We carried out an unannounced inspection of the service on 9 February 2017.

Adams House provides accommodation and personal care for up to 24 people living with learning disabilities and an autistic spectrum disorder. At the time of our inspection there were 23 people living at the service. Accommodation included four bungalows and eight individual apartments and one shared apartment within the same grounds.

Adams House is required to have 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. At the time of the inspection a registered manager was in place.

Staff were aware of the safeguarding procedures and had received appropriate training. Safeguarding incidents had been reported and appropriate action taken to reduce further risks. People received their medicines as prescribed; some minor concerns were identified with the management of medicines but this did not impact on people’s safety. Safe recruitment practices meant as far as possible only people suitable to work for the service were employed.

Accidents and incidents were recorded and appropriate action was taken to reduce further risks. Improvements to the analysis and review procedure to help identify any themes, patterns or concerns were being made. Risks plans were in place for people’s needs and were regularly monitored and reviewed. The safety of the environment and equipment was checked regularly.

There were sufficient staff to meet people’s needs. People’s dependency needs were reviewed on a regular basis for changes.

Staff were appropriately supported, this consisted of formal and informal meetings to discuss and review their learning and development needs. Staff additionally received an induction and ongoing training.

People’s rights were protected under the Mental Capacity Act 2005 although some inconsistencies were found with the completion of capacity assessments.

People received sufficient to eat and drink and their dietary needs and preferences were met and choices promoted.

People’s healthcare needs had been assessed and were regularly monitored. The staff worked with external health professionals in meeting people’s healthcare needs.

People and relatives reported that staff had a good, caring approach. They described staff as caring, compassionate and knowledgeable about their needs. People’s preferences, routines and what was important to them had been assessed and recorded. Support was provided to enable people to pursue their interests and hobbies. Some inconsistencies were found with how staff communicated with people.

The provider supported people to be actively involved in the development and review of the care and support they received. This included regular discussions with people and formal meetings. Person-centred planning records showed gaps in how people were supported to achieve their future goals and aspirations.

People told us they knew how to make a complaint and information was available for people with this information. Confidentiality was maintained and there were no restrictions on visitors.

The provider had checks in place that monitored the quality and safety of the service. People and their relatives and representatives, received opportunities to give feedback about their experience of the service. The provider was aware of their regulatory responsibilities.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014. 

Our inspection was unannounced which meant the provider and staff did not know we were coming.

Adams House provides accommodation and care for up to 22 young adults with needs relating to learning disabilities. Accommodation is provided in four level accessed bungalows and six individual apartments, four of which are accessible by stairs. 19 people were accommodated when we visited. There was also a ground floor skills centre for people to use for daytime activities.

There was a registered manager who was on the premises throughout our inspection visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

People who lived in the home told us they felt safe and we saw there were systems and processes in place to protect people from the risk of harm.

Staff received a wide range of appropriate training and were knowledgeable about the needs of people living in the home. They provided effective care and support that met people’s individual needs.

During our visit we found a caring atmosphere and people told us that staff were kind to them. People were able to pursue a wide range of interests and hobbies with appropriate support from staff.

Management systems were well established to monitor the quality of the service.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS is a code of practice to supplement the main MCA 2005 code of practice. We found staff were knowledgeable about how to apply both of these and current applications for DoLS were being assessed.

Most people that used the service needed one to one attention from support staff throughout their waking hours and some needed two staff, particularly when they were accessing the community. When we visited on 21 May 2013, we were concerned that there were not always enough staff to meet people’s needs and we asked the provider to take action to improve staffing levels.

We reviewed a report about the action taken and we visited the service again to ensure sufficient staff were always available.

We observed how many staff gave support to people within two of the bungalows, we examined the staffing rotas and recruitment files and spoke with some staff.

Overall, we found improvements had been made and there were enough qualified, skilled and experienced staff to meet people’s needs.

We spoke with five people that used the service and with four staff working with them. We observed how staff gave support to people within two of the bungalows and one flat.

Staff were aware of people's individual preferences. People were supported individually by staff when they went out into the community and enjoyed a range of individually planned activities.

There were clear plans for staff to follow about how to support people safely and promote their independence.

The people we spoke with confirmed they felt safe and we found staff were fully aware of the procedure to follow should there be any suspicion of abuse of any kind.

We observed some of the staff working well with people individually, but we found there were not always enough qualified, skilled and experienced staff to meet people’s needs at all times.

We found clear information was available about how to make a complaint and previous complaints had been taken seriously and well managed.

We used a number of different methods to help us understand the experiences of people using the service, because many of the people using the service had complex needs which meant they were not able to tell us their experiences. We observed staff interacting with people. We observed people being given choices and spoken to in a respectful, caring and sensitive manner. We observed appropriate communication with staff using short simple language in a manner that gave the people time to understand, where this was needed.

We saw people had been supported to personalise their bedrooms. Rooms reflected the person’s favourite colours and were furnished to the person’s individual needs with their personal belongings.

One person said, “It’s alright here. I go out with staff and help them in the kitchen to cook meals.”

We spoke with two people who said they were happy in their bungalow and felt safe.

Two people living there told us that there were always staff around to help them. One person told us he was independent with his personal care, but knew staff were there to support him when needed.

A person told us they had seen a copy of their care plans and talked to staff while the care plans were being written. They felt listened to and were able to tell staff what support they wanted. They also told us that staff respected their privacy.

People told us they were well cared for and felt safe. A person said, “It’s nice.” They also told us they got on with everyone living at the home and went swimming, out for coffee and to the local disco. Another person told us they went out regularly and worked as a volunteer. They also told us that everything about the service was good.

A person told us that they self-medicated. People told us they liked their rooms. A person told us there were always enough staff, however, another person said there wasn’t always enough staff and it had stopped them from being able to do some activities. People told us staff were well trained and good at their jobs.