The inspection was announced and took place on the 12 July 2018.

At the last inspection the service was rated as ‘good’.

Asquith House is registered to provide accommodation and support for up to six people. At the time of the inspection the service was full.

This 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post within the service. 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.’

We identified that an exceptional level of support was provided when enabling people to access health services, and with identifying and working towards achieving positive outcomes for people.

In one example a person had been supported in a highly person-centred manner to access life-saving treatment when they had become unwell. We spoke to one health professional who was very complimentary about staff and the support they had provided to this person during this period. The registered manager had also praised the work undertaken by staff, telling us they had gone over and above their hours to ensure this person’s wellbeing.

There was a positive culture within the service which promoted people’s wellbeing. In one example this had enabled a person to feel safe and protected which had allowed them to take a significant step towards improving their own wellbeing with the support of staff and the registered manager.

During the inspection we found that one person had been supported by staff to get a job working for the registered provider. Care had been taken to support this person in such a manner that they did not become overwhelmed and could work at their own pace. This was part of the person’s goal to achieve greater levels of independence.

We spoke with staff who told us the registered manager was very supportive of them. Morale amongst the staff team was good and staff told us they enjoyed coming to work. This was reflected in the positive, friendly atmosphere that was apparent throughout the service.

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.

Staff had undertaken training in safeguarding vulnerable people and had a good understanding of safeguarding processes. They were able to describe the different types of abuse that could occur and what action they would take in situations where they identified that abuse was taking place.

Risk assessments had been completed to support people maintain their safety. These clearly outlined what actions staff should take to ensure people’s wellbeing was maintained.

The safety of the environment was being maintained through regular checks and servicing. For example water temperatures were being monitored to ensure they stayed within safe levels and remained free from harmful bacteria. Protocols were in place to ensure staff knew how to respond in emergencies and equipment that was used for responding to emergencies, such as fire extinguishers were being maintained.

Staff had received training in areas relevant for their role which helped ensure that they could provide people with the support they required.

Care records were in place which clearly outlined people’s needs. These were reviewed on a routine basis and provided staff with the information they needed on how to support people.

There were quality monitoring systems in place to monitor the se

The visit took place on the 28th of January 2016 and was unannounced.

Asquith House provides accommodation and care for six adults with a learning disability. It is set in a residential area of Chester, close to local amenities and the city centre. All six bedrooms are single and five of them have en-suite showers and toilets. There is one communal shower/bathroom/toilet on the first floor and a toilet on the ground floor. There is a lounge and a dining room on the ground floor. The garden at the back of the home provides a well maintained area.

The service had 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. The registered manager was on sick leave during our visit yet the registered provider had appointed an interim front line manager from within the staff team to run the service in the Registered Manager's absence. The interim manager was present during our visit.

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People who used the service told us that they were happy living at Asquith House, felt safe and considered that staff cared about them. This was reinforced by observation of the care practice provided to two people who were present during our visit.

Staff explained to us what they would do to keep people safe and how they protected their rights. Staff had been provided with training and showed an understanding about safeguarding adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff practice was focussed completely on the needs of people and this was delivered in a friendly yet dignified manner. People had full access to other medical services as well as advocacy when required.

There were opportunities for people to take part in group activities but they were also encouraged to develop personal interests and this was evident throughout the building and through individual discussions.

Staff protected people from the risks associated with poor nutrition and hydration as they encouraged people to eat and choose a balanced diet. Staff ensured that people were able to eat independently but with discreet supervision to ensure that this was done safely.

Records that we looked at were comprehensive and kept up to date. Support plans contained detailed information on each person and how their care and support was to be delivered. The information was regularly reviewed with the person who used the service and significant others. Care plans were presented in a format that was appropriate to the communication needs of each person. This meant that people received personalised care in line with their wishes and preferences.

People were supported by staff who were well trained and regularly supervised. The service was run by a registered manager and registered provider who were open and transparent in their practice, responsive to the views of staff and people alike and monitored the quality of care in an objective and transparent manner.

Our inspection team was made up of one inspector. We looked at our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that staff treated people who used the service with respect. We noted that the needs of people were addressed at all times. Interactions between staff and people who used the service were friendly, respectful and positive. Staff demonstrated patience in reassuring and interacting with some people. People who used the service told us that they felt safe living there. We saw that risk assessments designed to keep people safe were updated regularly and with the involvement of the people they related to. Staff told us that they had received training in safeguarding and this was confirmed through training records. Those people who could not verbally communicate appeared to be relaxed and comfortable with the staff team.

Is the service effective?

People had links with local advocacy services as well as other agencies designed to give people a voice. All people had been assessed as having the capacity to make their own decisions about their own lives.

People’s health and care needs were assessed on a regular basis and this work was done into conjunction with the people they related to. No one had specific dietary needs but arrangements were in place for people to select what meals they wanted.

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Is the service caring?

Our observations noted that staff were attentive to the needs of the people and that their work focussed exclusively on people’s needs. People we spoke with told us that staff cared about them. They told us that they were “great”, “caring”, and “alright”.

Is the service responsive?

The service had an extensive quality assurance processes in place which sought to include all the views of those connected with Asquith House. This was done through supervision and appraisal of staff, quality audits from the provider and other audits.. Staff considered that they were listened to and supported by the provider. We saw evidence in health records which demonstrated that as soon as new health conditions arose, the staff team ensured that people received prompt referral to medical agencies. More general health check-ups were available to people as well. We also saw evidence through care plans that as needs changed; plans were amended and reviewed on a regular basis.

Is the service well-led?

The service had a manager who was registered with us to carry out their roles. We noted that the service always told us when there were significant incidents. The service remained part of a larger organisation which had systems in place to ensure that people received a person centred level of support. We saw evidence in care plans that the service worked with other agencies to ensure positive outcomes for people.

This was an unannounced inspection of Asquith House. We were able to speak to two people. Comments included:

"I am happy here"

"I like the staff"

"They are good"

"This is my home"

"Staff are like friends"

"If I had a problem I would talk to staff and they would sort it out"

"Staff do a good job and they look after me well"

Our observations noted that people were relaxed and involved themselves in the day to day running of the service. People were as independent as possible and felt very relaxed and at ease with the staff team.

We found on this visit that the service promoted the care and wellbeing of people through a person centred approach to care. Their wellbeing was further promoted by the safe management of medication. Individuals had the opportunity to express their views and concerns knowing that the staff team would deal with them. We found that staff were supported by the provider to do their job effectively and that people benefitted from accurate record keeping.

We found that people’s privacy, dignity and independence were respected. People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. One member of staff said, "I love working in this house. Everyone is treated as individuals with the utmost respect."

People experienced care, treatment and support that met their needs and protected their rights through good care planning and risk assessments. One person who uses the service said, "I am happy."

We found that people who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. One family member said, "The staff are very nice. I would be happy to talk to them if I had a problem. My relative always looks happy and relaxed."

There were enough qualified, skilled and experienced staff to meet people’s needs. One person who uses the service said, "The staff are good."

The provider had an effective system to regularly assess and monitor the quality of service that people receive. One of the family members we spoke with said, "I think it's brilliant. I have no qualms or complaints."

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

We met three people living at Asquith House. When we visited Asquith House we had the opportunity to observe the support that was being given to people.

Staff explained that most people living at the home had various non verbal signs of communication. People living at the home looked content, happy and comfortable with the staff supporting them.

We saw many examples of good communication and patience by support staff, who interacted with people they were supporting in a positive manner. Staff were friendly and respectful to the people they were supporting.

People who live in the home were seen making decisions on for example: whether they spent time sat alone: choosing what to eat: with staff dressing the Christmas tree: making crafts and Christmas decorations in a group.

The people at the home during our visit let us get involved with their arts and crafts session were we all got involved in making Christmas decorations in the afternoon.

We had also contacted the local authority contracts and monitoring team for Cheshire West and Chester before we visited the service. They had no issues of concern to report.