The unannounced inspection took place on the 29 September and 05 October 2016.

230A Mountnessing Road provides accommodation and nursing care for eight persons who have learning disabilities and other multiple/complex needs.

The service is required to and did have 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.

Staff had good knowledge of safeguarding procedures and understood their responsibilities and how to keep people safe. People’s rights were also protected because management and staff understood the framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Management applied such measures appropriately.

There was sufficient, regular and consistent staff to meet people’s individual needs. A robust recruitment process was in place and staff were recruited and employed upon completion of appropriate checks. Care workers were well trained and effective support was delivered by staff who felt supported. People’s safety was ensured whilst independence and wellbeing was promoted by the staff providing the care. People’s medicines were managed safely by qualified staff.

People had enough to eat and drink and staff understood and met their nutritional needs. People were offered choice. Staff ensured people had access to a range of health professionals to maintain the good health of people.

Privacy and dignity was valued by staff that were observed to be respectful and compassionate towards people. Staff interacted with people respectfully and displayed kind manners. Staff understood their roles in relation to encouraging people’s independence whilst mitigating potential risks. People displayed good knowledge of the people they supported and provided support in a person centred way. People were helped to identify their own interests and pursue them with the assistance of staff. These person centred activities took place within the service as well as in the community.

The registered manager and provider had effective quality assurance systems in place to identify any improvements needed. A complaints procedure was in place and had been used appropriately by management. Systems were in place to make sure that people’s views were gathered and the service was well managed.

On the day of our inspection there were eight people using the service. We spoke with two people who used the service, the registered manager and one member of staff.

We thought about what we found and asked the questions that we always ask; Is the service safe, effective, caring, responsive and well-led?

This is a summary of what we found:

Is the service safe?

When we arrived at the service we were asked to sign the visitor's book and our identity was checked. This meant that people were protected from unwanted visitors to the complex where they lived.

The registered manager had carried out regular medication audits to ensure that the medication systems and practices were safe for people who used the service.

Staff had received training in the administration of medication. The registered manager had carried out checks on some staff’s competence to administer.

This showed that the service had medication systems in place to help keep people safe.

Is the service effective?

People who used the service looked happy and relaxed and they indicated that their needs were met. People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure their safety and welfare. They had been regularly reviewed and updated.

Mental capacity assessments had been carried out for all areas of need. This showed us that people’s level of capacity had been considered to ensure that they received an effective service which was tailored to their individual needs and circumstances.

Is the service caring?

We saw staff interacting with three people throughout our visit on 17 July 2014 and they did so in a respectful, kind and caring way.

Is the service responsive?

We saw that staff were responsive to people’s needs and that they supported them in a way that best suited them.

Is the service well-led?

The registered manager had completed all of the actions identified at the service’s last inspection on 27 September 2013. Regular medication audits had been carried out. The storage temperature of medication had been checked and recorded daily.

This showed that there was an effective medication system in place and that the service was well-led.

As part of this inspection we observed how people were being cared for, spoke with the manager, deputy manager and two support assistants and reviewed three people's care records. On the day of our inspection there were eight people living at 230a Mountnessing Road. The manager told us that the needs of people living at the service were varied and complex. The majority of people had complex communication difficulties and were unable to tell us about their experiences of using the service. Our observations suggested that people living at the service were happy, that they felt safe and were well cared for.

People's health and personal care needs were assessed and there were detailed care plans in place for support assistants to follow so as to ensure that people were supported safely and in accordance with people's individual preferences and wishes. Support assistants spoken with demonstrated a good understanding of people's health and personal care needs and how each person wished to be supported.

The provider was able to demonstrate that a robust staff recruitment policy and procedure was in place and followed to ensure that people living at the service were kept safe. Improvements were required in relation to the management of medicines and ensuring that mental capacity assessments were completed for each person.

The people living at Mountnessing Road had complex care needs and were unable to provide us with feedback on their care and the services they received. We tried, as part of this inspection, to contact relatives who visit people at the home but were unsuccessful. From our observations and time spent at the home we concluded that the people living there were receiving the care and support they needed in an individual way and wherever possible the staff team tried to facilitate choice and independence. The staff team looked after the healthcare needs of the people living in the home in a proactive way.

The staff team at the home were well trained but not always regularly supervised and supported through the management supervision scheme.

The provider had systems in place for monitoring and assessing the quality of service provision.

The people that live at 230 Mountnessing Road had limited communication skills. At times they expressed their views by using facial expressions, body language and gestures.

Where people did respond it was in a happy and positive way, however, they did not respond to many of the questions that we asked in any of the outcome areas.