This inspection took place on 8 March 2017 and was unannounced. Abbey House provides accommodation for up to six adults who have a learning disability. There were six people who were living at the home on the day of our visit.

At the last inspection on 16 December 2014 the service was rated as good. There was a registered manager in place at the time of our inspection. 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 at Abbey House live with complex learning disabilities and were unable to verbally communicate with us. We spent our time with people in the communal areas of the home; we observed how staff interacted with people and how people responded to staff. From what we saw and heard the atmosphere in the home was calm and relaxed. People were free to mobilise around the home through their choice. People were happy and responded well to the staff who were working on the day of our inspection. Relatives we spoke with felt their family members were looked after well and kept safe by the staff who worked there.

People lived in a safe environment as staff knew how to protect people from harm. Staff recognised signs of abuse and knew how to report this. Risk assessments were in place and staff took appropriate actions to minimise those risks without taking away people’s right to make decisions.

There were sufficient staff on duty to meet people’s needs and keep them safe. Staff worked flexibly to reflect people’s activities that were happening that day. People’s medicines were administered and managed in a way that kept people safe.

The provider supported their staff by arranging training in areas that were specific to the people who lived in the home. People received care and support that met their needs and reflected their choice. Staff provided people’s care in line with their consent and agreement; staff understood the importance of this. We found people were supported to eat a healthy balanced diet and with enough fluids to keep them healthy. People had access to healthcare professionals and attended appointments where required.

We saw staff treated people in a dignified and respectful way. Relatives told us that they felt staff treated their family member kindly, with dignity and their privacy was respected.

We saw that relatives, healthcare professionals, and where appropriate, the people, were involved in the planning their care. Relatives we spoke with and records we viewed showed that relatives had expressed their views and decisions and they were listened to and acted upon in-line with the person’s best interest.

Relatives knew how to complain and felt comfortable to do this should they feel they needed to. We looked at the providers complaints over the last 12 months and found that no complaints had been received.

Staff told us the provider visited the home and ensured people were happy with the service they were receiving. The registered manager demonstrated clear leadership. Staff were supported to carry out their roles and responsibilities effectively, so that people received care and support which was in-line with their needs and wishes.

We inspected Abbey House on the 16 December 2014. Abbey House provides accommodation, personal care and support for a maximum of six people whose primary condition is learning disabilities. At the time of our inspection there was 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.

We found that people were kept safe by trained staff who knew how to protect people. We found that people were cared for in a supportive way that did not restrict their freedom. There were sufficient staff to meet people’s needs.

People’s medication was stored and managed in a way that kept people safe. People received their medication at the correct times by staff who were trained to do so.

People who lived at Abbey House were unable to tell us verbally if the staff were kind and caring however we observed that people were relaxed and calm in the home. We saw care staff spoke kindly to people and maintained their dignity when providing assistance. People were supported to remain independent and received assistance when they needed it.

We found that the provider was meeting the legal requirements for the Mental Capacity Act (MCA) (2005) and the Deprivation of Liberty Safeguards (DoLS). Staff understood what this meant for the person and the way in which they were to be cared for.

People were provided with a healthy balanced diet that matched their dietary requirements. Relatives spoke about the good support people were offered with maintaining their nutrition where there were concerns. We observed people received regular fluids and staff supported those who needed assistance.

Abbey House had an experienced team of staff and management who knew people well. This meant that the registered manager knew what people’s needs were, what skill mix of staff they had and was able to ensure that staffing levels remained at a safe level for each shift. Staff told us that they had no concerns around staffing levels that they were able to meet people’s needs and did not need to use agency staff.

We found that the service was responsive towards people’s social needs. Staff showed us how they used people’s history and past experiences to develop activities that people enjoyed and that they were personalised to their choice. Staff knew people’s likes and dislikes and respected their wishes.

Relatives told us they found staff and the registered manager approachable and told us they could raise any complaints or concerns should they need to. Most relatives we spoke with told us that they had never needed to complain or had anything to complain about. One relative had raised concerns and the registered manager had responded to this.

Through regular meetings and using an ‘open door’ policy we found that the registered manager promoted a positive culture, in which they invited people to talk with them about any concerns they may have. We found that when concerns were raised to the provider, the provider had acted promptly and appropriately.

We found the registered manager had systems in place to ensure that the quality of the care was monitored. Checks such as medication and environment were carried out and completed monthly. Where there were any actions following these audits they were followed up and improvements had been made.

During this inspection we spoke with two relatives of people who lived at the home and with four staff. We were unable to speak with all the people who lived there due to their level of complex health needs. Therefore we looked at some people’s care plans which provided information on the needs of each person. We also looked at how staff cared for the people who used lived at the home.

We found that people were being supported to make choices and decisions about the care that they received. One relative told us: "What we have seen are staff that will always try to listen to what the people want".

We saw that people appeared relaxed and comfortable. They were being cared for in a way that they preferred. The relatives we spoke with were positive about their experiences of the home. One person said that the: "Service is excellent". Another relative told us that people living at Abbey House are: "All very well cared for".

We found that medicines were being appropriately stored and administered.

There was a complaints policy in place and people were being supported to raise any concerns.

People who lived at the home were not able to give us their views directly. However we were able to speak to some of the relatives of people who lived there. They told us that the provider was good at involving people’s families in the care and support that was provided. One relative told us, ‘We are involved. We get consulted on everything. We even go along to doctor’s appointments. They always keep me informed.” They said the provider listened to their views and acted on what they said.

The relatives told us they were happy with the standard of care provided at the home. One said, “We’re extremely pleased. X is very happy. You can tell he’s always happy to go back there. We regard it as a home from home. The staff are virtually family.” Another told us, “They always seem to go the extra mile under very difficult circumstances. “

The relatives we spoke with told us that they knew how to raise concerns. One said, “If I wasn’t happy about something I’d speak to the manager or the deputy. I feel they’d listen. Actually there are a number of staff I could speak to.”

They said that staff understood the needs of people who lived at the home and so were able to provide appropriate care and support. Talking of their own relative they said, “They know his character very well.”

We carried out this review to check on the care and welfare of people using this service.

People were not able to talk us about their care and treatment. We observed how care workers met the needs of people who lived at the home. Care workers were able to talk to us about each person as an individual, understanding their needs and abilities and how they communicated their thoughts and feelings. We saw that people who lived at the home appeared comfortable and relaxed and were positive when interacting with care workers. The home provided activities and social interaction in an atmosphere that was calm, quiet and inclusive.

People accessed services in the local community and five people had attended a day centre, four days a week. The home had considered the age range of people living in the home in deciding how to meet their health, care and welfare needs. There was good care worker involvement which provided constant care, praise and encouragement for people who lived at the home.