3L Care Limited is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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 is registered to provide accommodation for up to six people who require support and care with their daily lives.

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

The service provides a mixture of permanent accommodation and respite support for up to ten people with complex needs, including physical and learning disabilities. Respite can be used as a short period of support for people away from their own homes, for the purpose of carer relief or rehabilitation. The service contains single bedrooms which are located on the first floor together with four bathrooms. Other facilities include a cinema room, an activities room, a quiet sensory room, and a garden. At the time of the inspection there were eight people living in the home.

The service had a registered manager in post who was also the provider. 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.

We spoke with one person who lived in the home and one relative of a person who lived in the home and both gave positive feedback about the home and the staff who worked in it.

Staff spoken with and records seen confirmed training had been provided to enable them to support the people with their specific needs. The service provided care to people who had very complex needs and needed specialist support. We found that staff were knowledgeable about the support needs of people in their care. We observed staff providing support to people throughout our inspection visit and observed warm, positive relationships.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. We did find one medication cupboard unlocked but this was rectified at the inspection.

The management team understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that people were supported to make their own decisions and their choices were respected. We asked that the audit trails around these decisions be improved and this was being actioned during the inspection.

Care plans were person-centred and driven by the people who lived who lived in the home. We saw clear one sheet profiles that gave clear information about the most important aspects of their care for that person. They detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required. We saw that the home tried hard to enable people to engage in making decisions about their lives no matter how small the decision.

The provider and the management team used a variety of methods to assess and monitor the quality of the service. These included regular audits of the service and staff meetings to seek the views of staff about the service. The staff team were consistent and long standing. They demonstrated that they were committed to providing the best care possible for the people living in the home.

The inspection was unannounced and took place on the 10 December 2015.

The service provides a mixture of permanent accommodation and respite support for up to ten people with complex needs, including physical and learning disabilities. Respite can be used as a short period of support for people away from their own homes, for the purpose of carer relief or rehabilitation. The service contains single bedrooms which are located on the first floor together with four bathrooms. Other facilities include a cinema room, an activities room, a quiet sensory room, a hydrotherapy pool and a garden.

The last inspection took place on the 02 August 2013 The inspection found the service met all the regulations that were assessed.

The service had a registered manager 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 2008 and associated Regulations about how the service is run.

There were sufficient numbers of staff in place to ensure that people’s safety was maintained. The registered manager reviewed staffing numbers each week, to reflect the number of people on respite within the service. Recruitment processes were robust and ensured that people within the service were kept safe.

Staff were able to identify potential safeguarding issues and they gave examples of indicators and signs that may indicate abuse is taking place. Staff knew how to report any concerns and felt confident in being able to do so.

People’s care records clearly outlined risks and how these should be managed by staff. Care records were personalised and showed that people and where appropriate, their families had participated in the planning and development of care.

Accidents and incidents were logged and an analysis of them had been undertaken to prevent future issues. The registered manager had monthly correspondence with the local safeguarding team to keep them up-to-date on any safeguarding issues that may have arisen.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA 2005 is legislation designed to protect people who are unable to make decisions for themselves and to ensure that any decisions are made in people’s best interests. The registered manager kept a record of all people subject to a Deprivation of Liberty Safeguard (DoLS), and when these needed to be renewed.

Staff had undertaken training that enabled them to carry out their work effectively. The management team within the service were supportive of staff gaining additional qualifications and were in the process of supporting them to access funding to do so.

People were supported with maintaining their diet and fluid intake. Staff had undertaken the training necessary to support those people who were unable to take diet and fluids orally. People had been supported to access support from dieticians and other health professionals where required. This meant that people were receiving the support they needed to maintain their wellbeing.

Staff were caring and respectful in their approach towards people. People’s dignity was maintained during personal care interventions, and we observed that bedroom doors remained closed when staff were supporting people. People’s care records were kept in a locked cabinet which helped to maintain people’s confidentiality.

People were supported to undertake activities and they had their own activity planner for the week. People made use of the facilities within the service which included a hydrotherapy pool and a sensory room which could also be turned into a cinema. People were supported to attend day care and they had key workers who supported them to attend trips out in the community. This prevented people from becoming socially isolated.

People felt that their complaints and concerns would be listened to. The registered manager held family open days twice a year and also had an open door policy for anyone with any concerns. We saw examples of where concerns had been raised and how the registered manager had responded appropriately to these.

Quality audits were completed by the registered manager and the registered provider. The information from these was used to generate improvements to the service which benefited people who used it.

This inspection was carried out because we had received concerns that the provider did not carry out proper checks on staff before employing them. However, we found that the required checks were carried out.

On the day of our visit there were two permanent residents and three people receiving respite care. There were enough staff to meet people's needs.

People's needs were assessed before admission and they were given a contract that identified the service they would receive and how much it would cost.

People were happy with the care provided. One relative said the home could not do enough for both her and the person who used the service. A representative from the clinical commissioning group confirmed that the person they funded had been assessed by the home manager before admission and when they visited after admission the person seemed settled and well cared for.

People were given their medicines as prescribed by their doctor and were helped to access other health and social care services that might help them.

There was an accessible complaints procedure in place and complaints were investigated and acted upon.

We spoke with a relative of a person who was staying at the home at the time of our visit. They told us that the registered manager and another member of staff visited the person at home to discuss what their needs were and what their likes and dislikes were before they went to stay in the home. The relative said that staff were always readily available, they were all caring and attentive and the care provided was “very supportive, providing plenty of encouragement”.

A person using the service told us they had first visited the home for tea, then for a day, then stayed overnight, then for a couple of nights, and this time they were staying for a week. This was so they could get to know the staff and the staff to get to know them on a gradual basis. They said that they liked staying there. They said they were offered choices, such as when they would like to get up or go to bed, what they would like to eat and what they would like to do during the day.

We also spoke to the social worker of another person using the service, who said that the person’s family were very happy with the care provided.

People we spoke with said they were confident that people were safe in the home.