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Inspection carried out on 13 March 2019

During a routine inspection

About the service:

Elm is registered to provide accommodation and personal care to three people who may have physical, sensory or mental disabilities. At the time of inspection, three people were using the service.

People’s experience of using this service:

People continued to receive safe care. Staff understood safeguarding procedures to follow to report abuse and incidents of concern. Risk assessments were in place to manage risks to people, while also promoting their independence.

Staff recruitment procedures ensured that appropriate pre-employment checks were completed. Staffing numbers matched the level of people’s assessed needs within the service during our inspection.

Staff training was provided to ensure they had the skills, knowledge and support needed to perform their roles. Specialist training was provided to make sure that people's needs were safely met and they were supported effectively.

Staff were well supported by the manager and management team. Staff we spoke with were positive about the senior staff and management in place, confirming staff had regular supervision meetings.

People's consent was gained before any care was provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff continued to treat people with kindness, dignity and respect and spent time getting to know them. Care plans reflected people's likes and dislikes and staff spoke with people in a friendly and respectful manner.

People were involved in the planning and development of their care plans and were able to contribute to the way they were supported. People and their family were involved in reviewing their support and making any necessary changes.

A process was in place which ensured people could raise any complaints or concerns. Concerns were acted upon promptly and lessons were learnt, following open communication.

The service continued to be well managed. The provider had systems in place to monitor the quality of the service. Actions were taken and improvements were made when required.

Rating at last inspection: Good (Report published 18 May 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

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 5 January 2016

During a routine inspection

This inspection took place on 5 January 2016 and was unannounced.

Elm is owned by Innova House Heath Care Limited and offers ground floor accommodation for up to three adults with brain injuries and physical disabilities. There were two people living there when we visited.

There was a registered manager who was based in another service close by, but visited Elm each day. 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.

People were safe and protected from harm at Elm. Any risks to the safety of people were assessed and reduced as far as possible. There were always enough staff available to meet people’s individual needs and action was taken to ensure people received their medicines safely.

A range of training was available to staff, though some staff were waiting for some courses that were being arranged. They had information about the Mental Capacity Act and the manager ensured people’s rights were protected

People received appropriate support with their eating and drinking needs, their independence was promoted and arrangements were made for sufficient food to be made available. However, they did not always receive their preferred choice of meal. People’s ongoing health was monitored, but any specific action that may be needed to stay healthy and promote their health was not always discussed with people.

There had been some recent staffing changes and people were getting used to different staff. They told us they got on very well with the staff they had known for several years. All staff showed kindness and compassion in the way they spoke with people. People were supported to maintain relationships with family and friends and there were no restrictions on visitors.

Staff showed respect for people’s privacy and dignity. They understood the importance of confidentiality, keeping all personal information about people safe and secure.

The service was responsive to individual interests and preferences and plans of support and care were person-centred and specific to people’s individual needs. People were also satisfied with responses they had received when they raised any concerns a made specific requests.

There were systems in place for staff to discuss their practice and to report any concerns. The quality of care was monitored by a management team on behalf of the provider.

Inspection carried out on 02/04/2014

During a routine inspection

Elm is owned by Innova House Health Care Limited and offers ground floor accommodation for three adults with various complex needs. The bedrooms are single with ensuite facilities and there is a shared kitchen and lounge area. The home is located next to other services owned by the same company and a shared activities centre is available. There is a registered manager for this service

Three people were accommodated when we visited and they told us they were happy living there and felt safe. We found staff had been trained in how to safeguard people who used the service. We also found that people's care and support plans incorporated comprehensive risk assessments which promoted their health and ensured their support was given safely.

We found the provider ensured the premises were maintained and equipment had all been serviced as needed to ensure it was safe to use.

People described the staff as “Good” and “Very caring”. The staff told us they received some good support from the manager when they asked for it, but we identified some improvements were needed in providing formal staff supervision. The manager immediately arranged some meetings for two staff with their team leader.

Care and support plans were detailed and contained specific guidance for staff, but not everyone felt they were involved in making decisions about their care. The manager assured us this would be addressed.

People told us about a large range of activities in response to their particular interests. They confirmed they had frequent shopping trips, bowling, pub and cinema outings, rock and roll weekends and they could also attend an activities centre provided next to the home.

We found that the service was well led and the manager and general manager responded to all comments made about the service in order to make any improvements needed. One relative told us, “They have always listened to what I have said.”

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. (The deprivation of liberty safeguards is a code of practice to supplement the main Mental Capacity Act 2005 Code of Practice.)

We saw evidence to suggest that one person who lived in the home was being deprived of their liberty, due to increased supervision when in the community. The manager was in the process of making an application for DoLS in order to protect the rights of the person by ensuring that any restrictions on their freedom and liberty were assessed by professionals who are trained to assess whether the restriction is needed.

Inspection carried out on 4 July 2013

During a routine inspection

During our visit, we saw all three of the people using the service and spoke in more detail with two of them. We also spoke briefly with a relative of one person and we consulted staff including the general manager.

People told us they had a lot of choice, but were dependent on support from staff. They each had their own activity timetable and were involved as much as possible in daily living tasks. We saw evidence in their care files of their involvement in planning their individual care and support.

Care and treatment was planned and delivered to ensure people�s safety and welfare. People we spoke with confirmed they felt safe living at the service and we saw in their care plans that all risks to their safety had been fully assessed. The provider responded appropriately to any allegation of abuse and we found that the staff understood how to protect people and report any concerns.

People who used the service told us staff were caring and a relative told us, "All the staff here are amazing with what they do."

There were usually at least two staff on the premises at all times. When we found one of the staff was not available for a short time, immediate action was taken and we found there were additional staff to assist people to take part in activities. Staff were trained to meet people's needs.

All aspects of the service were monitored by the general manager on behalf of the provider and people were consulted about the quality of their care.