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Inspection carried out on 12 December 2018

During a routine inspection

About the service: Elm Tree House provides accommodation and personal care for up to 20 older people who are living with dementia. The home is situated on a main road location in Newton Le Willows and is close to shops and other local amenities. Accommodation is provided on the ground and first floor and a passenger lift and stair lift are in place for ease of access.

What life is like for people using this service:

The atmosphere at Elm Tree House was calm and homely; the management team and staff had developed strong, familiar and positive relationships with people and family members. Throughout the inspection the registered manager, management team and staff were seen to be warm and affectionate towards people and often displayed physical contact that was appropriate and accepted by people.

Staff showed a genuine motivation to deliver care in a person centred way based on people’s preferences. People were treated with kindness, compassion and respect. Staff used techniques to help relax people with positive outcomes. Everyone we spoke with told us Elm Tree House was homely place to live and staff were always kind and caring towards them.

People told us they felt safe living at the service and family members were confident their relatives were kept safe. Risks that people faced were identified and assessed and measures put in place to manage them and minimise the risk of harm occurring. Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm. Medicines were managed safely and people received their prescribed medication at the right time. The environment was safe and people had access to appropriate equipment they needed.

Enough suitably qualified and skilled staff were deployed to meet people’s individual needs. Staff received a range training and support appropriate to their role and people's needs. The registered manager recognised the importance of ensuring staff were happy in their roles and provided incentives to promote this.

People’s needs and choices were assessed and planned for. Care plans identified intended outcomes for people and how they were to be met in a way they preferred. People told us they received all the right care and support from staff who were well trained and competent. People received the right care and support to eat and drink well and their healthcare needs were understood and met. People who were able consented to their care and support. Where people lacked capacity to make their own decisions they were made in their best interest in line with the Mental Capacity Act.

People received personalised care and support which was in line with their care plan. People, family members and others knew how to make a complaint and they were confident about complaining should they need to. They were confident that their complaint would be listened to and acted upon quickly.

The leadership of the service promoted a positive culture that was person centred and inclusive. People, family members and staff all described the registered manager and deputy manager as supportive and approachable. The management team showed a continued desire to improve on the service and worked closely with other agencies and healthcare professionals in order to do this. Effective systems were in place to check on the quality and safety of the service and improvements were made when required.

Rating at last inspection: Good (report published 5 May 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service had maintained a rating of ‘good’.

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

Inspection carried out on 15 March 2016

During a routine inspection

This was an unannounced inspection, carried out on 15 March 2016.

Elm Tree House provides accommodation and personal care for up to 20 older people who are living with dementia. The home is situated on a main road location in Newton Le Willows and is close to shops and other local amenities. Accommodation is provided on the ground and first floor and a passenger lift and stair lift are in place for ease of access.

The registered manager had been registered with the Care Quality Commission (CQC) since December 2010. 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 last inspection of Elm Tree House was carried out in January 2015 and we found that the service was not meeting all the regulations we assessed.

People who used the service said they felt safe. Staff knew about the systems in place to protect people from the risk of harm and they also knew how to recognise and respond to allegations of abuse appropriately.

There were sufficient staff on duty to ensure the needs of people were met. Effective recruitment processes were in place and were followed by the service. Staff received on-going training and support to ensure they carried out their role effectively.

Medicines were managed safely and processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. People received care and support from staff that knew them well, and had the knowledge and skills to meet people’s individual needs. People told us staff always treated them well and promoted their choices regarding their care, support and the activities they participated in. People spoke positively about staff, their comments included, “The staff are all respectful” and “I like the staff”.

People’s risks were anticipated, identified and monitored. Staff managed risk effectively and supported people’s decisions, so they had as much control and independence as possible.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We saw that there were policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and DoLS to ensure that people who could not make decisions for themselves were protected.

People had enough to eat and drink. People were offered drinks and snacks throughout the day. People who were at risk of poor nourishment were regularly weighed. This ensured peoples health and well being was closely monitored and any changes were responded too.

Staff were patient and friendly and knew people well. Staff interacted well with people and engaged in conversation about things of interest to them.

People’s care and support needs were up to date and reviewed on a regular basis with the person or other appropriate people. Staff provided people with person centred care and support.

One formal complaint had been made to the registered provider since the last inspection in January 2015. People were aware of how to make a complaint if required and they told us they would not be worried about complaining if they needed to. People were confident that their complaints would be listened to and acted upon.

Systems were in place to regularly check the quality of the service provided and to ensure improvements to the service were made. The registered manager and staff established good working relationships with family members and visiting professionals to the benefit of people who used the service.

Inspection carried out on 19 and 20 January 2014

During a routine inspection

Elm Tree House provides accommodation for up to 20 people who need support with their personal care. The home mainly provides support for older people and people who are living with dementia. The home is a large, converted period property. Accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor.

This was an unannounced inspection, carried out over two days. During the inspection we spoke with 11 people who lived in the home, four visitors, six staff, the deputy manager and the registered manager. 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.

We observed care and support in communal areas, spoke to people in private, and looked at care and management records.

People told us that they felt safe in this home and they did not have to wait long for staff to assist them.

We saw that medication was not always managed safely, given in a manner that meet people’s individual needs or stored correctly.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the safe management of medication. You can see what action we told the provider to take at the back of the full version of this report.

Some of the systems used to assess the quality of the service had not identified the issues that we found during the inspection. The majority of these were discussed with the registered manager and deputy manager who put into place new systems during the inspection.

People told us that they, and their families, had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided.

People told us that they were treated with kindness, compassion and respect. We saw many positive interactions and people enjoyed talking to the staff in the home.

People told us that were able to see their friends and families as they wanted. We saw that there were no restrictions on when people could visit the home. All the visitors we spoke with told us they were made welcome by the staff in the home.

The staff told us they were aware of their responsibility to protect people from harm or abuse. They knew the action to take if they were concerned about the safety or welfare of an individual. They told us they would be confident reporting any concerns to a senior person in the home.

Inspection carried out on 1 November 2013

During a routine inspection

There were 20 people living in Elm Tree House when we inspected. We talked with people in the home either individually or in small groups. Some people had dementia and had limited verbal communication. They were unable to have an in-depth conversation about the care and support they received. However we talked with people in a general way and we observed how staff supported people.

People told us that the staff were excellent and that they received care and support when they wanted it. One person said �The staff are marvellous. They are good fun�. Another person told us, �The staff can�t be as good as these anywhere else.�

We saw that people were supported to get up in the morning and go to bed when they wanted to. This allowed them to make choices about when they wanted to rise and retire and when they wanted to eat.

Care records were in place and up to date. This meant that all involved were aware of the care and support needs of people.

People living in the home and relatives told us that they were well supported by the manager and staff team. There were regular checks by senior staff to make sure the home was running well.

The home was maintained and equipment was serviced regularly so that it was safe for people to use.

Inspection carried out on 13 February 2013

During a routine inspection

We were able to speak to a number of people living at the home, about how they were cared for, whether that care met their needs, and if they were happy living at the home. We were able to speak to relatives of people living at the home. We asked them about the service, whether or not they felt included, and if they felt the wishes, dignity and independence of their family member was respected. One relative told us "My father-in-law is much better here. There is quite a lot of activity. When I visited to speak to the manager before my father-in-law came here, people were laughing and joking in the front lounge, and they were playing board games. The atmosphere and companionship here is good for him, his need is for some support but he can retain some independence, which is what he wanted."

A person living at the home told us they felt well cared for, and described how they spent time on the internet. Staff explained how a particular carer helped this person when using a laptop computer, provided by the home, to support this person in their interests and hobbies.

As part of our inspection, we looked at nutrition, how people were able to express choice, and have suggestions for alternative meals, or the make up of meals, brought into practice. We were able to confirm that when a particular dish was requested, staff would invariably meet this request.

Inspection carried out on 26 July 2012

During an inspection looking at part of the service

During our inspection visit we observed positive interactions between members of staff and people living at the home.

Inspection carried out on 5 March 2012

During a routine inspection

The expert by experience spoke with several people who used the service and some visitors. The people who used the service made positive comments about the service and staff. Some comments made were:

"My room is kept lovely and clean.�

"They keep my hair really nice for me."

"Staff ask me regularly how I am."

"All the staff know what I like or don't like."

"The meal was good today but the food always is."

"If you can't sleep the night staff do not mind a bit if you go down and have a chat with them.�

The visitors spoken with also had positive comments to make about the service. Some comments made to the expert by experience were:

" I really like this place. My other relative was here for years and very happy and content"

"The staff are great people and always make you welcome."

A relative of a prospective resident said "The home provided us with all the information we asked for and have been very open and welcoming. The staff have been very good at answering all our questions.�

St Helens Council provided us with their last monitoring report of the service following a visit in January 2011. They found that there was evidence of good practices at the service and some areas where improvements where needed. A follow up visit in April 2011 identified that the manager had taken action to address the shortfalls identified.

St Helens Council reported that five safeguarding matters had been brought to their attention. One matter had resulted in the home taking action to prevent the re-occurrence of a serious incident.

St Helens Local Involvement Network (LINk) had no information concerning this service.

*LINKs are networks of individuals and organisations that have an interest in improving health and social care services. They are independent of the council, NHS and other service providers. LINks aim to involve local people in the planning and delivery of services.