This inspection took place on 15 August 2018 and was unannounced. The last inspection of the service was on 17 and 19 February 2016 when we found the service was meeting the fundamental standards and rated it as good.

The provider, Consensus Support Services Limited, provides support and accommodation for individuals with a learning disability, autism and complex needs. 46 The Grove is a care home that provides care and accommodation for up to seven people with a learning disability. 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 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.

The service has a registered manager who also manages another of the provider’s locations at 48 The Grove. 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.

The provider had systems to keep people safe from abuse. Staff understood these and had completed safeguarding training.

The provider assessed possible risks to people and acted to mitigate any risks they identified.

People received the medicines they needed safely and as prescribed. Care staff understood people’s nutritional care needs and made sure they received varied and nutritious meals in the service. People received support with their health care needs from their GP, other NHS services and specialist learning disability services.

There were enough care staff to meet people’s support needs. The provider carried out checks on new staff to make sure they were suitable to work in the service. Care staff had the training they needed to provide effective care and support to people using the service.

The service provided a good standard of accommodation with sufficient private and communal space for people to spend time on their own or with others.

Care staff sought consent from people when they provided care and support. People were not deprived of their liberty unlawfully.

Care staff were kind and caring. They understood the care needs of people they supported and treated them with respect and compassion.

People’s care records showed that care staff involved them in making decisions about their care and support.

Throughout the inspection we saw that care staff respected people’s privacy and dignity and encouraged independence.

The registered manager, team leaders and care staff assessed and reviewed people’s care needs. People had a person-centred support plan that reflected their wishes and aspirations.

People’s support plans included information about their cultural and religious support needs.

The provider had a policy and procedures for responding to any complaints they received.

The service had a manager who registered with the Care Quality Commission (CQC) in 2012.

Care staff told us they felt supported and the service was well led.

The provider consulted people using the service, their relatives and representatives and care staff about the care and support people received and ways they could improve service delivery.

The provider had a clear strategy, aim and vision for the continued improvement of people's lives.

This inspection took place on 17, 18 and 19 February 2016. The visit on 17 February was unannounced and we told the registered manager we would return on 18 February. On 19 February we met with the registered manager to feedback our findings from the inspection. The last inspection of the home was in May 2014 when we found the provider was meeting all of the standards we inspected.

46 The Grove is a care home for up to seven people living with a learning disability and complex needs. When we inspected, seven men were using the service, all of whom had been living at the service for at least five years. The service had a registered 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.

The provider had systems to keep people safe and support staff followed these.

There were enough staff to meet people’s care needs and the provider carried out pre-employment checks to make sure new staff were suitable to work in the service.

People received the medicines they needed safely.

Support staff had the skills and knowledge they needed to support people using the service.

The provider took action to identify and manage possible risks to people using the service.

People had access to the health care services they needed.

People’s relatives told us people were well cared for in the service.

Staff treated people with kindness and patience.

Staff offered people choices about aspects of their daily lives.

The provider and support staff had assessed and recorded people’s individual care and support needs.

There was an appropriate complaints procedure and the provider also produced this in an accessible format.

Support staff were aware of the provider’s goals and values and they told us they enjoyed working for the organisation.

The provider had systems in place to gather the views of people using the service and others.

The registered manager and provider carried out a range of checks and audits to monitor quality in the service.

People using the service were unable to communication with us due to their complex needs. We spoke with two staff members and the registered manager. At the time of the inspection there were seven people using the service.

The inspection was carried out by an inspector during one day. This helped answer our five questions;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Support plans had details of people's needs and how these were to be met. These plans were regularly reviewed with the person using the service. Risk assessment related to the care and support being provided and were regularly reviewed to ensure people's individual needs were being met safely.

We saw that a weekly medicines audit was carried out where the stock balance of prescribed medicines for each person was checked against the Medicines Administration Records (MAR) which showed what medicines had been administered. This enabled the risks related to medicines administration to be assessed and managed.

The service had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We found the service was meeting the requirements of the Deprivation of Liberty Safeguards.

Is the service effective?

People received effective support from staff who were trained and supported by the manager. We saw that staff completed a range of courses which were identified as mandatory each year to meet individual support needs.

People using the service, their relatives and professionals providing support were involved in the development and review of their support plans so they understood and agreed to the care planned for them.

People were involved in the planning and cooking of their meals. The service identified individual needs in relation to nutrition and ensured that appropriate procedures were in place to ensure that people were protected from the risk of poor nutrition.

Is the service caring?

People were supported by kind, attentive staff who treated them with respect and dignity. We saw people were supported and encouraged to be actively involved in their daily care and activities.

Is the service responsive?

We saw that each person had an activity plan and the staff explained that these were developed based upon the interests and support needs of the individual. Activities included music therapy, hydrotherapy sessions and visits to an outdoor activity centre. During our visit a group of people using the service wanted to go to the park and the staff went with them to provide support.

We saw that the service was working with the local Speech and Language Therapy Team to identify and develop various communication methods to meet the individual needs of the people using the service.

We saw a copy of the complaints procedure in an easy read format was displayed in the communal hall area on a notice board. People were given support by the provider to make a comment or complaint where they needed assistance. The manager told us if a person wanted to make a complaint and were unable to complete the form staff would provide suitable support. They could also receive support from local advocacy services who visited the home.

Is the service well led?

The service had a quality assurance system in place. Records seen by us showed that any issues identified in relation to the quality of the care provided. As a result the quality of the service was continuingly improving.

People using the service, relatives, staff and professionals involved in providing support could complete an annual satisfaction survey to provide feedback on the care and support received. The results were used to identify any areas for improvement.

Regular audits of the support plans and risk assessments were carried out and any identified actions had a completion date. This enabled people to be involved in the decisions regarding the support they received and for staff to identify if the care provided met the needs of each individual using the service.

During our visit we spoke with three people who use the service. People said they were happy and enjoyed living at the home. We observed positive interactions between the staff and people who use the service.

There were sufficient staffing levels to meet the needs of the people and people were able to spend time individually with staff, or doing group activities.

However, we identified that the system for handling medication could put people at risk of being given too much medication.

Some people were not able to verbally communicate with us due to their complex needs. We were able to communicate with two people using sign language but they were unable to tell us about their care and experience of living at the service. We observed how people were cared for and spoke with staff and senior management so we could understand people's experiences of care.

We found people lived in an environment that promoted their dignity and values, for example people's bedrooms had been decorated in a tasteful manner and with their involvement. There were areas of the home that did require decoration and the manager acknowledged our comments.

We looked at the care records of four people and found care was not planned and delivered in accordance with people's needs. We found staff did not have a good understanding of people's communication needs and where people appeared confused or did not understand what staff were saying it often led to staff raising their voices or repeating what was said. We found people did not engage in age appropriate activities and were not actively stimulated in meaningful activities. We found that care plans required improvement to ensure that staff were aware of how to deliver care that met people’s needs.

We found staff had been appropriately trained in safeguarding people from abuse and administering medicines. This meant people were protected from risks of harm.

The service maintained its records and kept them securely. We looked at two members of staffs personal records and found the service had carried out all relevant and necessary checks before people started work in the service. Personnel records were maintained and kept securely along with care records and other important information relating to people.