About the service:

19 – 23 Church Street is registered to provide accommodation and personal care for up to ten people with learning disabilities. At the time of inspection, nine people were using the service. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

People continued to receive safe care. Staff understood safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place to manage risks within people’s lives, whilst also promoting their independence.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out. Staffing support matched the level of assessed needs within the service.

Training was provided to ensure staff had the skills, knowledge and support they needed to perform their roles.

Staff were well supported by the registered manager, and had regular one to one supervisions. Staff were positive about the management of the service.

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 manner.

People and their relatives were involved in care planning and were able to contribute to the way in which people were supported. People and their families were involved in reviewing people’s care and making any necessary changes.

A process was in place which ensured people could raise any complaints or concerns. No complaints had been received since our last inspection.

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. The inspection report was published on 5 April 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.

We inspected this service on 21 November 2015. The inspection was unannounced.

19-23 Church Street is a care home for people with a learning disability situated in the North Nottinghamshire village of Market Warsop. The service was based in a purpose built two storey building on the outskirts of the village. All the floors were level access with a lift to the first floor. Accessible bathrooms and toilets were provided. A car park is available for visitors and level access into the building is also provided. The service is registered to provide accommodation for people who require nursing or personal care for ten people. On the day of our visit ten people were accommodated there.

The service had a registered manager in place at the time of our visit. 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.

Some of the people who use the service have severe learning disabilities and their use of verbal communication is limited. We found that most of the staff had worked in the service for a long period of time and had an excellent knowledge of how each person communicated verbally and with gestures and body language.

People felt safe and staff knew how to protect people from harm. Staff knew how to respond to incidents or concerns and how to report these. Robust systems were in place to protect people from the risk of abuse.

Staff had the knowledge and skills to provide safe, effective and appropriate care and support to people. There were enough staff employed to meet the needs of people using the service.

Medicines were managed safely and people received their medicines as prescribed.

People were supported to make decisions about their care, support and daily activities. Where people did not have capacity to make decisions they were protected under the Mental Capacity Act 2005.

People were supported to maintain healthy nutrition and staff were monitoring and responding to people’s health conditions. People’s privacy and dignity were respected by staff and they were supported to maintain and develop their independence. People were supported to have a social life and to go out into the community and go on holidays.

Effective systems were in place for people, their relatives and staff to give feedback about their experiences of the service. Comments and suggestions were acted on. Systems to monitor the quality and effectiveness of the service were used to continuously improve the service.

When we visited the home on 9 December 2013, we found staff were not all following guidance for infection control and some areas of the premises had not been regularly cleaned. We asked the provider to send us a report of the actions they would take to comply with regulations and ensure people were fully protected from the risk of infection. We received an appropriately detailed plan and we visited again to confirm all the planned action had been taken.

Staff had been given updated information and there was a revised cleaning schedule. The manager made sure all areas were cleaned each day.

We found people who lived in the premises had been provided with some new equipment, new bedroom carpets and much of the flooring throughout the home had been replaced. This made it easier for staff to keep all areas clean.

Also, several bedrooms had been redecorated and one person was choosing new wallpaper for one wall in their bedroom. One staff member told us, "All the staff know what they are doing now. It's all much better."

We spoke with two people who were accommodated at the service and observed some of the care of two others. We also spoke with the relatives of another person. We saw people ask for support and appropriate support given immediately. One person told us that they were content with the way their needs were met. A relative said, "The care here is as good as it could possibly be." We found that care was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found the general lounge areas appeared clean and the home was free from any offensive odours. A regular visitor said "It's always as clean as it is now" However, we saw evidence that some areas had not been cleaned regularly and staff were not following appropriate guidance to ensure risks of infection were minimised.

A relative told us they thought the staff were caring, well trained and knew people's needs well, particularly regarding communication. We saw evidence of staff training and supervision and we concluded that people were cared for by staff who were supported to deliver care safely.

The manager sent a weekly report to the provider about aspects of the service and there was evidence that learning from incidents took place.

Many of the people who received a service at or from 19-23 Church Street had complex needs affecting their mobility and communication. Individual people had their own way of communicating and this included facial expressions, body language, gestures, specific Makaton signs and some speech. We communicated with some people who lived at the service and observed staff working with others. We saw staff offering assistance and communicating with people. It was clear that people consented to the practical care given.

One person that used the service indicated they were content with the way their needs were met. Another person was enthusiastic about how staff encouraged them to be active. We saw people involved in activities and they could choose what they wanted to do at any time. There were sufficient staff available at all times to meet people's individual needs. The staff we spoke with were well aware of people's individual care and support needs.

Medicines were prescribed and given to people safely and only the staff that were trained and competent were responsible for medication.

Staff received appropriate professional development and worked well together as a team. Tasks were shared and people who lived at the service indicated they knew the staff and enjoyed their company.

We found that comments and complaints people made were responded to appropriately, though not all information about how to make a complaint was accessible by people that used the service.

On the day of our visit to 19-23 Church Street there were 10 people living at the care home.

Many of the people who live at Church Street have issues with their communication, which made gaining their views difficult. However there was a great deal of positive body language, smiling faces, and the people who were able to express a view told us that they were very happy.

The observations we made of the staff working with people who lived at the care home showed that people were well cared for, and treated with respect and consideration.

We spoke with one person about their experiences of living at 19-23 Church Street. We asked if they felt safe, and they said that they did. This person was unable to tell us about the policies that the home had for keeping them safe, or give any insight into staff training in safeguarding procedures. We also asked if they thought there was enough staff employed and working at the home. We were told that they thought that there were.