We inspected the service on 20 November 2018. The inspection was unannounced.

429 Warwick Rd 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 accommodates seven people who are living with a learning disability.

On the day of our inspection there were six people using the service.

At our last inspection 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.

There was a registered manager at this. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

The care service had not originally 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. Part of this best practice approach is to ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, people were given choices and their independence and participation within the local community is encouraged.

People felt safe around the staff supporting them. Staff understood how to keep people safe and had received training to support this. Staff knew the risks to people’s health and how to manage these risks safely. People were able to access support from staff when needed, and staff were happy with the staffing levels at the service. Recruitment processes included background checks on staff. People were supported with their medicines when needed. Checks were also in place to ensure people received their medicines safely. Staff understood how to keep the spread of infection to a minimum. Accidents and incidents were recorded and monitored so that people’s care could be adapted as appropriate, and learning from any untoward incidents was shared with staff.

Staff training was based on best practice and the individual needs of people living at the service. Training was monitored so that staff had skills in line with people’s needs. People were supported to make decisions about their care where this was needed. People were supported to access help from medical professionals and advice was incorporated into people’s care plans. People were offered choices in their meals and were offered support to develop their own menu plans.

People liked and valued the staff supporting them. Staff had a detailed knowledge of the people they were supporting. People were supported to develop their independence where possible and were treated with dignity. Where appropriate, end of life plans were developed in consultation with the relevant people.

People were involved in developing their care through regular meetings with key workers. When people’s care needs changed, care plans were updated to reflect these changes. Important information about what people wanted to achieve was captured in their care plans. Staff supported people to work towards achieving these plans. People felt assured they could complain if they needed to, and that their complaints would be taken seriously.

The registered manager promoted an inclusive approach to providing care for people living at the service by involving people and staff in making decisions about people’s care. People were in

This inspection took place on 4 May 2016. The inspection was unannounced.

429 Warwick Road provides accommodation, care and support for up to six people with learning disabilities or autistic spectrum disorders. The home is located in Solihull in the West Midlands. There were six people using the service when we visited. Accommodation is provided in a detached house in a residential street. There were two bedrooms on the ground floor and four on the first floor, a shared lounge, conservatory, and kitchen diner at the home.

The service had a registered manager. This is a requirement of the provider’s registration. 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 refer to the registered manager as the manager in the body of this report.

People and their relatives told us staff were caring and kind. Staff had a good understanding of people’s needs. People were treated as individuals whose preferences and choices were respected. Staff treated people with dignity, and supported people to maintain their privacy and independence. People made choices about who visited them at the home. This helped people maintain personal relationships with people that were important to them.

Staff had received training to help them safeguard people who used the service. They were able to explain the correct procedure to follow if they had concerns. There were enough staff to meet people's needs safely and effectively. Staff recruitment checks ensured staffs’ suitability prior to them starting work at the service. Risk assessments around the provision of people’s care and support had been carried out and action was taken to reduce any identified risks.

People and their relatives were supported to be involved in decisions about their life and their support needs. People were supported to make decisions about their environment and choose how their room was decorated. The atmosphere at 429 Warwick Road was homely and relaxed.

Each person had a care and support plan with detailed information and guidance personal to them. Care plans included information on maintaining the person's health, their daily routines and preferences.

People, their relatives and staff spoke positively about the manager. They were able to talk with the manager if they had any concerns and felt their concerns would be dealt with. The manager ensured staff received on-going training and had regular meetings in which their performance and development was discussed.

The provider understood their responsibilities under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom. The provider had made applications to the local authority in accordance with DoLS and the MCA and at the time of our visit was awaiting the outcome of some of these applications.

People told us they felt safe and liked living at the 429 Warwick Road. We saw there was a good choice of food available and people could get snacks and drinks when they wanted them. People were supported effectively with their health needs and saw the appropriate healthcare professionals when necessary. There were systems to ensure that medicines were stored and administered safely.

People were supported in a range of activities, both inside and outside their home. People had been asked what was important to them and how they liked to spend their time. Activities enabled people to be part of their local community and to take regular holidays.

People who lived at 429 Warwick Road and their relatives were given the opportunity to share their views about how the service was run. Quality assurance procedures identified where th

We visited the home to check that improvements had been made since our last visit in 2013 when we found the home non-compliant in four of the areas we looked at. These concerned care and welfare, medication, staff support and quality assurance. There was a support manager in post. The previous manager had not yet had their registration cancelled.

We found that care needs of people were more effectively monitored and catered for. Care plans were clearer and up to date.

The administration of medicines was much improved. Areas of weakness around returning unused medicines had been addressed.

We found morale amongst staff we spoke with much improved, with staff telling us they felt well supported and part of a team with everyone working together.

We saw the service was monitoring and auditing what it did more effectively and acting on highlighted issues to improve the service.

We saw all five people who lived at the home, spoke with the manager and the three staff on duty and spoke with three relatives. People commented on improvements, both in the environment and in the day-to-day working of the home.

One relative said, “It’s a much nicer environment, I’ve noticed a big improvement.”

Another said, “Overall, it’s far better. Staff work really hard; that hadn’t always been the case – previously, there wasn’t effective management.”

A member of staff told us, “It’s much better now. We are well supported. We work as a team.”

We visited unannounced at midday and stayed until people who lived at the home were preparing for their evening meal. We spoke with four staff and three Voyage Care managers who were present during our visit. We looked at records and observed interactions in the home.

We met four people who lived at the home when they returned home from day services or other activities outside the home. After our visit we spoke with relatives of four people who lived at the home.

People who lived at the home were relaxed and comfortable around the home and enjoyed a good rapport with staff. Staff were positive about the home and the work they did. “I love working here” was a typical response. They acknowledged some shortcomings, principally around the environment, but were confident that improvements were taking place.

We were concerned that care plans and monitoring checks were not up to date. This had the potential to lead to uncertainty whether all the care needs of people were being met properly. The operations manager told us they were aware of these shortfalls and were in the process of addressing them.

Relatives we spoke with after our visit told us they were happy with the care and support, told us they were kept informed of issues concerning the care and support of their loved ones and were invited to reviews and able to have their views heard.

"We are happy with the care" one relative told us.

We visited the service unannounced on a weekday afternoon and stayed until people who lived at the home were about to have their evening meal. There were two residents at home at first. Three other people later arrived. Two members of staff were on duty. One person was away on a holiday with a family member.

One person was rather loud at times, but did not appear unhappy, and was pleased to have our attention. Another person was quieter, but happy to be introduced to us. The others were pleased to meet us and show us around on their return from day activities.

People who lived at the home all had very different strengths and needs. We saw people being supported in ways that suited their individual needs.

We spoke with relatives of five people who used the service. The majority said they were very happy with the service. Several people told us that they liked the stability of the home, as people who lived there and most staff had been there a number of years. Several people said that the home was ‘like a family’.