We inspected the service on 27 November 2018. The inspection was unannounced. 53a Ipstones Avenue is a care home for people with learning disabilities and autistic spectrum disorders. 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 service accommodates five people. On the day of our inspection five people were using the service.

At our last inspection on 14 July 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’. 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.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks associated with people’s needs including the environment, had been assessed and planned for and these were monitored for any changes. There were sufficient staff to meet people’s needs and safe staff recruitment procedures were in place and used. People received their prescribed medicines safely and these were managed in line with best practice guidance.

People continued to receive an effective service. Staff received the training and support they required including specialist training to meet people’s individual needs. People were supported with their nutritional needs. Staff identified when people required further support with eating and drinking and took appropriate action. The staff worked well with external health care professionals, people were supported with their needs and accessed health services when required. 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 principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. People’s independence was promoted.

People continued to receive a responsive service. People’s needs were assessed and planned for with the involvement of the person and or their relative where required. Care plans were developed to support peoples specific individual requirements and staff knew and understood people’s needs well. People received opportunities to pursue their interests and hobbies, and social activities were offered. There was a complaint procedure and action had been taken to learn and improve where this was possible.

The service continued to be well led. There was an open and transparent and person-centred culture with effective leadership. People using the service, their relatives and staff were confident about approaching the registered manager if they needed to. The provider had effective auditing systems in place to monitor the effectiveness and quality of service provision. The views of people and their relatives on the quality of the service, were gathered and used to support service development.

The inspection took place on 14 July 2016 and was unannounced. At our last inspection on the 16 June 2014, the provider was found to be meeting all of the essential standards relating to the quality and safety of care.

53a Ipstones Avenue (Ipstones Ave) is a care home for up to five people with learning disabilities and autistic spectrum disorders. At the time of inspection there were five people living at the home.

There was a registered manager in post. 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 kept safe by staff who were knowledgeable about people’s needs and because the provider had systems in place to manage the potential risks to peoples’ wellbeing. People were cared for by staff that understood different types of abuse, and knew what action they would take if they thought a person was at risk of harm.

We found that the provider had systems in place to ensure enough staff were available to meet people’s needs in a timely way.

People were supported to receive their medication as prescribed.

People received care from suitably qualified staff. People’s health care needs were effectively met by the systems the provider had in place. Staff were aware of people’s support needs at meal times.

Staff interactions with people were relaxed and friendly. The staff were knowledgeable about people’s likes and dislikes. Staff ensured that people’s privacy and dignity was maintained.

People had access to a variety of activities including sensory spaces and chose what they wanted to do. Peoples’ care needs and plans for what they wanted to do were discussed in review meetings.

The registered manager carried out audits to evaluate the quality of the service provided to people.

We visited this service and talked with people to gain a balanced overview of what people experienced, what they thought and how they were cared for and supported. There were four people living in the home at the time of our visit. We saw three people during our visit.

We spoke with three members of staff and the manager. People using the service had limited verbal communication skills. We observed how people were cared for and how staff interacted with them to get a view of the care they experienced. We spoke with three relatives of people living in the home and one regular visitor to the home.

We considered all of the evidence we had gathered under the outcomes that we inspected. Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that people's individual needs had been assessed and that there were enough suitably trained staff to support and care for people. We observed the interactions between the people who lived in the home and staff. People looked at ease in their surroundings. Staff spoke with them in a calm and friendly manner.

We saw there were systems in place to ensure people received their medicines safely and as prescribed.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes and hospitals. No applications had been made. The manager understood how this legislation applied to people and protected their rights.

We found that equipment was serviced at regular intervals to ensure it was safe to use.

Is the service effective?

People's care and health needs were assessed and planned for with the involvement of their relatives and professionals acting on their behalf if they were not able to express their opinions. Specialist mobility and equipment needs had been identified in care plans where required. This meant that people's care was planned and delivered in line with their individual needs.

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and knew them well. We saw people's care plans and risk assessments were reviewed on a regular basis to ensure their changing needs were planned for.

People living in the home were encouraged to maintain and develop their independence.

We saw the menus reflected the foods liked by the people who lived in the home and that choices were available.

Staff training was sufficient to meet all the needs of people using the service.

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. Staff had developed a range of communication methods to ensure they could enable people to make choices and decisions on a daily basis.

People appeared settled and happy. The relatives we spoke with told us the home offered a good service. One relative told us, “Absolutely fantastic service. We can totally relax, the home cares for him. They keep in touch with us.” Another relative said, “We trust them he is treated well.”

We saw that people were supported to take part in a range of activities of their choice. This ensured people led fulfilling lives. People were supported to maintain relationships that were important to them. 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?

We saw people's care plans and risk assessments were reviewed on a regular basis to ensure their changing needs were planned for.

People regularly completed a range of activities in and outside the service. The home had access to transport which helped keep people who were unable to use public transport involved with their local community.

Records showed that staff responded quickly to changes in people's health. We saw people had access to a variety of health care providers to ensure their needs could be met.

Is the service well led?

The registered manager had been in post since the home had opened. The manager was experienced and caring and provided good leadership based on how best to meet the needs of people in an individualised way.

Staff were supported to meet the needs of people through the provision of regular training, supervision and staff meetings that enabled good practice to be developed.

There was a robust system in place to monitor the quality of the service provided. This included regular audits of all aspects of the care and support given to people and the views of relatives and other people who visited the home. The manager was able to give us examples of actions taken and changes that had been made as a result of listening to the relatives of the people who lived in the home.

There were four people living at the home on the day of our inspection and a fifth person was in hospital. They were not able to tell us their experiences because of their complex needs. We spent time observing how staff supported people, looked at care records, talked with five staff and the registered manager. We also spoke with the relatives of four people who used the service to help us understand their experiences.

We saw that staff at the home treated people with warmth and kindness. We found that people’s privacy, dignity and support to make choices was respected.

Care was planned and designed to meet people’s individual health and welfare needs. The relative of a person who used the service told us, “We can relax knowing that [person’s name] is getting the care they need”.

We found that people were protected and kept safe from abuse.

Managers and staff told us and we saw that the provider had robust recruitment procedures in place to ensure that people employed at the service were of good character. We saw that staff had the necessary skills, qualifications and knowledge to meet the needs of the people who used the service.

The provider had robust systems in place to assess and monitor the quality of the service provided. One person told us, “We may mention something and we see that it’s always dealt with by our next visit”.

During our visit we met all five people who lived at the home. Because of their complex needs most people were unable to share their experiences of using the service with us. We therefore used a number of different methods to help us understand their experiences. This included speaking with staff, people’s relatives (who were visiting the home and by telephone), observing care and reviewing relevant information made available to us.

We received positive comments about the home from the relatives of people who used the service. These included: “I have never seen a bunch of staff act so well and positively and efficiently” and “It’s a good home, it’s well run, it’s clean and tidy. Nothing is a problem.”

Staff understood people’s care and treatment needs and helped to support their independence. Staff also supported people in making ‘every day’ decisions about their care.

We found the home clean and tidy and systems in place helped to ensure that people lived in a hygienic environment.

Records relating to people’s needs and the general management of the home were in good order and supported the smooth running of the home.

There were five people living in the home at the time of our visit. The people living in the home were unable to tell us about the service they received. We spoke to one care worker during our visit and two after our visit.

We saw the way care workers spoke to and assisted people living in the home. Care workers were friendly and helped people appropriately. We saw them helping people to make choices. When we talked to care workers they knew the needs of the people they were caring for.

We spoke to the relatives of three of the people living in the home. They told us that they were generally happy with the service provided. They felt that people living in the home were supported to have their health needs met. They said people were supported to keep in touch with their families.

Relatives told us care workers and managers were professional and skilled. They were kept informed of people’s well being. One relative told us that people had not been away on holiday for a long time.

People had been taken out during the day of our visit. People were encouraged to be involved in daily activities in the home such as tidying up and making drinks. They were able to go into the kitchen and be involved in cooking.