About the service:

Bells Court is a small residential care home providing personal care and support to three people aged under 65 who had learning disabilities or autism.

The care service had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. The home had been registered before such guidance was produced. The guidance focussed on values include choice, promotion of independence and inclusion so that people with learning disabilities and autism using a service can live as ordinary a life as any citizen. However, it was clear that people living in Bells Court were given such choices and their independence and participation within the local community had been and was continuing to be encouraged and enabled.

People’s experience of using this service:

People who used the service continued to be supported to remain safe. Staff knew people well and supported them with kindness and consideration.

People received medications safely and risks to people had been assessed and managed to identify and reduce or remove safety risks. Other aspects of safety, including environmental and issues of personal safety, were also addressed and well managed in the home.

Peoples rights were upheld and protected. People were supported to have choice and control over their day to day lives.

People continued to be supported by an established team of staff who provided kind and personalised care to people living in the home. Safe recruitment of staff ensured people were supported by staff of good character.

There was a range of monitoring systems in place that checked if the home was well managed and effective in supporting people to have a good quality of life. People were supported by staff who were well trained and focussed on supporting them with their plans.

The registered manager was keen to promote opportunities to support people to engage in the community and enjoy a range of experiences in line with their wishes. Staff provided encouragement and enabled people to do these as much as possible.

The home continued to meet the characteristics of a rating of good in all areas. More information about the inspection is in the full report.

Rating at last inspection:

The home was rated good at the last inspection (report published in March 2016).)

Why we inspected:

This was a planned unannounced inspection based on the previous rating.

Follow up:

We will continue to monitor the home through information we receive.

This inspection took place on 21 December 2015 and was unannounced. The previous inspection was in June 2014 where we found that regulations had been met. The home was providing accommodation and personal care for three people with learning disabilities and /or autistic spectrum disorders.

There was a registered manager in post at the time of the inspection. 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 were assisted to understand potential risks to their safety including abuse. Staff knew how to recognise signs of abuse and who to raise concerns with. People had assessments which identified actions staff needed to take to protect people from risks associated with their specific conditions and challenges to themselves and others. People were supported to accept their medicines. Medicines were appropriately stored and managed and this helped to keep people well.

People were supported by enough staff to keep them safe and to receive support when they wanted. There were recruitment and induction processes in place to ensure new members of staff were suitable to support the people who were living in the home. People were happy with how staff supported them. Staff demonstrated skills and knowledge to ensure people were supported effectively and safely.

The registered manager and staff we spoke with were knowledgeable of the requirements of the Mental Capacity Act 2005. Staff sought consent from people before providing support and people were in control of the support they needed. People’s rights were protected as they had control over their lives unless action had been taken to legally restrict their liberty.

People were supported to have a choice of suitable food and drink that met their health needs. Where necessary arrangements had been for people to have extra support with their nutrition. Staff supported people to access to routine checks from health professionals to keep people physically and mentally as well as possible. In addition staff acted quickly when people’s health deteriorated.

People were happy about the relationships they had with the staff that supported them. Staff spoke about people as being part of their family. Staff knew how to communicate with people and how to allow people to have privacy, control and confidentiality when supporting them.

People did not have any complaints about the support they received. People, relatives and a social care professional told us that the home was well led by the registered manager. The registered manager and staff provided calm, professional and person centred care for the people who lived in the home. There was evidence that people’s capacity and opportunity to enjoy new experiences had improved. There were systems in place for the registered manager to check the quality of the service day to day and monitor for any trends in how the home was operating over a longer period.

There were three men living in the home when we inspected. We spoke with two of them. Our inspection team was made up of one inspector who considered 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. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

We found that the support people received was safe. People had their health and welfare needs met. They appeared happy and well cared for. Their comments included: "...Yes I am safe here” and “I am happy…I am being spoilt.”

We checked people's care plans and found that these were detailed and up to date. Risks were identified and plans were detailed enough to ensure that people had the care provided safely and risks to them and / or other people were minimised. Staff we spoke with were aware of the care that people needed to keep them safe.

There were appropriate infection control arrangements in place to minimise the risks of people becoming unwell.

People received their medicines at the right time in the way that was appropriate to the individual and checks were in place to ensure that all medicines were accounted for. Medicines were administered safely.

Staff were recruited appropriately with checks being completed to make sure that they were safe to work with vulnerable people. Their induction involved, learning about people who lived in the home, training and supervision. One member of staff told us that they were unable to support people on their own until they had received all the training.

Is the service effective?

People were involved in planning their support. Their care plans were discussed with them. People were involved in planning the food for their meals and were supported to understand what support they needed to maintain a healthy diet. Where specialist dietary support was needed this was arranged for them.

We saw that the service had involved other professionals in a decision that needed to be made in a person's best interest to keep them safe and well.

Is the service caring?

During our observations we saw that people were supported by kind and attentive staff. We saw that care staff showed patience and allowed people time to communicate what they wanted. Staff reassured people by positive comments such as: "You are doing really well on your diet" and "You are getting better at telling us what you are feeling."

People’s preferences, interests, aspirations and diverse needs had been recorded in people's care plans and people were supported as much as possible with these interests.

Systems were in place for people to give regular feedback about the care they received in residents' meetings. Where they had made suggestions these were acted upon.

Is the service responsive?

People both suggested and were involved in a range of activities. There were board games, televisions and music centres to keep people occupied inside and one person looked after a pet. People went out on an activity almost every day. There was a car available to assist people with going to activities but public transport was also used to keep people involved in the community.

People were supported to attend doctors, dentists and other health appointments when needed.

Is the service well-led?

Policies and procedures were available for staff for all areas of the work of supporting people. Systems were in place to monitor the quality of service the home provided and to minimise risks of harm to people so that people were safe and well cared for.

We saw that people who lived in the home were able to speak with the manager at any time. Staff told us that they were able to comment on the service provided and they were well supported by the manager of the home. Staff told us they were clear about their roles and responsibilities.

We saw that there were systems in place to monitor for example the safety of the home, medicines, infection control and the car safety. These measures helped to ensure that people received a good quality of service at all times.

During this inspection two of the three people that lived in the home were present. The third person was on an activity with a member of staff.

We found that there were good arrangements for people being involved in planning and making suggestions about their care. We saw one of the three people was relaxed and happy. They told us about their day: "(I am) Happy just chilling." A person had periods of being upset during the inspection but also at times was calm and spoke with the manager and staff in an easy manner.

Staff showed knowledge about the person’s preferences and the risk management plans in place. There were sufficient staff on duty to ensure that people had access to activities and to work with people when they were upset. Staff had appropriate training to meet the needs of people they were caring for.

We had received no information about complaints or safeguarding concerns about the home in the last year. 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.

Good systems were in place to review and monitor the care that people received and to respond to any changes in people’s need. Additional risks to people's well-being were considered, such as potential fire safety risks and poor administration of medicines. Appropriate systems were in place to manage and monitor these risks.

We visited Bells Court on 15 May 2012. They did not know we were visiting before we arrived. We spoke with two out of the three people that lived in the service. Some people living in the home had difficulties with verbal communication and one person spent most of their day out of the home. We observed how support workers assisted people in the home. We spoke to two support workers, and the registered manager.

People living in the home said or indicated that they were happy living in the home. Two people living in the home said staff were "alright."

A completed survey from relative said that they were happy with care offered, staff were polite and helpful. They said they had no problems contacting the home. Another said that they were: "Mostly happy."

Two people showed us their rooms. These were furnished well and showed evidence of people's interests. People agreed that they had a choice of food and activities.

We saw how support workers and managers spoke with people living in the home. People were treated with respect and kindness. People were reminded gently of agreed plans. We saw people being encouraged keep their room clean and heard people being encouraged to manage their own personal care.

A health professional wrote in a survey that they: "Have a lot of confidence in the care provided."