The inspection took place on 19 February 2018 and was unannounced. This was the first inspection of this established service after being acquired by the current providers in April 2016.

The Elms Residential Home 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 Residential Home is registered as a care home without nursing for a maximum of 19 people who were adults over 65 yrs. The service provides support for people living with dementia and/or with physical disabilities or sensory impairments

The service is accommodated in mainly single storey buildings in a small village surrounded by countryside. Bedrooms were comfortable and there were pleasant lounges and communal rooms for people to use. The home had a secure outside garden and a conservatory that looked out over the rear garden.

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. The registered manager was appointed in May 2017.

At this inspection the service was rated Good.

The home was well led by a well-qualified registered manager. The provider offered support and resources to enable the services to continue to develop and maintain high standards of care.

People felt safe at the home and with the staff who supported them. One person said “We certainly are well looked after here. I do feel very safe here. I am quite content.” Another person said “There is always someone to talk to when you want them. The care staff are very good. You can tell them anything. Overall I am ok.”

There were systems and processes in place to minimise risks to people. These included a robust recruitment system and managers and staff who were trained and effective in protecting people from potential abuse. There were adequate numbers of staff available to meet people’s needs promptly.

People had access to a good diet which met their needs and preferences. People were offered a choice of well cooked food presented in an attractive and appetising manner.

People received effective care from staff who had the skills and knowledge to meet their needs. Staff monitored people’s health and well- being. People had access to healthcare professionals according to their needs.

People were supported to have maximum control and choice of their lives and staff supported them to be as independent as possible. People were able to make choices about their day to day routines. They had access to a range of organised and informal activities which provided them with mental and social stimulation.

People were supported by staff who were caring and respected them as individuals. People received care at the end of their lives that was kind and compassionate.

This inspection was unannounced and took place on 5 August 2015 it was carried out by two inspectors.

The Elms Residential Home is registered to provide personal care and accommodation for up to 16 people. The home specialises in the care of older people. At the time of our inspection there were 15 people using the service.

The last inspection of the home was carried out in June 2013. No concerns were identified with the care being provided to people at that inspection.

The service has a registered manager who is also the provider. The registered manager has managed the service for many years. 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. On the day of our visit the home was being managed by the acting manager, who was being supported by the deputy manager and three members of staff.

People spoke positively about the home and care provided. One person told us.” I used to live over the road, so my neighbours still come and see me when they like. All carers without exception are very good”. One relative told us” we don’t think we could have chosen a better home, we have no concerns for mum’s well-being”.

We observed people were cared for with kindness and respect. There was a calm relaxed atmosphere in the home, staff were very visible and attentive to people’s needs. Throughout the inspection staff were observed working well together supporting each other in tasks around the home. All staff we spoke with told us they enjoyed working at the home. One member of staff told us “I love working here” and “we all work well together.”

There was an established staff team, who had been through a recruitment process and they had the skills and qualification needed to support the people living there. Throughout the visit we observed that staff had built up caring relationships with people and their families. Call bells were answered in an appropriate time. One relative told us “I have worked in care and I have never seen such happy staff, it doesn’t matter how busy they are they all have time for you, they are just wonderful”.

Medication policies and procedures were in place and senior staff had the skills to safely administer medicines One resident told us” I have lots of medication but I don’t have to worry about it as the staff are very good at bringing them to me when it is time for me to take them.”

Systems were in place which ensured people’s wishes and preferences during their final days and following death, were respected. The home had achieved accreditation to the National Gold Standard Framework’ (GSF). This is a comprehensive quality assurance system which enables care homes to provide quality care to people nearing the end of their life.

People were complimentary about the food served in the home and said there was always a choice of meals. Comments included; “very good food here,” “ if I don’t like what I have chosen I can change it” and “I find it difficult to eat meat so they always offer me an alternative.” A relative told us “if I am here at meal times they always offer me a sandwich”.

People’s privacy was respected and all personal care was provided in private. People were able to socialise in communal areas of the home or spend time on their own. One resident informed us “I have made friends with the other residents”.

People received care that was responsive to their needs and personalised to their wishes and preferences. Care was regularly reviewed and adjusted to meet people’s changing needs.

People continued to make choices about their day to day lives and were involved in decisions about their care and support. One relative informed us “we preferred a room that was vacant to the one our mother had, so we asked if they could move and this was done for us”.

People and their representatives were involved in the planning and delivery of their care. A resident’s wish tree was available where people could hang their wishes. One wish is picked monthly by the staff team to see if they can make the wish come true. People made these wishes with the support of their families and staff.

The home had a secure outside space with pleasant seating and flowers and views into the distance. The lounge and conservatory looked out over the rear garden. There were futher lounges and quiet rooms for people to use.

We spoke with five people. All spoke positively about the home and the care provided to them. One person told us, “It’s super here, the staff are all very kind.”, and another person said “It’s enjoyable being here.” We saw that people or their representatives were involved in the planning and delivery of their care. People’s care needs and risks were assessed and care was delivered to meet their needs.

People were protected from the risks associated with medicines and the provider had effective systems to monitor pre-employment checks and recruitment procedures for staff.

The home had suitable systems to monitor the quality of service provided.