The inspection took place on the 26 September 2018 and was announced, which meant the service was given notice of our inspection.

43 Station Road is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during the inspection.

43 Station road is registered to provide care (without nursing) for up to six people with learning disabilities. The service specialises in supporting people with autistic spectrum disorder and behaviours that challenge.

At the time of our inspection there were four people using the service, supported in the home by nine permanent staff.

There was a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

43 Station Road is a small service located close to local amenities. The home is a large detached property with a generous rear garden. The home has communal areas including a sensory room and all bedrooms have en-suite facilities.

At our last inspection on 30 December 2015 we rated the service overall as good with requires improvement for the Safe domain. This was because recruitment checks were not always completed in line with Regulations. Therefore, we made a recommendation about improving recruitment checks.

At this inspection we found the service remained good overall. We found improvements to recruitment processes and records which meant safe and suitable staff were recruited to support people. 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.

Staff received safeguarding of vulnerable adults training and understood how to protect people from harm and who to alert if they had any concerns. We have made a recommendation that the provider accesses classroom safeguarding training for staff and the registered manager attends additional safeguarding training in line with the their role. Risks to individuals and general operational risks were identified and appropriate actions were taken to reduce hazards. There were enough staff on duty to meet people’s diverse, individual needs safely. Medicines were managed effectively and staff received appropriate training to administer medication safely.

People’s health and wellbeing needs were met. The service worked closely with clinicians and other professionals and followed advice and treatment plans effectively. Staff understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and the principles of gaining consent or making decisions in peoples’ best interests. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service provided a calm and friendly atmosphere and staff demonstrated kindness and commitment to people’s welfare. Staff approaches were respectful of privacy and dignity and upheld people’s rights with regards to equality and diversity. People were involved in agreeing their care plans. People’s relatives and relevant others were consulted to make decisions in people’s best interest, where people lacked capacity to consent. Care plans were person-centred and responsive to individual’s current and changing needs. People were supported to follow their interests and work towards their own goals.

Management were described as being approachable and effective. Staf

43 Station Road is based in Wraysbury. The service is registered to provide care for up to six people with learning disabilities. At the time of our inspection 4 people were living at 43 Station Road.

This inspection was undertaken on the 30 December 2015 and was unannounced.

43 Station Road had a registered manager in place. 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.

43 Station Road is a small service which is located close to local amenities. During our inspection, people were supported to access the outside community frequently as there were enough staff to assist on outings.

We found the service to have a calm, relaxed feel. We observed that people appeared settled and happy living at 43 Station Road. The home was maintained well and was kept clean. One relative told us they felt this was the best service their loved one had ever lived at.

People were supported by staff who knew their needs well. Staff were able to explain how they supported people in a person centred manner and how they promoted people’s choices. This was consistent with information we found in people’s care plans.

Staff told us they felt supported in their roles, both as a team, and by management. We found appropriate processes in place to ensure staff were supported, for example, training provision, supervision and a formal induction for new staff members.

A newly appointed deputy manager had recently commenced employment. They advised us of ways they intended to make the service better and were working closely with the registered manager to put improvements into place, for example, a new sensory room and garden.

People were protected from risk of harm as staff were aware of how to raise concerns if they suspected potential abuse. Where people received medicines, these were administered by staff who were trained and deemed competent to do so.

We have made a recommendation around ensuring robust recruitment checks are in place.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

The three people living at the home were not able to take part in detailed interviews, but we spoke with them during our inspection and observed them interacting with each other and with staff. As part of this inspection we also spoke with the registered manager, three care staff and three local authority care managers. We reviewed records relating to the management of the home which included: three care plans and daily care records. We looked at a selection of health and safety monitoring records, premises risk assessments, provider monitoring audit records and staff rotas.

Is the service safe?

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. The provider had effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager was aware of a recent Supreme Court judgement changing the way a 'deprivation of liberty' is determined. The manager had reviewed all people at the home that the ruling applied to and had made applications as required under the Deprivation of Liberty Safeguards.

Is the service effective?

Care managers we spoke with felt the staff were meeting the needs of the people living at the home. Staff showed skill at communicating with people and understanding their individual ways of communicating. We saw staff identified and provided care and support where needed.

CQC monitors the operation of the Mental Capacity Act 2005 which applies to all services providing care and support for people. We saw before people received any care they were asked for their consent and the staff acted in accordance with their wishes.

Is the service caring?

During our inspection we saw people were being spoken with and supported in a sensitive, respectful and professional manner. In the records we sampled and in our observations of interactions between staff and people living at the home, we saw people's diversity, values and human rights were respected.

Is the service responsive?

We found changes or newly identified needs were added to people's care plans and any actions taken in response were clearly recorded. Where changes were identified appropriate actions were taken. For example, consultation with or referral to an external health professional.

The provider took account of complaints and comments to improve the service. People we spoke with felt staff listened to what they said and changed things they didn't like.

Is the service well-led

The provider had an effective system to regularly assess and monitor the quality of service that people received. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

We carried out an inspection at 43 Station Road to review the care and welfare of people who lived at this service. There are currently four people living at this home, and one was away visiting family during this inspection. We spoke with the three residents who were at home, and made observations throughout the day. We also subsequently carried out a telephone interview with one relative, and contacted the local authority to ask their opinion about this service.

The current service users were not able to take part in detailed interviews, but we spoke with them throughout the visit and observed them interacting with each other and with staff. The residents indicated they were happy living at 43 Station Road and we noted there were good arrangements in place to gain their consent to care.

There were satisfactory arrangements in place for managing people's meals and nutrition, and people who lived at the service were included in choosing menus. We found the home to be clean and fresh throughout with some residents taking part in some domestic duties. We checked the arrangements for making complaints and found these to be satisfactory, with a user friendly complaints procedure available for residents.

We found some minor shortfalls on the staff recruitment records we checked, and these were addressed by the manager before the draft report was completed.

At the time of this inspection there were three people living at the service. All three were able to take part in short discussions, and two were able to participate in more detailed interviews about their care. We also made observations throughout the day and contacted the families of two residents for their comments.

The people who lived at the service indicated that they were happy living there, and observations throughout the visit showed staff treated people respectfully and took their wishes into account.

We were told people got the care they needed, and felt safe living at this service. Those who were able to comment on the staff, told us they were satisfied with the support they received from staff, and overall they were happy with the quality of the service. Residents described the home as “Good” and “Alright.” One person who used sign language, indicated, with help from a member of staff who was supporting them with their communication, that they were happy at this home.

There is a new manager in place at this service. The manager named on this report has yet to deregister with CQC for the Station Road location.

People who live at this service have special communication needs so two out of the six residents currently living at this home were spoken with at length, and three others were involved in shorter exchanges and were observed interacting with staff and each other during the visit to the home. Both people spoken with agreed that they and their families were treated well by staff, and that they were given choices and supported to make decisions in their daily lives.

They agreed that there were opportunities for them to be involved in their care and welfare, including their care planning. Examples of things they had made choices about included choosing the weekly menu, deciding which short and longer term activities they would like to do, and taking part in cultural activities.

People spoken with said they had no concerns or worries about the care they received and from observations of interactions between residents and staff it was concluded that there was a good rapport between staff and the people who live at this service.

Families of people who live here said the home continues to improve and all were able to give examples of improvements and things the home does well. However, there were still a few concerns raised by some relatives, and these were passed on to the new manager for her attention.

The local council's community team for people with learning disabilities told us that the concerns raised during the last year in relation to safeguarding adults had all been dealt with, and that improvements had been made at this home as a result.