We undertook an unannounced inspection on 06 August 2018 and returned for a second announced visit on 07 August 2018. The service registered 27 July 2017 and this was the first time it had been inspected.

3L Care Atherton provides nursing care for people with complex health needs, acquired brain injury and associated physical and learning disabilities. The home is registered to provide care and support for up to nine people. At the time of the inspection there were six people living 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.

At the time of the inspection only six of the bedrooms located on the ground floor were occupied. Each bedroom has French doors with ramp access so people could access either a small garden or courtyard area. The home has a total of five bathing areas that offer a range of assisted and non-assisted options. Three large bathrooms have ceiling tracking hoists which ran through people’s bedrooms to assist people with moving from their bedroom to the bathroom. The bathrooms are spacious and have sufficient space for moving wheelchairs or hoists. The baths have a raise and lower facility to aid access. There is also an assisted shower room for those people who prefer that facility.

The large living area and kitchen provide a central hub for the home and there was a sensory room and garden available for people to freely access.

At the time of the inspection there was a registered manager in place who was also supported by a home 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.

People’s relatives spoke positively about the staff and management at the home. Relatives were complimentary about the care provided and had no concerns regarding their relatives or other people’s safety living at the home.

Medication records were well maintained and detailed policies and procedures were in place. Safeguarding processes were aligned with the Local Authority safeguarding tier system. Safeguarding issues had effectively been identified and reported to statutory bodies.

Staff went through a robust recruitment process before starting work which people living at the home. People using the service were encouraged to participate in recruitment process to ensure correct employment decisions were made. Sufficient staff were deployed which was responsive to people’s needs and preferences enabling people to lead fulfilled lives. It was clear throughout the inspection; staff had a good rapport with people and provided flexible, tailored support to meet people’s individual needs.

Relatives were involved in assessments and people had comprehensive risk assessments which were reviewed regularly and updated to meet theirneeds. People and their relatives’ views and decisions about care provided were listened and acted upon.

We found staff received appropriate training, supervision and appraisal to support them in their role. Bespoke training was provided depending upon people’s individual needs.

Relatives told us that the service had made a real difference to theirs and their family member’s lives. They told us they had no concerns and were comfortable leaving their family member in the care of the staff team as they were confident they were extremely well cared for.

People were supported by staff that were creative in their ways of communicating with people to ensure they understood people’s needs. Staff encouraged p