10 Nimrod Drive is registered to provide accommodation and personal care for up to six adults with learning disabilities and autism. At the time of our inspection there were five people using the service.

The home is built over three floors and is in a residential area.

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.

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At this inspection we found the service remained Good.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and they felt confident in how to report these types of concerns. People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient staff with the correct skill mix on duty to support people with their required needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. Effective infection control measures were in place to protect people.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people. 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 received an induction and on-going training. They had attended a variety of training to ensure that they were able to provide care based on current practice when supporting people. They were also supported with supervisions and observed practice.

People were able to make choices about the food and drink they had, and staff gave support if and when required to enable people to access a balanced diet.

People were supported to access a variety of health professionals when required, including opticians and doctors to make sure that people received additional healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times. Care plans were written in a person-centred way and were responsive to people’s needs. People were supported to follow their interests and join in activities.

People knew how to complain. There was a complaints procedure in place and accessible to all. Complaints had been responded to appropriately.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

Further information is in the detailed findings below.

The inspection took place on 30 and 31 March 2016 and was unannounced. Nimrod Drive is a care home without nursing that provides accommodation for up to six younger adults who live with learning disabilities. At the time of our inspection five people were living at the home. We simultaneously inspected a sister service located at 4 Nimrod Drive, a service which has the same registered manager.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

Most people who were present at the home during our inspection were unable to communicate with us verbally. People who were able to communicate told us they felt safe and secure. Staff had received training in how to safeguard people against the risks of abuse and knew how to report concerns both internally and externally.

Safe and effective recruitment practices were followed. Flexible arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

Plans and guidance had been put in place to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe. People were supported to take their medicines by trained staff. Potential risks to people’s health and well-being were identified, reviewed and managed effectively.

People were positive about the skills, experience and abilities of the staff who supported them. Staff received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and access health and social care professionals and specialist services when necessary. They were provided with appropriate levels of support to help them eat a healthy balanced diet that met their individual needs.

Staff obtained people’s consent and permission before providing support which they did in a kind and compassionate way. However, this was not always accurately or consistently reflected in people’s individual plans of care. People were supported to access local advocacy services if they needed independent advice or guidance.

Staff developed positive and caring relationships with the people they supported. People and their relatives were fully involved in the planning, delivery and reviews of the support provided. The confidentiality of information held about people’s medical and personal histories had been securely maintained.

Support was provided in a way that promoted people’s dignity and respected their privacy. They received personalised support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines, goals and personal circumstances.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community. Relatives told us that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded properly and investigated promptly.

Relatives, staff and professional stakeholders very were complimentary about the registered and assistant manager and how the service operated. Measures were in place to monitor the quality of services provided and reduce potential risks.

We consider all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we ask;

•Is the service safe?

•Is the service effective?

•Is the service caring?

•Is the service responsive?

•Is the service well led?

This is a summary of what we found.

Is the service safe?

We spoke to three carers on the day of inspection and two family members over the phone the following day. One family member we spoke with said, "I have complete faith in the service and am happy for my [Family member] to be there”. One carer said, "People are having more activities now. They all have an activity plan but sometimes they do refuse, then we offer them other things to do." Another said, "All staff are very caring. We work as a team."

We looked at staff training records. These showed that staff had completed safeguarding training together with annual refresher training. We saw copies of Hertfordshire local authority safeguarding and whistle-blower policies displayed on the office wall.

We saw that regular audits of all medicines held within the home had been carried out. There was a list of signatures of staff members that had been trained to administer medicines. At the time of our inspection there were no controlled drugs being used.

During our inspection we saw that the outside of the building and the garden had been well maintained. There were security systems in place, for example, we had to identify ourselves before entering the premises and were required to sign in and out of the building.

We looked at the staff training matrix. We found that staff were up to date with their training in areas such as: first aid, managing challenging behaviour, how to assist people to move safely and the safeguarding of vulnerable adults. We spoke with three staff, one said, "People are well cared for and they are safe.” Another member of staff said, “I have recently completed medication training on-line and have been updated by my manager about the new system on administering medicines.”

Is the service effective?

We saw the provider had a system in place ‘The Purple Folder’. This was used for medical appointments or emergencies. The separate folder contained all relevant information about the person, for example: contact details, medical history, medication and allergies the person might have. This meant that there was a procedure in place to help with the sharing of information in an emergency

Is the service responsive?

We looked at two care plans and found that these were detailed and centred on the person’s needs including information about their lifestyles, communication, behaviour support plan and their likes and dislikes. The care plans included risk assessments for areas such as, behaviour management. All staff signed to say they had read and understood the risk assessments contained in people’s care plans. There was clear guidance for staff to follow in the care plans for example: one person’s risk assessment around eating and drinking stated that there was a risk of choking and also listed the guidance for staff to follow to keep the person safe.

Is the service well led?

Not assessed during this inspection

We used the information we had gathered to answer the five questions we always ask:

Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found:

Is the service safe?

We found that people's needs had been assessed and that their care and support had been planned and delivered in a way as to ensure their safety and welfare. Due to people’s learning disability, we were unable to communicate with them. However, one person who used sign language did put their thumb up to indicate that they were being supported in meeting their needs.

Risk assessments had been carried out and regularly reviewed to reflect the changes in people’s needs. We found that one person who had lost weight did not have their weight checked and monitored to ensure that their health and wellbeing was maintained. We also found that people did not have their individual activity plan so that they were engage in meaningful activities.

The systems for the administration and management of medicines were ineffective and unsafe. The recording on the medicine administration record charts were unclear. This meant that people may be at risk of being given the wrong dose of medicines.

There were sufficient numbers of staff on duty to meet the needs of people. Health and safety audits were carried out so that people lived in a safe and comfortable environment.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. No applications had been submitted under this system. We saw evidence that staff had received training in Mental Capacity Act and DoLS and there were appropriate policies in place. The manager stated that they were in the process of completing a DoLS application for people who used the service.

Is the service effective?

People's care needs were met. We observed that there was good interaction between people and the staff. The staff were aware of each person’s needs and communicated with them by using objects of references, signs and pictures. The staff had received the relevant training so that they were able to support the people in meeting their needs. Each person had their own health action plan folder which had been completed by other health care professional such as the GP, dentist and nurses. The folders provided information for staff indicating the reasons for their visits and the treatment prescribed.

Is the service caring?

The care plans we looked at showed that these were centred on the person so that staff were aware of their needs, their likes and dislikes and preferences. We observed that people were well groomed and well dressed.

Is the service responsive?

The care plans we reviewed demonstrated that people's needs had been assessed and met appropriately. People had been seen by their GP when required to ensure that the health and welfare was maintained.

Is the service well-led?

People’s care and support had been assessed and planned and delivered in accordance with their identified needs. Regular audits had been carried out to ensure that people’s needs were met and that they lived in a safe and comfortable environment.