16 Balnacraig Avenue (The Leaves) is a home for seven people with a learning disability and physical disability. There were six people using the service on the day of the inspection.

At the last inspection on 23 April 2015, the service was rated Good.

At this inspection we found the service remained Good.

People who used the service were protected from abuse and staff were clear about what to do if they needed to report allegations or if they had witnessed abuse. Appropriate risk management plans ensured that people were protected from avoidable harm. Sufficient staff were deployed to meet the needs of people who used the service. Medicines were managed safely and people could be confident that they received their prescribed medicines safely. The home was clean and free of any offensive odours.

Staff had received a wide range of training and were knowledgeable and skilled to ensure that people’s needs were met. 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. People who used the service benefitted from a varied, nutritious, well-balanced and healthy diet. Close links with a wide range of health care professionals and clinicians ensured that people’s health care needs were met.

People and staff had formed positive caring relationships and people were well cared for. Their dignity and privacy was respected and people were supported to follow their faith and maintain their cultural identity.

People’s care was planned with putting the person’s needs in the centre of the treatment or care provided. Regular reviews of care plans meant that changes in people’s needs was responded to swiftly and ensured people’s needs were fully met. People who used the service and visitors were encouraged to raise concerns.

The service promoted a positive open and inclusive environment. People, their relatives and care workers were encouraged to regularly contribute to improve the service provided. A robust governance system ensured that any shortfalls were responded quickly and people were provided with good person centred care.

Further information is in the detailed findings below.

We conducted an unannounced inspection of 16 Balnacraig Avenue (The Leaves) on 23 April 2015.

At our last inspection on 5 August 2014, the service met the regulations inspected.

16 Balnacraig Avenue (The Leaves) is a home for seven people with a learning disability and physical disability. There were six people using the service on the day of the inspection. The home is part of a larger national provider Voyage 1 Limited and a manager is registered with the Care Quality Commission. The service had 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.

Relatives and staff told us people were safe. There were systems and processes in place to help protect people from the risk of harm. These included thorough staff recruitment, staff training and systems for protecting people against risks of abuse.

Relatives told us staff were respectful towards them and staff were caring and supportive to people throughout our visit.

There were enough suitably trained staff to meet people’s individual care needs. We saw staff spent time with people and provided assistance to people who needed it.

Medicines were managed and administered safely and staff received appropriate training and their competency was assessed annually.

Staff were available to support people to go on trips or holidays and a wide range of in-house activities were provided.

Staff understood they needed to respect people’s choice and decisions. Assessments had been carried out and reviewed about people’s individual capacity to make certain care decisions. Where people did not have capacity, decisions were taken in ‘their best interest’ with the involvement of family members where appropriate and relevant health care professionals. This meant the provider was adhering to the Mental Capacity Act (MCA) 2005 Code of Practice.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. The provider was meeting the DOLS requirements. At the time of this inspection, all people had a standard DoLS authorisation in place. The registered manager was aware of the impact of a supreme court judgement on the implementation of DoLS.

People’s health and social care needs had been appropriately assessed. Care plans provided detailed information for staff to help them provide the individual care people required. Identified risks associated with people’s care had been assessed and plans were in place to minimise the potential risks to people.

There were effective systems in place to monitor and improve the quality of service through feedback from people who used the service, staff meetings and a programme of audits and checks.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, is the service effective, is the service caring, is the service responsive, is the service well led?

During the inspection we spoke with relatives of two people who used the service. We spent time observing and we spoke with two care workers, and the registered manager.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Relatives of people who used the service told us that they felt their loved ones were safe and staff were friendly. We saw staff interact with people who used the service in a respectful manner.

People's care needs had been assessed and care and treatment was planned and delivered in a way that promoted people's safety and welfare. Risk assessments had been carried out where necessary. There were safe systems in place to ensure that medicines were dispensed and administered safely.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to homes. The registered manager had recently assessed that some of those using the service required this safeguard and had taken steps to ensure this was in progress.

Is the service effective?

Relatives of those using the home were very complimentary of staff, praising their professionalism and care. Staff told us there was good communication amongst staff about the service and people's needs, which enabled them to carry out their roles effectively in providing the care and support people needed.

Care plans had been regularly reviewed with involvement from people and those who were important to them and changes required in care and support needs had been addressed by staff.

Is the service caring?

We saw people were supported by kind, attentive staff who approached people in a friendly manner. Staff were knowledgeable regarding the specific care needs of people and respected the choices people made.

Staff had an understanding of people's cultural and religious needs and where appropriate, arrangements had been made to meet these needs. People's privacy and dignity was respected by staff during the course of their caring duties.

Is the service responsive?

People received individualised care that was responsive to their interests and preferences. A variety of activities were available for people to participate in as they chose. People's care and health was monitored closely. Written notes about people's health and care were completed by staff. People's health, safety and welfare were protected as they received the advice and treatment they needed from a range of health and social care professionals.

We saw food was provided in a safe way which ensured people were provided with a balanced diet that met their health needs. Relatives of those using the service were given various opportunities to provide feedback on the service. This feedback was used by the provider to improve the service.

Is the service well-led?

The home had recently recruited a new manager and we saw they had strengthened various systems within the home to improve safety and accountability.

Monitoring checks of the quality of the service were carried out. These included checks of the care provided to people and the quality of their environment. Improvements were made when needed. Staff meetings took place regularly so staff views about the service were taken into account.

People living at The Leaves were non-verbal and were able to communicate using gestures, sounds and facial expressions.

We observed people making choices and staff demonstrated good understanding of non-verbal communication cues used by people using the service.

Care plans were up to date and people using the service and significant others were involved in the review process.

People using the service can be confident in staff's ability to administer medicines safely.

People using the service were supported to raise concerns if required.

We were not able to speak to people using the service, because people were unable to verbally communicate with us due to their learning disability. However, we gathered evidence of people’s experiences of the service by using the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed staff offering people using the service different choices throughout our inspection. For example, where to sit and relax, where to go to as part of an activity and what people wanted to eat.

We observed staff talking to and treating people in a respectful and dignified way.

During our SOFI observation it was evident, that people were involved in tasks for the majority of time and most of the time interacted with staff. Interactions between staff and people were positive during the time we undertook our observation.