This was an unannounced inspection which took place on 15 November 2017. A further announced visit took place on 21 November 2017.

Ballard’s Ash is a residential care home which is registered to provide a service for up to ten people with learning disabilities. People had other associated difficulties such as behaviours that may cause distress to themselves and/or others and some people were on the autistic spectrum.

At the last inspection, on 23 September and 3 October 2016, the service was rated as requires improvement in the effective and responsive domains. This meant that the service was rated as overall requires improvement. At this inspection we found the service was good in all domains and therefore overall good.

There is a registered manager running 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.

People, staff and visitors were protected from harm and the registered manager ensured the service remained as safe as possible. Safety was maintained and promoted by staff who had been trained in safeguarding vulnerable adults and health and safety policies and procedures. Staff understood how to protect the people in their care and knew what action to take if they identified any concerns. General risks and risks to individuals were identified and appropriate action was taken to reduce them, as far as possible.

People benefitted from adequate staffing ratios which ensured there were enough staff on duty to meet people’s diverse, complex, individual needs safely. Recruitment systems were in place to make sure, that as far as possible, staff recruited were safe and suitable to work with people. People were supported to take their medicines, at the right times and in the right amounts by trained and competent staff.

People were assisted by well-trained staff who were supported to make sure they could meet people’s varied well-being and complex needs. Staff worked very hard to deal effectively with people’s current and quickly changing health and emotional well-being needs. The service worked closely with health and other professionals to ensure they were able to meet people’s special needs.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. The policies and systems in the service support this practice.

People were supported by a caring staff team who were committed to meeting people’s needs with patience and kindness. The staff team were attentive and were able to communicate with people by using detailed individual communication systems.

The service was extraordinarily person centred and responsive to people. Staff had made very positive impacts on people’s feelings of well-being. Support planning was highly individualised and regularly reviewed which ensured people’s needs were met and their equality and diversity was respected. People were provided with varied activities to enable them to lead as fulfilling a lifestyle as possible.

The registered manager was highly respected and ensured the service was well-led. She was described as open, approachable and supportive. The registered manager and her team were committed to ensuring there was no discrimination relating to staff or people in the service. The quality of care the service provided was constantly assessed, reviewed and improved, as necessary.

This inspection took place on 23 September 2016 and was unannounced. We returned to complete the inspection on 3 October 2016. The last inspection took place on 5 December 2013 and no breaches of legal requirements were found at that time.

Ballards Ash provides care and accommodation for up to 10 people with a learning disability. At the time of our inspection there were nine people using the service.

There was a registered manager in place 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.

Procedures were in place to manage and dispense people’s medicines safely. Medicines audits were also undertaken. Stock levels that we checked were correct.

There were risk assessments in place to ensure that staff received guidance in how to support people safely. These were reviewed and updated accordingly when necessary.

Staffing levels were assessed and a minimum number of staff required on duty had been set. However, on some days this number fell below the number set by the provider. A recent recruitment drive had resulted in several new members of staff being employed.

Some families and professionals told us they did not feel that people were always supported to make choices around their preferences for participating in individual hobbies and interests.

Staff received support through supervision and training and felt supported by the management team.

Some aspects of the Mental Capacity Act 2005 were not being adhered to and some people were not fully supported by the company appointee to choose how they spent their money.

People received care which was responsive to their individual needs. People were able to follow their own preferred routines during the day, for example by getting up and going to bed when they wished. Staff worked with healthcare professionals to ensure professional advice was sought when necessary.

Staff were kind and caring and treated people with respect. People were encouraged to maintain relationships with other people that were important to them.

The service was well led by the registered manager. Staff reported feeling well supported and able to raise any concerns or issues. There were systems in place to monitor the quality and safety of the service. This included a programme of audits that included: medicines, the environment and people’s care plans.

On the day of our inspection one person had an annual review. We spoke with the family of this person who told us that they attended care plan reviews and were kept well informed about any significant changes by the manager. They told us, “This home is brilliant, they let me know what is going on and really know what my daughter needs.”. Another relative said, " We had to wait a couple of years for a vacancy but it is the best thing we ever did. I cannot believe there is a better home."

People were provided with choices of food and drink to meet their diverse needs. We found that the cook knew the individual nutritional requirements of people contained within their care plans. The cook bought fresh produce and made home cooked meals. We observed these were presented in an appetising way to encourage people’s enjoyment.

We found that staff and people who used the service or their representatives understood the safeguarding process and how it applied to them. This meant that people were protected from abuse and their human rights were respected.

Staff told us there was a good team spirit at Ballards Ash, cultivated by an experienced and approachable manager and deputy. We found that training in core subjects was up to date and that staff thought that this equipped them to fulfil their roles effectively.

The provider had a clear system for handling and responding to complaints, although there had been none recorded since the last inspection.

We spoke with five people who lived in the home. Four people told us that they had that they had been Christmas shopping which they had clearly enjoyed. One person said that they enjoyed music and were enjoying listening to a CD and singing along. Later we saw that they are involved in playing a musical instrument as part of a music activity.

We saw the people were supported to go out at different times of the day. One person was supported to go Christmas shopping. We saw staff asking people throughout the day what they wanted to do and what support they needed.

People's needs were assessed and care was planned so that they experienced care, treatment and support that met their needs and protected their rights. There were suitable arrangements for obtaining, administering, recording and storing medicines so that people received the right medicines at the right time.

Before staff started to work with people they had strict recruitment checks and they provided information about their employment history, qualifications and experience. The manager and staff made sure that all the necessary records were in place to support people and manage the home.

People living at Ballards Ash had a high level of needs and not everybody at the home could express their views verbally. Staff told us they had got to know people’s preferred communication methods and how each person showed their feelings. We observed staff interacting well with people and using methods such as signing and physical prompts to aid communication.

We saw people being offered choices, for example about what to eat and how to spend their time. Mealtimes were recognised as an important time and support was being provided to meet people’s individual needs. People looked well supported with their personal care and appearance. We had visited the home on a cold day and people who went out were appropriately dressed for the weather.

People were involved in the community, for example by attending college, helping with the shopping and using the sports facilities. We were told about people’s individual goals, which included being more independent in day to day tasks and starting new activities such as horse riding and being part of a ‘drum circle’.

People’s next of kin and other parties were being given the opportunity to pass on their views about the home. Their feedback in surveys was very positive, with comments such as “the service is excellent” and “the home is a clean and safe place for service users and staff”.