s records were not always maintained or kept up to date.

On the day of our inspection we found that the registered manager had been absent for over five months and this was not reported as required. The deputy manager was in charge of the day to day running of the service at the time of our inspection.

Staff told us people using the service were referred to as residents because the Elms was their home. The residents we spoke with were complimentary about the home and the staff. One of them said, “It’s lovely. They’re nice people.” Someone else said, “They’re very pleasant and I get on well with them.”

Residents’ needs were reviewed regularly and care plans kept up to date. A resident told us, “The care plans are updated regularly and I can have a look at them at any time. I say what I need.” Relatives commented that staff identified changes in their parents’ health or mood and took action find the reason for these changes.

There was a variety of activities taking place at the service. Residents who preferred to stay in their rooms were able to do so.

Residents had enough to drink and eat. They were complimentary about the food and if they did not want the food that was on the menu, they were offered alternatives.

Residents and relatives commented on the care taken to appoint the right people when new staff were needed. Appropriate checks were made before new staff started working.

The manager, deputy manager and other staff were vigilant and addressed issues that arose that might affect the safety and wellbeing or residents.

We spoke to three people using the service and to one relative who was visiting the home. We also observed interaction between people using the service and staff.

People we spoke with commented on feeling part of the Elms. Comments included “I feel part of the Elms” and “It’s home”. People said the staff were kind and one person said “They know how to look after old people”. We observed that staff were respectful towards the people using the service and provided support at a pace that was appropriate to them. We saw people smiling and laughing with the staff. The relative we spoke with said the care and attention people received was “top notch”.