Archived: Elm House

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained Good.

The service was Safe. People their medicines on time and in the right way. Systems were in place to keep people safe and risks had been assessed and considered. Recruitment processes were in place which made sure that staff were recruited safely.

The service was Effective. Staff were given a robust induction when they started and had been trained to meet people’s needs. They received regular supervision and appraisals. People had access to see a GP and other healthcare professionals when they needed to do so. 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.

The service was Caring. Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights. The care and support people received was individualised.

The service was Responsive. People’s health and emotional needs were assessed, monitored and met in order for them to live well. The policies and systems in the service support this practice. A range of activities was on offer and people were supported to live day to day lives such as socialising and working. We have made a recommendation about the accessible communications standards.

The service was Well-Led. Audits were carried out on a regular basis, and surveys had ben carried out which looked at the quality of the service people received. The registered manager had a clear oversight of the service.

Further information is in the detailed findings below.

Elm House is a residential care home that provides care and support for up to four people. The service aims to provide short-term and long-term rehabilitation service and enable people who have an acquired brain injury to continue to maximise their potential for improvement. At the time of our inspection there was one person using the service.

A registered manager was in post at the service. 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 also registered to manage another similar service, Elm Cottage, provided by Partnerships in Care, the same provider and located a short distance away.

The service was last inspected 25 October 2013 and at that time requirements in the health and Social Care Act 2008 and associated Regulations were met.

People were protected from avoidable harm and potential abuse. This was done consistently so that people were safe whether they were in the service itself or out in the community. Potential risks of harm to the individual or others in their daily lives were assessed and identified. Detailed management strategies were planned for to provide guidance to staff on what actions to take to minimise risk. They also provided appropriate and individualised support that enabled people to participate in activities of their choice and access the community safely. Management and staff had a positive attitude towards managing risk whilst balancing the need for preference and choice with safety and effectiveness.

The provider had a thorough recruitment and selection process in place to check that potential new staff were suitable to work with people who used the service. People were supported by sufficient numbers of staff. Staffing levels were flexible and supported people to follow their interests, receive care and therapy, take part in social activities and, where appropriate education or work.

Medication was stored safely and administered correctly. The provider had robust systems in place to ensure medication was managed safely and appropriately.

Staff had developed good relationships with people living at the service and respected their diverse needs. They were caring and respectful and had the required knowledge and skills they needed to meet people's needs appropriately and safely. Staff knew people's individual care and support needs well. People's privacy and dignity was respected and upheld and they were supported to express their views and choices.

Management and staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions in some areas of their care and support.

People received personalised care specific to their individual needs; their independence was encouraged and their hobbies and interests supported. They received continuing specialist help pertinent to their needs and healthcare needs. They had prompt access to healthcare professionals when they became unwell.

The provider had arrangements in place to routinely listen and learn from people's experiences, comments and views. There was a strong emphasis on promoting good practice in the service and there was a well-developed understanding of equality, diversity and human rights and management and staff put this into practice. The registered manager was knowledgeable and inspired confidence in the staff team, and led by example.

Quality assurance systems were robust and helped to ensure the service delivered was of a good quality and safe, and continued to improve.

Care plans we reviewed were relevant and up to date. It was clear that staff supported people in a way that met their needs and preferences.

We found that there were enough skilled staff to meet people's needs. Staff told us they enjoyed their work and felt supported. However, supervision records were not consistently up to date and it was not always possible to locate appraisal records.

A number of different systems were in place to monitor the quality of care provided. We saw that the provider regularly sought the views of people who use the service and responded to feedback. We also reviewed a wide variety of records during our inspection. Overall, we found they were accurate, accessible and securely held.

We saw that Elm House worked closely with Elm Cottage, a similar community facility. Staff worked across both sites; and policies, procedures and operational practice were also the same.

When we last visited Elm House in August 2012 we found that the staffing levels were not sufficient and impacted on the people using the service in that there was not enough staff to enable people to go about their daily lives as detailed in their support plans.

We have received information and documentary evidence that provided assurance that proper steps have been taken to ensure sufficient staffing levels at Elm House and staff numbers have been increased. This means that people using the service are supported to meet their needs and go about their daily lives as detailed in their individual care and support plans.