This unannounced comprehensive inspection took place on the 5 December 2018.

At the last inspection in January 2016 we rated the service good overall and in four key questions. The caring key question was rated outstanding. At this inspection we found the service had improved its overall rating to outstanding.

Abbey House is registered to provide accommodation for persons who require nursing and personal care for up to 13 younger adults living with a learning disability and or autistic spectrum disorder related conditions. Most younger adults attend the local Linkage college facility full-time and reside at the service during term-time only. The service is a large detached period property in a central location in the town close to all local amenities. At the time of the inspection the service was supporting 13 people.

The care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance in that it was registered to accommodate up to 13 people and would be considered a more congregate setting, however the service was registered prior to the Care Quality Commission(CQC) implementing this guidance. Values such as, choice, promotion of independence and inclusion underpin the ethos of the service and what it continually strives to achieve for people. People with learning disabilities and autism using the service can live as ordinary a life as any citizen during their placement at Abbey House. Following graduation, many people have chosen to stay in the area, living in residential care settings or supported living placements as they have developed such close friendships, support networks, secured regular work placements or paid employment and feel part of the community.

There was a very experienced, popular and well-established registered manager in place at the time of our inspection. A registered manager is a person who has registered with the CQC 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.

This service was selected to be part of our national review, looking at the quality of oral health care support for people living in care homes. The inspection team included a dental inspector who looked in detail at how well the service supported people with their oral health. This includes support with oral hygiene and access to dentists. We will publish our national report of our findings and recommendations in 2019.

The genuinely caring and inclusive culture at the service was outstanding. Staff demonstrated extremely caring values and showed a very positive regard for what was important and mattered to people. Staff were compassionate and kind and went ‘above and beyond’ to ensure people received positive outcomes. The trust developed between people and staff helped promote people’s independence, confidence and helped them achieve excellent outcomes. The registered manager and staff were very proud of the support they provided and people’s achievements were celebrated.

Respect for equality, diversity and inclusion was fully embedded within the service and integral to everything the staff did. Staff used innovative and effective ways to communicate with people and follow each person's wishes on their preferred method of communication.

The registered manager and staff had an excellent understanding of people's needs. A wide range of educational, vocational, leisure and voluntary activities were offered to people who used the service to aid independent living and support strong community inclusion. Staff found ways to improve people's lives by introducing creative activities that opened new possibilities for people and encouraged them to be active and healthy. Positive risk taking was driven throughout the organisation to support people

Abbey House is registered to provide accommodation for persons who require nursing and personal care for up to 13 younger adults with a learning disability and or autistic spectrum disorder related conditions. The younger adults attend the local Linkage college facility full time and the service is closed during college holidays. The service is a large detached period property in a central location in the town close to all local amenities. Accommodation is provided over two floors with stairs access to the first floor.

On the day of the inspection there were 12 people using the service. People have varied communication needs and abilities.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 service allowed people to express their individuality whilst facilitating and developing their independent living skills, so they could achieve their full potential. Staff used innovative ways to make sure people had accessible, tailored and up- to-date methods of communication.

The service developed and maintained strong links with external organisations and within the local community. There was a strong emphasis on key principles of care such as compassion, inclusion, respect, dignity and enablement.

People participated in a range of vocational, educational and personal development programmes at the organisation’s college facility. They also accessed a range of community facilities and completed activities within the service. They were encouraged to follow and develop social interests and be active and healthy. All programmes and support were geared to maximising the person’s independence and support them into adulthood, staff were very skilled and consistent in their approach.

Staff had developed very positive relationships with the people who used the service and respected their diverse needs. Staff knew people's individual care and support needs very well. People told us staff looked after them well and they were kind. People felt cared for and that they mattered. Staff supported people to maintain their relationships with friends and family. Comments from relatives were very complimentary and consistent stating they were extremely happy with the care, treatment and support the service provided.

The environment was accessible and safe for people. Although the service provided short term placement there was evidence that people were consulted about the décor in the bedrooms and were supported to personalise their rooms.

Staff were recruited in a safe way and all checks were in place before they started work. The staff had received an induction and essential training at the beginning of their employment and we saw this had been followed by periodic refresher training to update their knowledge and skills. People were supported by sufficient numbers of staff.

There were policies and procedures in place to guide staff and training for them in how to keep people safe from the risk of harm and abuse. Positive behaviour plans directed staff to effectively support people’s behaviour that challenged the service. Systems to monitor and review all incidents were in place. Medicines were administered and stored safely.

Assessments of people’s needs were completed and care was planned and delivered in a person-centred way. Risk assessments had been developed to provide staff with guidance in how to minimise risk without restricting people’s independence. People we spoke with told us they felt safe living in the service.

People’s nutritional needs were met and people were supported to shop for food supplies and were assisted to prepare meals. Where people had special dietary requirements we saw that these w

The inspection was carried out by one inspector over one day. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• 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. Due to the complex needs of the people who used the service we were unable to gain some people’s views. Therefore we used a number of different methods to help us understand their experiences. This included observing how staff supported people, speaking with staff and checking records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw people who used the service were treated with respect and dignity by the staff who supported them.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helps the service to continually improve.

The home was clean and fresh throughout. The service was generally well maintained, although some improvements were needed to the management of hot water to better protect people’s safety.

There were sufficient numbers of staff on duty to support people’s individual needs and promote their independence.

Is the service effective?

We found people were encouraged to express their views and were involved in making decisions about their care and treatment. The staff we spoke with gave us good examples of how people were involved in making decisions about the care and support they received.

People’s health and care needs were assessed on a regular basis. We saw people who used the service and their relatives had been involved in writing plans of care and setting individual goals which were reviewed and updated.

People’s care needs were coordinated with other health and social care professionals in the community and when admissions to hospital were required. The transition team in place, focused on providing support for people moving to and from the service.

The majority of staff had received appropriate professional development. We saw they had access to a varied training programme that helped them meet the needs of the people they supported, for example staff had completed courses on epilepsy, autism and colostomy care. A small number of staff had not recently accessed refresher training in fire safety and moving and handling and this was addressed following the inspection.

Is the service caring?

People were supported by kind and caring staff. We saw staff showed encouragement and patience when supporting people. All interactions between staff and people who used the service were positive.

Care files contained good levels of information about people’s needs and preferences. This included the people important in their lives and their personal aims. We saw care and support had been provided in accordance with people’s wishes.

Is the service responsive?

Care records demonstrated that when there had been changes in people’s needs, health care professionals, for example doctors, speech therapists, occupational therapists and psychologists had been consulted and their advice sought.

Records showed people had access to a variety of social activities. During our visit we saw people going out into the community supported by staff or participating in activities at the service.

The service had a complaints procedure which was available to people who used and visited the service. Satisfaction surveys and review meetings had been used to enable people to share their views on the service provided. This helped the provider to assess if people were receiving the care and support they needed or if any changes were needed.

Is the service well-led?

There was a quality assurance system in place to assess if the home was operating correctly. This included surveys and internal and external audits. We saw action plans were generally in place to address any shortfalls and progress was being made to address these.

Staff were clear about their roles and responsibilities. We saw staff had access to policies and procedure to inform and guide them. Staff training and development needs had been assessed to enable the provider to arrange future training sessions.

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

What people who used the service said about the care and support they received: -

We asked some people who used the service about the activities they enjoyed, they told us, “I’m in a show today, it’s really good, my parents are coming to see me and then it’s the holiday” and “We go to pubs and discos. Lots to do here, like playing pool and the computer.”

People we spoke with were positive about the care and support they received. One person told us, "Staff are nice and help me with my independence.” Another person said, “I have meetings with my key worker and we look at my care plan.”

One person told us they had been involved in work placements at a local leisure centre and also a charity shop. They told us, “I liked the job at the gym but it finished. Working at the shop is good.”

The people we spoke with said they were happy with their rooms and the home’s general facilities. Comments included, “My room is nice; I’ve got all my things from home” and “I’ve got a new scooter and I’m having a ramp made so I can go out on it.”

People we spoke with told us they liked the staff who worked in the service. One person told us, "The staff are nice and friendly.” Another person said, “Staff take us out and come to college, they help us.”

People who used the service told us they were happy with their care and living at the service. One person told us, “I’m happy here.”

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

The manager confirmed that they would complete an assessment if capacity to make decisions was in doubt and a best interest meeting would be held.

Comments included “I like living here and having my independence.” “The staff are friendly, open, and they listen to you.” “We can go to any of them for anything and they will sort things out.” “I feel safe and supported here, it’s like a home from home.”

One person told us “Staff organise things and help me with my routine and structure which I need. They understand this and that if I don’t have it I get upset.”

People were happy with the care they received and told us they saw a range of health professionals for advice and treatment. Comments included, "We are all supported to attend appointments that we have and see a doctor if we are unwell.”

We found that staff helped to make sure health and social care was coordinated when provided by a range of professionals.

We found that all staff employed in the service received regular supervision, training and support to enable them to fulfil the role expected of them.

Appropriate records were maintained of the care people who used the service received and for the running of the service.

People told us they were happy with the care and support that Abbey House provided. People’s comments included: “I really like it in this house. They do respect me,” and “It is very welcoming. Our dignity is respected at all times.” One person told us about the weekly meeting to decide menus, leisure activities and allocation of tasks which promoted independent living skills: “One thing I love is we sit down and have weekly meetings about what we want to eat, and the menus.”

People and their relatives spoke positively about their care and support. People’s comments included: “Care is to a very high standard,” “The care is good. The food is good, it is what we want,” and, “The care is faultless.” Another person told us, “Before coming here I didn’t have a social life; no friends; but I’ve ended up being more independent since being here.” A visitor commented about their relative, “We are almost shocked how well he has settled at this house.”

People spoke positively about the staff that worked with them. They said: “Staff are very helpful, understanding, friendly and warm. The staff are supported in their jobs,” “Staff are good,” and “The staff are very nice to me and I have not a bad word to say about them.” A visitor said, “When we come it is solely about our relative. Every staff member gives me a breakdown of what he has done.”