The inspection took place on 11 September 2018 and was unannounced.

33 Blanford Road is a care home providing accommodation, personal care and support for up to six adults who have a learning disability, physical disability or mental health conditions. At the time of the inspection six adults were resident at 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in place at the service at the time of the inspection. 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.

At the last inspection, on 6 May 2016, the service was rated as good in all but one domain. This meant that the service was rated as overall good. At this inspection we found the service had remained Good.

The service was responsive and went above and beyond to meet people's aspirations and lifestyle choices. It was flexible and readily adapted to meet people's changing, diverse and complex needs. It was extraordinarily person centred and people were seen and responded to as individuals. Activity programmes were creative and designed to meet people's individual preferences and choices. Care planning was highly individualised and regularly reviewed which ensured people's current needs were met and their uniqueness and individuality was respected.

Policies, procedures and staff training were in place to protect people from avoidable harm and abuse. Staff had identified risks to people and these were managed safely. People were protected from the risk of infection. Recruitment processes were followed to ensure suitable staff worked at the service. Staffing levels were sufficient to ensure people’s safety and the provider had thorough pre-employment checks in place to ensure staff were suitable to support people with a learning disability. Arrangements were in place to receive, record, store and administer medicines safely and securely.

Risks to people’s safety were identified and action taken to keep people as safe as possible. Accidents and incidents were reviewed and measures implemented to reduce the risk of them happening again. People’s care would not be interrupted in the event of an emergency and people were made aware of fire procedures.

People’s rights under the Mental Capacity Act 2005 were respected. Staff understood the importance of gaining people’s consent to their care and how people communicated their decisions. Applications for DoLS authorisations had been submitted where restrictions were imposed upon people to keep them safe.

People were cared for by staff who had received comprehensive training, support and supervision in their role. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were supported to eat and drink sufficiently for their needs. Staff supported people to see a range of healthcare professionals in order to maintain good health and wellbeing. The home provided bright and spacious accommodation with access to large grounds and outside space. People had been encouraged to choose the décor and were able to personalise their bedrooms.

Staff treated people with kindness. Staff supported people to make choices about their lives. Staff treated people with respect and upheld their dignity and human rights when delivering their care. People had a comprehensive assessment of their support needs and guidelines were produced for staff about how t

The inspection took place on 6 May 2016 and was unannounced.

33 Blanford Road is owned and operated by Prospect Housing and Support Services. It provides accommodation for six adults with learning disabilities. At the time of the inspection six adults were resident at the service. The majority of people who live at the service were unable to communicate verbally with us. We therefore observed their response to staff and how they interacted with staff during the day and have used our observations in the report.

At the time of the inspection the service did not have a registered manager they had recently appointed a new manager who was in the process of applying to CQC for registration. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

People were protected from the risk of abuse, avoidable harm or discrimination because staff understood their roles and responsibilities in protecting them. Staff understood the importance of gaining consent from people and acted in accordance with the principles of the Mental Capacity Act 2005. However it was identified that three people required Diazepam to be given as sedation prior to the district nurse taking blood and no evidence of best interest meetings in place.

People were safeguarded from the risk of harm because the provider had taken appropriate steps to ensure only suitable staff were employed. There was a training programme in place which helped to ensure that new and existing staff had the necessary skills to meet the needs of the people living at the service.

There had been a change within the structure of the organisation as a result the records management at the service was in a period of transition from one format to a new corporate one. As a result of these changes records management at the home was not effective and did not allow easy access for people and staff to follow.

At our last inspection in 18 December 2013 we raised a concern about "The health and safety of the people who used the service as there was no quality assurance system in place to record the findings of quality questionnaires, analyse the results, identify and record action to improve quality and feed back to the people who use the service." We saw during this inspection the service was now undertaking quality questionnaires and using the analysis to improve the service.

There were enough staff on duty to meet people’s needs safely and promptly. The service had a number of staff vacancies which whilst being recruited to were being covered by the use of agency and relief staff. Whilst it is beneficial to have a core of permanent staff, we were told that the service had taken appropriate steps to mitigate the impact of this by using regular agency staff who had become familiar to people and their needs.

There was positive feedback about the home and caring nature of staff and from relatives of people who lived at the service.

People received personalised care that was responsive to their needs. Each person had a detailed plan of care that was kept under regular review. Risks to people were identified and managed in a proactive and enabling way that balanced their safety and independence.

The service had a relaxed and friendly atmosphere. There was a strong emphasis on key principles of care such as compassion, respect and dignity. We observed that the people who used the service were treated with kindness and that their privacy and dignity was respected at all times. Staff had a good understanding of people's needs and engaged with and supported them effectively.

People were supported to be actively involved in making decisions about their care as much as possible and staff understood the importan

During our visit we met six people who used the service. People had complex care needs which meant they might have had difficulty describing their experiences of the service. We gathered evidence of people's experience of the service by observing the care they received from staff using our SOFI tool. We also spoke with the registered manager, three staff and one relative.

We spent time observing how people spent their time, the support they received from staff and whether or not they had positive experiences. Our observations of staff practice showed that people were receiving effective, safe and appropriate care, which was designed to meet their specific needs.

We saw people felt comfortable in approaching staff and asking for assistance. People were relaxed and content in their surroundings. Staff engaged positively with people who used the service to encourage them to communicate their consent to personal care, wishes and choices.

We spoke with two people who used the service. One person told us “I like it here as I feel safe and I like fish and chips.” Another person told us “I like my fried breakfast every week and staff are nice.”

We spoke to one relative who told us that “The service is good and staff always give a very big welcome, I have no complaint to make as I am happy with the care my relative receives and the home keep me informed about my relative care.”

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The home had a robust recruitment procedure in place; this meant that people were cared for by people who were suitable to work with vulnerable people.

The provider did not have an effective system to regularly assess and monitor the quality of service that people receive

Our follow up visit took place between 11.00 and 15.30 hours and was carried on an 'unannounced' basis. This meant that the service was not told beforehand that we would be visiting.

All of the people who live at the service were involved in this review through either their feedback or our observations of their interactions at service and with staff. We spoke with two carers (relatives) either on the day of our site visit or via telephone following our visit. We also consulted with five staff members. The site visit was in part facilitated by the area manager. On the day of our site visit there were six people living at the service.

Some people living at the service do not use verbal forms of communication. Observation showed that some people used single words and some sentences and other people had their own style of communicating, we saw interactions in which staff understood and responded to these forms of communication.

A person who lived at the service told us their preferred times of rising and retiring and that this was respected by staff and that they could vary these times according to their personal choice. A person told us that they had not had any planned activities cancelled which were not request by them.

A carer told us how they had noted improvements in the overall standards of care that their relative. We observed many positive interactions between staff and people who live at the service with humour often being used to effectively communicate with a person who clearly enjoyed this interaction with staff.

We observed people showing positive body language and engagement during the lunch time meal. This included smiling, touching and clapping. Other people described their lunch as “nice” and “great”. A carer told us that they regularly see staff sitting at the table with people to eat meals all together

We observed that all areas we visited in the service were clean. A person told us that their bedroom was always cleaned if they wanted it cleaned.

A carer told us how kind staff were and how knowledgeable they were about their relatives needs, they told us “I love the way that some staff talk to him as they make him laugh”.

A resident told us that they liked living at the service. Carers generally spoke positively about the overall care and support their relative received. A carer noted that the service was good at “providing basic care and understanding”. A carer expressed their concern that sometimes residents were not dressed in a way that promoted their dignity due to poor standards of laundering.

Some residents do not use verbal forms of communication. Observation showed that some residents used single words or gestures and other residents had their own style of communicating, for example, the use of body language, facial expressions or other forms of behaviour. We observed several incidents in which staff did not effectively interpret these none verbal communication indicators.

Carers consistently told us how welcome they are made to feel when they visit by being offered beverages. Carer’s feedback that they felt that there was a good level of communication with senior staff who notify them of significant events or changes in their relatives needs.

A resident told us that they had been unwell recently and how staff had made an appointment to see the Dr for them. Carers told us that the service takes prompt action to seek medical advice or intervention.

A carer feedback they felt that the service does not always provide enough stimulation or things to do and that their relative will often say that they did not do an activity as there was no driver available.

A resident told us that the “food is alright, I can tell the staff what I would like”. Carers feedback that they observed that the meals very rarely use fresh vegetables and that there does not seem to be any fresh fruit offered. Several staff and a carers feedback that residents do not have puddings as the food budget does not facilitate this.

A resident told us how much they like their bedroom as they could listen to music in their bedroom. The spacious layout of the service enabled a resident to walk around independently enjoying the space and the freedom. A carer told us how much they enjoyed being able to sit out in the garden during the summer with their relative.

A resident told us “I like the staff they take me out”. We received variable feedback from carers regarding staffing. This included “most of the staff seem caring enough” and “Just lately they seemed to be really short staffed, and they use bank staff who are nice enough but don’t know the residents”.

A resident told us that if they were not happy with something they would tell the staff. We received variable feedback from carers about their experiences when they have feedback their views and concerns to the service.