The inspection was carried out on 17 April 2018, and was unannounced.

579 Maidstone Road provides care and support to adults with learning disabilities, limited verbal communication abilities and challenging behaviour. The service provides care in an all-female environment for up to six people with complex needs. 579 Maidstone 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 this inspection. At the time we visited, there were six people living at the service.

At the last Care Quality Commission (CQC) inspection on 18 March 2016, the service was rated Good in Safe, Effective, Caring, Responsive and Well Led domains with overall Good rating.

At this inspection we found the service remained ‘Good’.

There was a registered manager at the service. 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 and associated Regulations about how the service is run.

Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them. However, sometimes, people had not been able to pursue their desired activity of the day. We have made a recommendation about this.

People continued to be safe at 579 Maidstone Road. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for. There were systems in place to support staff and people to stay safe.

The provider continued to follow safe recruitment practice.

Medicines were managed safely and people received them as prescribed.

Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

People received the support they needed to stay healthy and to access healthcare services.

People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.

There were enough staff to keep people safe. The registered manager continued to have appropriate arrangements in place to ensure there were always enough staff on shift.

Each person had an up to date, person centred support plan, which set out how their care and support needs should be met by staff.

Staff received regular training and supervision to help them meet people's needs effectively.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Staff showed they were caring and they treated people with dignity and respect and ensured people's privacy was maintained, particularly when being supported with their personal care needs.

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 provider ensured the complaints procedure was made available in an accessible format if people wished to make a complaint. Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.

The registered manager continued to provide good leadership. They checked staff were focussed on people experiencing good quality care and support.

We inspected this home on 18 March 2016. This was an unannounced inspection.

579 Maidstone Road provides care and support to adults with learning disabilities, limited verbal communication abilities and challenging behaviour. The service provides care in an all-female environment for up to six people with complex needs. At the time we visited there were five people living at the home and one person in hospital.

There was a registered manager at the home. 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 were protected against the risk of abuse. We observed that people felt safe in the home. Staff recognised the signs of abuse or neglect and what to look out for. Both the registered manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

The home had risk assessments in place. This was to identify and reduce risks that may be involved when meeting people’s needs such as inability to verbally communicate, which could lead to behaviour that challenges and details of how the risks could be reduced. This enabled the staff to take immediate action to minimise or prevent harm to people.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Staff attended regular training courses. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.

Effective recruitment processes were in place and followed by the manager. Staff had the opportunity to discuss their performance during one to one meetings and annual appraisal so they were supported to carry out their roles.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. People had good access to health and social care professionals when required.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people

Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.

People’s care plans contained information about their personal preferences and focussed on individual needs. People and those closest to them were involved in regular reviews to ensure the support provided continued to meet their needs.

People were able to make choices about the food and drink they had, and staff gave support when required.

People were involved in assessment and care planning processes. Their support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans available.

Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded and acted on. People’s feedback was sought and used to improve the care.

People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with the Commission.

Our inspection team was made up of an inspector, during this visit we were able to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking the staff supporting people who used the service and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect and dignity by the staff. Systems were in place to make sure that the manager and staff team learn from events such as accidents and incidents. This reduces the risks to people and helps the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. We found that three applications had been submitted to the local authority. The local authority had not replied as at the time we visited.

The service was safe, clean and hygienic.

Policies and procedures are in place to make sure that unsafe practice is identified and people are protected.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People who used the service were not able to complete an annual survey because of communication difficulties but their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. We observed this when we visited as two members of staff supported one person into the community for shopping as stated in their support plan.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service has a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

The people who lived in the home had complex needs and could present challenging behaviours. We observed how staff supported people and spoke with staff and the manager. We spoke to two relatives both during and after our visit. We also asked people in the home about their experiences.

One person told us that they had visited a castle and enjoyed their day out. Another person said they were happy in the home.

Care and support needs were identified and were different for each person, which meant that the support was individualised

Staff interacted well with people and listened to what they had to say. They were quick to respond to any potentially challenging behaviour.

People received the medication they needed at the time they needed it.

Staff were given the training they needed to enable them to provide appropriate care and treatment.

Staffing levels generally met the needs of the people who lived in the home .

A relative told us that there had been some concerns but felt that things were, “Getting better”. The service was working with families to continue to address concerns.