This comprehensive inspection took place on 1 and 2 August 2018 and was announced.

74 Wilson Avenue is a 'care home'. 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 is registered to accommodate a maximum of six people with learning disabilities, physical disabilities and autistic spectrum. At the time of our inspection, there were five people living at the service. They had diverse and complex needs such as learning disabilities, cerebral palsy, autism, diabetes and limited verbal communication abilities.

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

At our last inspection in March 2016, we rated the service Good overall. 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.

At our last inspection, we made a recommendation because we identified a gap in the training schedule which showed that staff had not completed buccal midazolam training needed for the safe and effective administration of the emergency medicine. We rated the Effective question as Requires Improvement. During this inspection we found this issue had been addressed.

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.

People continued to receive safe care as they were supported by staff who knew how to protect them from harm. Staff were aware of people's individual risks and plans were in place to minimise these while maintaining people’s independence. Recruitment of staff was safe and robust. We

saw that pre-employment checks had been completed before staff could commence work. There were sufficient numbers of staff to support people to stay safe. Staffing remained flexible to suit the people living at the service and was arranged based on people's individual needs.

Staff received an induction when they started at the service and completed ongoing training to support them in meeting people's needs effectively. Staff had the right skills to provide the care and support that people required. Staff received supervision to support them in their role.

There was a safe procedure for managing people's medicines and people continued to receive their medicines as prescribed. Staff understood the importance of maintaining good infection control procedures to maintain the cleanliness of the service and minimise the risk of the spread of infection.

Systems were in place to assess people's needs before they started using the service to determine if their needs could be met. 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 support this practice.

People had support plans with detailed information and guidance personal to them to support staff in meeting their needs. Staff knew people's abilities, support needs and preferred routines and encouraged people to make their own decisions where possible. People had opportunities to engage in, and experience

We inspected this home on 08 March 2016. This was an unannounced inspection.

74 Wilson Road is a purpose built home, providing care and support for four people with severe learning disabilities and physical disabilities. At the time we visited there were five people living at the home. The home is part of a group of homes managed by the Avenues Trust. The people who lived at 74 Wilson Road had diverse and complex needs such as learning disabilities, cerebral palsy, autism and limited verbal communication abilities.

There was a registered manager at the home. 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.

Staff had the knowledge and skills to meet people’s needs, and attended regular training courses. However, staff training plan showed that staff did not have all the essential training they needed to ensure they understood how to provide effective care, and support for people. There was a gap in the training schedule which showed that staff had not completed buccal midazolam training needed for the safe and effective administration of the emergency medicine. We have made a recommendation about this.

People were protected against the risk of abuse. We observed that people felt safe in the home. Staff recognised the signs of abuse or neglect and what to look out for. Both the registered manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

The home had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs such as inability to verbally communicate, which could lead to behaviour that challenges and details of how the risks could be reduced. This enabled the staff to take immediate action to minimise or prevent harm to people.

There were sufficient numbers of staff to meet people’s needs. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.

Staff were recruited using procedures designed to protect people from unsuitable staff. Staff were trained to meet people’s needs and they discussed their performance during one to one meetings and annual appraisal so they were supported to carry out their roles.

The systems for the management of medicines were followed by staff and we found that people received their medicines safely. People had good access to health and social care professionals when required.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and the home complied with these requirements.

Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.

People’s care plans contained information about their personal preferences and focussed on individual needs. People and those closest to them were involved in regular reviews to ensure the support provided continued to meet their needs.

People were involved in assessment and care planning processes. Their support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans available.

People were always motivated, encouraged and supported to be actively engaged in activities inside and outside of the home. People went out to their local community for activities and travel on holidays.

Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded and acted on. People’s

The inspection was conducted by one inspector. There were 4 people who lived in the home at the time of our visit. Some people at the home had communication difficulties. This meant they were not always able to tell us about their experiences. The report is based on our observations during the inspection, talking with people who used the service, relatives, and staff who were working in the home, and reviewing records.

During this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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?

Systems were in place to ensure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Although no applications had needed to be submitted, relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people will be safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Recruitment practices were safe and thorough. No staff had been subject to disciplinary action. Policies and procedures are in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care through their relatives. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Families said that they had been involved in writing them and they reflected their current needs.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments. A relative said, “We started this home together in 1997. I was part of the people consulted on the home set up with the local authority. The home was adapted and purpose renovated for the type of disabilities our children have”. This showed that families and people’s representatives were involved in the design of the home in order for the needs of their children to be met.

Visitors confirmed that they were able to see people in private and that the home operated an open door system. One relative said, “I can come here unannounced at any time and I always find ‘X’ in a clean state”.

Is the service caring?

The home provides a specialist service in a homely environment to four people. People told us this was a lovely place to live and that the people were well supported by the provider. We observed that people were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. The results showed that people were generally happy with the service provided.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people’s wishes.

Is the service responsive?

People were able to access the activities they enjoyed and their preferences were taken into account when planning activities.

People knew how to make a complaint if they were unhappy. For example, one person said, “If I have a problem, I will talk with the manager and they will listen”.

We saw that the complaint procedure was available in an easy to read format for the people who used the service. This meant that people who used the service were provided with accessible information.

Is the service well-led?

The service has a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We observed that staff cared for people in a kind and respectful manner. The people using this service were unable to communicate verbally so we spent time watching the interactions which took place. We saw that people seemed relaxed and comfortable in the company of care staff.

Risk assessments had been made in order to keep people safe while giving them the independence to enjoy activities such as ice-skating, bowling and trips to night clubs. We spoke to a visiting relative who told us that they were very happy with the care provided.

We checked to see that the service had a current safeguarding of vulnerable adults policy and that staff understood how to identify suspected abuse and report it. We found that all the staff had received up-to-date safeguarding training and were aware of the particular vulnerabilities of the people in their care.

The service had been cleaned to an appropriate standard and we read schedules which itemised the cleaning tasks to be carried out and their frequency. We inspected the laundry facilities and found that they were operated in such a way as to reduce the risk of cross-contamination.

We found that the service had managed people’s medicines appropriately. Regular audits of medication and other areas had been undertaken by the service. We saw evidence of learning from these audits and from taking into account the views of people, staff and relatives; which had led to improvements in the quality of care provided.

We used a number of different methods to help us understand the experience of people using the service, because the people using the service were unable to verbally communicate and were not able to tell us about their experience.

There were four people living at the home at the time of our inspection. During our visit we spoke with five members of staff on duty and one relative.

We saw that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The relative told us that the service provided ‘first class care’ to their relative. This included being treated with dignity and good personal care. They also said that a range of activities were undertaken both at home and in the community.

We spoke to staff and reviewed records, which showed us that people were protected from abuse and that their care was planned and delivered in a respectful and safe way.

We saw that good nutritional care was provided in a way that met people’s needs and preferences.

Staff we spoke to and records we reviewed, demonstrated that staff were suitably experienced, skilled and supported to ensure that people received care that met their needs. A staff member told us "There is a good staff team morale and we are always trying to make it a happy environment for the residents".

We were unable to verbally communicate with the people who used the service, we therefore used our observations to help inform some of our judgements