Arshad Mahmood is a ‘care home’ for four people with learning disabilities and/or autism. There were four people living in the home when we visited. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The registered provider manages the service with care provided by a small team of staff. 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 Care Service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.

At our last inspection on 19 August 2016 we rated the service as overall ‘good’. At this inspection we found the evidence continued to support the rating of good and 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. We saw that people looked happy being with the staff who were supporting them and there were enough staff on duty to allow staff to spend time with people. People received their prescribed medication at the right time and medication was stored and checked safely. Staff knew how to report concerns and the risks related to people’s needs.

People continued to receive an effective service. Staff received training that was relevant to their role and enabled them to provide effective support. People’s health needs were monitored closely by staff and staff supported people to access healthcare appointments when required. The principles of the Mental Capacity Act (MCA) were followed and people were supported to have maximum choice and control of their lives.

People continued to receive care from staff who were kind, respectful and compassionate. Staff worked hard to develop people’s independence and helped people to make real progress in daily living skills. People were supported to maintain contact with families through the use of technology and through visits.

People continued to receive a responsive service. People’s needs were assessed and considered carefully before they came to live in the home to ensure they were well placed. People had access to activities which they enjoyed and had the opportunity to express their preferences for trips and holidays. Relatives told us they were involved in reviews of people’s care and were kept informed of any changes.

Improvements had been made and the service is now consistently well-led. Staff, relatives and professionals were happy with the way the service was led by the provider. There was a family atmosphere and the provider supported people, staff and relatives to receive the care they each required.. The provider had notified us of any incidents and changes as required and audits were effective in highlighting any gaps in the service.

Further information is in the detailed findings below.

Our inspection took place on 19 August 2016 and was unannounced.

At our last inspection on 21 August 2014, we saw that the provider was not meeting regulations in respect of keeping people safe because the appropriate applications had not been made to ensure that any restrictions in place were lawful. Also staff did not have a full understanding of the safeguarding procedures. At this inspection we saw that the appropriate Deprivation of Liberty Safeguards applications were in place and some restrictions on people’s liberty had been agreed.

The service is a registered care home providing accommodation and personal care for up to four people with learning disabilities. At the time of our inspection there were four people living at the home and shortly after we arrived they went out on their daily activities.

The quality assurance system was not robust and did not always identify shortfalls in the service, or develop action plans that ensured that improvements in the quality of the service were made. Although good day to day care was provided to people the service was not always personalised to the needs of individuals.

People felt safe using the service and they were protected from the risk of abuse because the provider had systems in place to minimise the risk of abuse. However this system was not always effective in ensuring that notifications of allegations were sent to us in a timely manner.

People were protected from injury and harm because staff knew how to manage identified risks.

People were supported by staff that had received training, supervision and support to carry out their roles.

Relatives were happy with the service provided and although they had never made a complaint they felt they would be listened to.

People were supported to make choices and ensure that the correct agreements were in place where people’s liberty was being restricted.

People’s representatives were complimentary about the kindness of staff and felt fully involved in people’s care. People were supported by staff that were kind and caring and who knew their needs well.

There were enough staff to support people safely. People received support from a stable staff team that had got to know people well.

People were supported to take their medicines and have their healthcare needs met.

People were supported to eat and drink food that they enjoyed and that met their dietary requirements.

We last inspected this service on 15 December 2013. At that time we found that the service did not always promote people's privacy and dignity. The environment did not always allow privacy in which people’s intimate care and support needs could be met. We also found that people did not always have their care needs met because people were not always provided with the appropriate support to be listened to. During this inspection we found that these areas had been adequately addressed.

During our last inspection the registered person did not have an effective operating system to regularly assess and monitor the quality of the services provided. During this inspection we found that these areas had been adequately addressed.

On the day of our inspection we talked with the manager and looked in detail at the records for three people. We spoke with the deputy manager who had the role of manager within the home. We observed how people were being cared for and saw how staff and people interacted. We visited on a weekday and all three people were at home. We talked with three staff members and one health professional. We also spoke with three relatives.

Below is a summary of what we found. The summary describes the records we looked at and what people using the service and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

We saw that people had been cared for in an environment that was safe and clean. There were enough staff on duty to meet the needs of the people living at the home during the day and night. Staff understood the complex nature of people’s support needs and there were measures in place to help communicate with people.

Safeguarding procedures were not robust and staff had a limited understanding of their role in safeguarding the people they supported. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager told us that no applications had been made in accordance with these safeguards. We did not find any evidence of capacity assessments or best interest meetings.

Is the service effective?

Staff had a good understanding of people’s care and support needs and knew them well. We saw that people were treated with dignity and care. Plans and care were linked to people’s individual needs, for example in relation to their support needs in the community. A relative told us, “I don’t know what we would do without them. They rescued X, they’ve worked miracles really.”

The service worked well with other agencies and services to make sure people received their care effectively. One relative told us, “I’m very pleased. I’m happy it’s great.”

Is the service caring?

We saw that people were supported by kind and attentive staff. We saw that the staff were patient and gave encouragement when supporting people. We found that the care and support was very person centred. All staff were aware of peoples choices, preferences and support needs. Care plans had been written to reflect this. A visiting professional told us, “They are very pleasant staff, very attentive to people’s needs, very gentle with them. “ One relative told us, “I think it’s absolutely wonderful, they are kind.”

Is the service responsive?

People had access to activities that were suitable to them. We observed people watching television and going out for the day with supportive staff. People had care and support delivered to them in a way they appeared happy with. Staff were aware that people’s needs changed and responded accordingly. A relative told us, “I can’t fault them, they are really co-operative.”

Is the service well-led?

The manager was not available on the day of our inspection. We spoke at length with the deputy manager and senior staff within the home. We saw that people appeared calm and relaxed within the home and comfortable with the staff who supported them. A visiting professional told us, “Staff support me with assisting the person with their care, they take people to the GP very promptly if there’s an issue.”

There were three people living at the home on the day of our inspection. 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 relative of a person who used the service to help us understand the people’s experiences.

We saw that staff at the home treated people with warmth and kindness. A relative told us, “They are very good with the people here, they really care and love them”. However we found that people’s privacy, dignity and support to make choices was not always respected.

Care was planned and designed to meet the individual health and welfare needs of the people who used the service. We saw people were supported to have regular health checks to ensure their wellbeing. A relative of a person who used the service told us, “It’s very good here, they look after [person’s name] really well”

People received sufficient quantities of food and drink to meet their needs and were supported to make choices about what they ate and drank. A relative of a person who used the service told us, “The food is great, there are no complaints there”.

There were enough staff to meet the care and welfare needs of the people who use the service. Staff received the training they needed to support the people living there.

The provider did not always have robust systems in place to assess and monitor the quality of the service provided.

When we visited 112 Carlton Road we met with two people who used the service. We met the deputy manager, a senior manager and two staff members. We had telephone discussions with one relative about the care their family member received at Carlton Road.

The people who lived at the home had high needs which meant they were not able to tell us their about their experience of living there. When we met with them they smiled when we asked them how they were. We found that staff knew people as individuals and understood their personal needs and ways of communicating those needs. We saw that people were relaxed and at ease with staff and within the home environment.

The relative we spoke with told us they were happy with the care their family member received. We were told, “I am very pleased with everything” and “I can talk to staff and I have no concerns.”

Each person had a care plan and these were written in a way that was easy for people to understand with the use of photographs and symbols.

We found procedures in place to protect people from harm and staff described what these were and how they would report any suspicion that a person who used the service had been at risk of harm.