Bells Piece is a care home providing accommodation, personal care and support for up to 13 adults who have a learning disability, physical disability or mental health conditions. At the time of our unannounced inspection on 21 May 2018, there were 13 people living in the home. 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.

There was no 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. A new manager had started at the service in March 2018 and had submitted their application to register with the Commission. The new manager (hereon in known as the manager) assisted us with our inspection.

At the last inspection on 4 December 2015, the service was rated Good. At this inspection we found the service remained Good in Safe, Effective, Caring and Well-Led. The service had progressed to ‘Outstanding’ in Responsive.

People ‘s care and support was planned proactively in partnership with them. Staff used individual ways of involving people and people took a key role in the local community and had opportunity to access education and work. People were supported in a way that promoted an enhanced sense of well-being. They had facilities and support available to them to help them live as fulfilling a life as possible

People had opportunities to take part in activities that reflected their interests and preferences. This included activities on site, such as gardening and growing their own foods, going to the on-site art studio and contributing towards the running of the shop. People told us how much they enjoyed living at Bells Piece, spending time with their friends and being given opportunities to learn and to work.

People were supported by sufficient numbers of appropriately skilled staff to meet their needs and keep them safe. Staff understood their responsibilities in safeguarding people from abuse and knew how to report any concerns they had.

Risks to people’s safety were identified and action taken to keep people as safe as possible. Accidents and incidents were reviewed and measures implemented to reduce the risk of them happening again. People’s care would not be interrupted in the event of an emergency and people were made aware of fire procedures.

People lived in a home which was clean and hygienic and both people who self-medicated and those who did not received their medicines safely and as prescribed.

People’s needs had been assessed before they moved into the home to ensure staff could provide the support they required. Staff had the training and support they needed to carry out their roles effectively. All staff attended an induction when they started work and had access to ongoing training.

People’s rights under the Mental Capacity Act 2005 were respected. Staff understood the importance of gaining people’s consent to their care and how people communicated their decisions. Applications for DoLS authorisations had been submitted where restrictions were imposed upon people to keep them safe.

People could make choices about the food they ate and were supported to maintain a healthy diet. People were supported to maintain good health and to obtain treatment when they needed it. Each person had a health action plan which detailed their health needs and the support they needed. Staff worked with external organisations and professionals to help provide the most effective care to people.

The home provided bright and spacious ac

Bell’s Piece is a residential home which provides care and accommodation for up to thirteen adults with learning disabilities including autism. It is set in a semi-rural area of Farnham, Surrey. At the time of inspection, there were twelve people living at the home.

The service also provides day support although this activity is not regulated by the Care Quality Commission (CQC). There is an activities centre onsite ; ‘Simply Unique’ offering a range of activities such as gardening, arts and crafts, literacy, IT classes, healthy eating programmes, music and games to people who live at Bell’s Piece and those people who visit.

The home also runs a farm shop which is open to members of the public. It has a range of goods on offer from arts and craft to homemade jams and chutneys. All these products are made by the people who live and visit Bell’s Piece.

There was 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 inspection took place on 4 December 2015 and was unannounced.

Staff understood what was important to people and worked closely with them, and with families to ensure each person had a meaningful and enjoyable life. People played an active daily part in the running and development of the home.

An outstanding feature of the service Bell’s Piece provided was the time spent in developing the service, using innovative strategies with communication and guidance to help people gain independence skills and supporting people to achieve their full potential. People had access to all sorts of social and skills development activities that were tailored to and met their individual needs. Some of these were based on site in Simple Unique, Classes Café and the farm shop. The home also promoted people’s participation in the wider community; supporting people access to friends, attending further education and developing citizenship. The staff knew the people they supported as individuals.

Innovative approaches such as ‘My Choice Pad’ and ‘Seed to Plate’ enhanced people’s quality of life and provided therapeutic benefit to people. My Choice Pad brings together proven speech and language therapy techniques with market leading technology to deliver language development via tablet computers that is both effective and measurable. Seed to plate is a horticultural programme that supports people to grow, harvest and cook their produce.

There was positive feedback about the home and caring nature of staff from people and relatives. A relative said, “They’re all very caring. I’ve never come across anyone who isn’t and I’m in and out a lot. It’s always open house. You can visit any time you want. They keep us involved.”

People were safe at Bell’s Piece. There were sufficient staff deployed to meet the needs and preferences of the people that lived there; A relative said, “There are enough staff to help.” One person said; “There’s always staff here.”

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks, without restricting people’s freedom. One staff member told us; “We risk assess to make sure people are safe, for example with bathing, we look to see if that person can get in and out of the bath, if they need help or if they can be left alone.”

Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police. One staff member said “If there was an incident or accident I would treat the injury and record it in the accident and or incident book” and “I would always tell the manager if I saw anything that wasn’t right.” There was clear informat

We reviewed records of people living at the home and spoke with two people and three members of staff. People were very familiar with the contents of their care records which were individualised and up to date. The records contained a great deal of personalised information about the people living at Bells Piece and they included clear guidance for staff regarding the best ways to provide care and support. This meant the provider had ensured that staff knew how best to meet people’s needs.

People told us they loved living at Bells Piece. They said it was a happy house and the staff were very good and some were wonderful. People told us they were supported to do the things they enjoyed and they had a lot of choice about how they spent their time.

We used a number of different methods to help us understand the experiences of people using the service. These included observing how people were supported, spending time with people and talking with them.

We spoke to five people using the service. Two people told us they were very happy and loved living at Bells Piece and had lived there for many years. Other people demonstrated that they were happy and content by their general demeanour and their response and interaction with staff.

Two people we spoke with told us that they felt the registered manager and staff listened to what they had to say. They said that they thought all the staff “were nice, friendly and helped them when they needed it.” They told us they liked to play jokes on the staff and liked having fun.

We also gathered evidence of the service provider's performance through observing staff practice and sampling records and documents during and following the inspection.

We saw that the staff appeared happy in their work and were positive about working at the service.

We did not speak directly to people using the service about their views as many of the people were busy getting ready to leave the service for the day.

Those people that we saw appeared relaxed and happy and were engaging with other people and staff in the service.

People told us they were involved in decisions about their care and support. People told us they liked having their own rooms and being able to be independent.

People told us that the staff were kind and helped them. Staff were there if they needed to talk to them and they felt safe.

People said they were involved in planning the support they needed and knew the staff that supported them.

People said they could say if they were unhappy about something.