This inspection took place on 13 December 2018 and was unannounced.

222 Bills Lane is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates a maximum of four people who have learning disabilities. At the time of the inspection two people were using the service.

At our last inspection in February 2016 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.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A registered manager was 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 and associated Regulations about how the service is run.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks associated with people’s health care needs had been assessed and planned for. These were monitored for any changes. Risks associated with the living environment had mostly been assessed. People did not have any undue restrictions placed upon them. There were sufficient staff to meet people’s needs in a flexible way and safe staff recruitment procedures were in place. People received their prescribed medicines safely and these were managed in line with best practice guidance. Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence.

People continued to receive an effective service. Staff received the training and support they required including specialist training to meet people’s individual needs. People were supported with their nutritional needs and healthy diets were promoted. Staff worked well with external health and social care professionals, people were supported to access health services when required. 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 principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported and their families. They understood people’s needs, preferences, and what was important to them. Staff knew how to comfort people when they were anxious and made sure emotional support was provided. People’s independence was promoted and people were supported to achieve their goals.

People continued to receive a responsive service. People’s needs were assessed and planned for with the full involvement of the person and professionals involved in their care. Care plans were user friendly and up to date. People had opportunities to lead their lives in the ways they chose, pursue their interests and maintain relationships with those important to them. There was a complaint procedure and action was taken to learn and improve where this was possible. End of life care was provided in a sen

We carried out this inspection on 8 February 2016.

222 Bills Lane provides residential care and support for up to four people with learning disabilities or autistic spectrum disorder. At the time of our inspection there were three people living at the home.

The service has a registered manager. 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. A registered manager had been in post since October 2014.

Relatives and staff told us people were safe living at the home. Staff had a good understanding of what constituted abuse and knew what actions to take if they had any concerns. Staff knew about processes to minimise risks to people’s safety.

There were enough staff to care for the people they supported. Checks were carried out prior to staff starting work to ensure their suitability to work with people who used the service. Staff received an induction into the organisation, and a programme of training to support them in meeting people’s needs effectively.

Care plans contained information for staff to help them provide personalised care. Care was reviewed regularly with the involvement of people and their relatives.

People received care from regular staff who knew them well. People and relatives told us staff were caring and had the right skills and experience to provide the care required. People were supported with dignity and respect. Staff encouraged people to be independent.

People received medicines from trained staff and medicines were administered, stored and disposed of safely.

Staff understood the principles of the Mental Capacity Act (2005) and how to support people with decision making, which included arranging for further support when this was required.

People had enough to eat and drink during the day, were offered choices and enjoyed the meals provided. People who had special dietary needs were catered for. People were assisted to manage their health needs, with referrals to other health professionals when required.

People knew how to complain and could share their views and opinions about the service they received. Staff were confident they could raise any concerns or issues with the managers, and they would be listened to and acted upon.

There were processes to monitor the quality of the service provided. This was through regular communication with people and staff. There were other checks which ensured staff worked in line with policies and procedures. Checks of the environment were undertaken and staff knew the correct procedures to take in an emergency.

The management team continued to adapt the service to meet people’s changing needs.

The three people living at 222 Bills Lane at the time of our visit were older people with a learning disability. The atmosphere was quiet, relaxed and homely. The home was comfortably furnished and well maintained. We chatted with all three people and watched the support and care provided to them. We also spoke with three members of staff and the manager of the home.

Care plans were tailored to people's individual needs and detailed how they preferred their care to be provided. Records showed that people were supported to engage with a range of health professionals on a regular basis.

People engaged in a relaxed manner with staff and each other. We observed that people were not hesitant about approaching staff and asking for assistance.

Staffing levels were sufficient to meet the needs of the people living in the home. Staff rotas confirmed staffing levels were consistent. Staff spoke positively about the service and their role in the home. One staff member said, “It is like a family.” Another member of staff told us, "It’s a great house to work in. Everybody gels together and we all help each other out.”

Regular audits were taking place such as medication administration, financial procedures, food hygiene and household checks. The audits identified whether staff were following the policies and procedures of the home.

We visited 222 Bills Lane without letting anybody know in advance. There were three people living at the home at the time of our visit. The home was carrying one vacancy. We spent time looking at care plans, talking to the people who lived there and staff and watching how staff supported people within their home.

We saw 222 Bills Lane was a comfortable and calm home. We saw that people were very relaxed and at ease with staff and within their home environment. We saw people interacting with each other in a warm and friendly manner. People took part in various activities both within the home and outside in the community.

Care plans provided information about what care and support people required. They were clear about what people could do for themselves and what they required assistance with.

There were systems in place to ensure medication was administered safely to people.

Staff told us and records showed they received a high level of support and supervision. Staff knew what people's care needs were and how they needed to be supported.

The home had a complaints policy which was in a format that was accessible to the people who lived there.

When we visited the service on 30 November 2011 there were three people living in the home. We spent three hours in the communal rooms of the home and saw people looked happy and alert and interacted with workers and with each other as well as they were able.

Workers supported people to use their kitchen and dining area and to chose food and eat as independently as possible.

All of the support workers that we saw including those from an agency treated people kindly and engaged with them constantly. People were encouraged to make decisions about how their day was spent.

We saw that people had their own bedrooms and the house had sufficient space for people to be away from each other if they chose. Bedrooms remained accessible to people during the day. We saw that people moved around the house freely and workers were available to support them whenever they needed it.

People also spent time out of the house including at the local supermarket to shop for meals.

We asked two people if they were looked after well and they indicated to us that they were.

People had extensive and up to date individual care plans. Workers supported them in a planned way that balanced the risks posed by their condition with their right to dignity, choice and independence.