Apsley House is a large end of terrace property located near the centre of Heywood. It is part of a larger organisation, Wellesley House Limited. Apsley House is registered to provide accommodation and personal care for up to five people with a learning disability / autistic spectrum disorder. On the day of the inspection five people were living at Apsley House.

The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This was an announced inspection which was carried out on the 29 November 2017.

The registered manager visited Apsley House one day per week. There was a day to day manager on site five days per week. There was a manager available by telephone at all times.

People told us that they felt safe at Apsley House. The service used the local authority safeguarding procedures to report any concerns. Staff had received training in safeguarding adults and were aware of their responsibilities to report any possible abuse.

A robust system for staff recruitment, induction and training was in place. This enabled the staff to support people effectively and safely.

Systems were in place to administer and store medication safely. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow.

The home was clean, tidy and homely in character. There were systems in place to prevent the spread of infection. Staff were trained in infection control.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

People who used the service were able to make choices about the activities that they wanted to do. They were involved in reviewing their action plans and setting goals. Person centred care plans and risk assessments were in place which enabled staff to support people with making choices.

The managers and staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS provide legal safeguards for people who are unable to make their own decisions.

We observed meaningful interactions between staff and the people who used the service. The people we talked to spoke positively about the staff. Staff demonstrated a clear understanding of people’s needs.

Effective quality assurance audits were in place to monitor the service. The service sought feedback from the people who lived there and their relatives. Staff had regular supervisions and were invited to team meetings. Staff told us that they enjoyed working at the service and felt that they were listened to by the managers.

The service had been developed and designed in line with the principles that underpin the Registering the Right Support and other best practice guidance, these values include choice, promotion of independence and inclusion. This policy asserts that people with learning disabilities and autism using a service should live as ordinary a life as any citizen. This policy can be found on the Care Quality Commission website.

This was an announced inspection which was carried out on the 3 December 2015.

Apsley House is a large end of terrace property located near the centre of Heywood. Apsley House is registered to provide accommodation and personal care for up to five people with a learning disability / autistic spectrum disorder. On the day of inspection five people were living at Apsley House.

The service had a registered manager in place. 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. The registered manager visited Apsley house one day per week. There was a manager in charge who was at the house on three days per week. The registered manager and manager in charge were available by telephone at other times.

People told us that they felt safe at Apsley House. Staff had received training in Safeguarding adults. There were sufficient staff on duty to meet people’s needs.

A robust system for staff recruitment, induction and training was in place. This enabled the staff to support people effectively and safely.

Systems were in place to administer and store medication safely. People were supported to access health care professionals when required.

Apsley House was clean and homely. Plans were in place in case of an emergency that would affect the running of the service; such as a utility failure.

The manager and staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS provide legal safeguards for people who are unable to make their own decision.

Person centred care plans and risk assessments were in place. These contained clear information and guidance for staff to support people with the choices and activities they wanted to do. The plans were updated monthly to ensure that the information reflected people’s current needs.

All the people spoke positively about the kindness and caring nature of the staff. Staff demonstrated a clear understanding of people’s needs. Staff explained that they supported people to be as independent as possible, whilst managing risks to keep them as safe as possible.

People who used the service were involved in reviewing their care plans, setting goals and the running of the home. People were able to make choices about the activities that they wanted to do.

The service had an open culture, with systems in place to gather feedback about the service. Information gathered was collated and acted upon. Staff told us that they enjoyed working in the service and the manager in charge was approachable and supportive. Regular supervisions and staff meetings were held. Staff input and discussion was encouraged to establish ways to improve the support provided.

Robust quality assurance audits were in place to monitor the service. Where actions were identified they were completed.

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?

This is a summary of what we found -

Is the service safe?

Emergency fire procedures were in place at the home. Fire alarms and emergency lighting were checked on a weekly basis. Full evacuations were held monthly. We also saw a dedicated hospital admission form that was completed in the event of a person requiring emergency hospital admission. This helped ensure the safety of people who used the service.

The store room for cleaning materials was in the cellar and we saw it was kept locked at all times when not in use. This helped ensure the safety of people who used the service.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us an application for a DoLS authorisation had been made in May 2014. We saw the procedure had been managed appropriately and the Care Quality Commission (CQC) had been notified in line with requirements.

Is the service effective?

One person who used the service required a specially controlled diet because of a medical condition. We saw a nutritional diet had been produced, in full agreement with the person, that met their needs and in accordance with their care plan.

We saw people`s likes, dislikes, choices and preferences had been recorded at the time of assessment. This showed people had been involved in creating their care plans and reflected a person centred approach to providing care.

Is the service caring?

We spent time in communal areas and saw staff interacted with people in a patient and caring manner. People were encouraged to be as independent as possible. There was a rota for people which included taking turns cooking. People were also encouraged and supported to keep their rooms clean and tidy and, when possible, do their own laundry.

We spoke with two people who used the service and one told us, "I really love it here. Staff help us all the time." Another person told us, "The staff have helped me become independent and I make my own choices."

Is the service responsive?

People at Apsley House had their own transport which helped ensure they were kept involved in activities around the local community. We saw a variety of activities which people were made aware of. If they chose to take part in any activity, they were supported by staff to attend.

We saw a complaints policy was present in the provider`s policies and procedures manual. An easy read version was also displayed on the wall. We spoke to one of the people who used the service and they told us, "If I had a problem I would just see one of the staff. I love them all."

Is the service well led?

The provider had procedures in place to monitor the quality of service being provided to people who used the service at Apsley House. Medication administration and people`s finances were checked on a daily basis. Every six months, the manager completed an environmental safety inspection.

General Practitioner and other professional visits and appointments were recorded which showed a multi-disciplinary approach to providing care was in place at Apsley House. This helped ensure people received appropriate care and support when they needed it.

During our inspection we saw that people were involved in decisions about the care and support they required. They decided on their daily activities, and staffing was arranged around the choices people had made. All staff had worked at the home for several years and therefore knew people living at Apsley House well.

We saw that people were regularly asked for their comments about the service. They were informed how to make complaints.

The Manager carried out regular checks to assess and monitor the quality if the service. We saw that if any improvements were required these were recorded and monitored until they had been carried out.

The atmosphere in the home was relaxed and people were comfortable speaking with staff. We spoke with one person who told us they attended college and took part in the social activities they chose. They told us they always had choices and loved living at Apsley House.

The two people we spoke with said they were involved in the planning of their support. They told us that staff compiled their care records with them, and they were asked about the support they needed at different times. People said they were very happy about living at Apsley House. There was a very relaxed atmosphere in the home and people were observed approaching staff in a comfortable manner. People told us they were able to choose how they spent their days. People said that they were not made to do anything, and staff supported them if they needed help with any of the activities they chose to take part in.

We saw recent results of the home's satisfaction survey for people living at the home. Everyone stated that they were happy with the way they were supported by staff.