Belstead Villa provides accommodation, care and support for up to four adults with a learning disability, autistic spectrum conditions and associated complex needs. There were two people living in the service when we carried out an unannounced inspection on 28 and 30 June 2017.

At our last inspection 14 April 2015 we rated the service as overall good, however well led was rated as requires improvement. At this inspection we found that previous shortfalls in this area such as not having a registered manager had been addressed and effective systems and procedures had been implemented to monitor and improve the quality and safety of the service provided. These improvements contributed towards people consistently receiving safe, effective, compassionate and high quality care.

A registered manager was 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 atmosphere in the service was friendly and welcoming. People received care and support that was personalised to them and met their individual needs and wishes. Staff respected people’s privacy and dignity and interacted with them in a caring, compassionate and professional manner. They were knowledgeable about people’s choices, views and preferences. Relatives were complimentary about the care provided and the approach of staff and the registered manager.

People were safe and staff knew what actions to take to protect them from abuse. The provider had processes in place to identify and manage risk. Regular assessments had been carried out and care records were in place which reflected individual needs and preferences.

Recruitment checks on staff were carried out with sufficient numbers employed who had the knowledge and skills to meet people’s needs. Retention of staff was good and supported continuity of care.

Appropriate arrangements were in place to ensure people’s medicines were obtained, stored and administered safely. People were encouraged to attend appointments with relevant professionals to maintain their health and well-being. Where people required assistance with their dietary needs there were systems in place to provide this support safely.

People and or their representatives, where appropriate, were involved in making decisions about their care and support arrangements. As a result people received care and support which was planned and delivered to meet their specific needs. Staff listened to people and acted on what they said.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). Staff understood the need to obtain consent when providing care. Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLs and associated Codes of Practice

People were encouraged to maintain relationships that mattered to them such as family, community and other social links. They were supported to pursue their hobbies and to participate in activities of their choice. This protected people from the risks of social isolation and loneliness.

There was a complaints procedure in place and people knew how to voice their concerns if they were unhappy with the care they received. People’s feedback was valued and acted on. There was visible leadership within the service and a clear management structure.

Effective systems and procedures had been implemented to monitor and improve the quality and safety of the service provided. Identified shortfalls were addressed promptly which helped the service to continually improve.

This inspection took place on 14 April 2015 and was unannounced.

When we inspected this service in June 2014, we had moderate concerns regarding the numbers of staff available to meet people’s needs at all times. At this inspection we found that improvements had been made.

Belstead Villa provides care and support for up to four adults with a learning disability. On the day of our inspection there were four people living at the service.

The service has had three changes of manager within a period of 18 months. The current manager was not registered with the Care Quality Commission (CQC) and was long term absent from the service. There was an interim manager in post. As part of their condition of registration the provider is required to have a registered manager at this location.  A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 found that the culture of the service was positive and focused on the needs of people who used the service.

Staff had received training and were able to describe how to recognise signs of abuse and how they would respond and alert relevant authorities should they suspect people were at risk of harm.

Staff had been trained in safe techniques and care plans provided guidance for staff in how to respond and support people appropriately when they presented with distressed reactions to situations or others.

People were relaxed and comfortable living at the service and their privacy and dignity respected and promoted. Staff regularly engaged with people and had a good rapport with everyone. People were involved in making decisions about all areas of their care.

Staffing levels were planned and reviewed to adapt to the changing needs of people. This meant that there was planning to ensure that there was sufficient staff available to meet the needs of people at all times.

Staff received the supervision support and training they needed in order to carry out the range of roles and responsibilities of their roles.

People were supported to be involved in the planning of menus and encouraged to be independent in learning budgeting and cooking skills. People were encouraged to eat a balanced diet and were involved in decisions regarding what they ate and drank.

The provider carried out regular quality and monitoring of the service. However, audits had failed to identify shortfalls with regards to work required to ensure the laundry room was maintained to a safe and hygienic condition and the monitoring of medicines stocks. Without adequate safety monitoring systems in place this presented a risk to people who used the service and staff.

Our inspection team was made up of one inspector. As part of this inspection we spoke with two people who used the service and a relative, the registered manager and four care staff. We also reviewed support records for people using the service and records relating to the management of the home, which included four staff files.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us and the records we looked at.

Is the service safe?

Staff were knowledgeable in safeguarding vulnerable adults procedures and were able to recognise signs of potential abuse. The service had a system to respond to allegations of abuse and had details of the local safeguarding team.

The service had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, although no applications had needed to be submitted.

Is the service effective?

The staff had the skills and experience required to meet the needs of people who used the service. The team had access to training courses to update their knowledge and become familiar with any changes in policies or procedures. Staff told us that they had access to training and had attended training in the past year.

The service undertook assessments with the people who used the service or a relative prior to admission to identify their support needs.

Is the service caring?

People who used the service or a relative were involved in decisions about their care and support. Staff supported people and advised them, but allowed the person who used the service to make the final decision. Staff told us, "We always ask [people who used the service] what they want."

Is the service responsive?

The service liaised with other health professionals to meet the needs of people who used the service. People’s individual needs were assessed and staff were aware of their needs.

Is the service well-led?

We saw evidence that there were processes in place to monitor and improve the quality of service delivery.

During our inspection we spoke with three out of the four people who used the service. People told us they were happy with the care and support they received at Belstead Villa. One person told us, "I have no complaints. It is good here."

We saw from a review of records that the provider had taken steps to assess and manage risk relating to the health, safety and welfare of people who used the service. We saw that care planning took account of people's rights to choice and supported the planning of their lifetime goals and aspirations.

We observed staff interacting with people and saw that interactions were positive. Staff were seen to promote people's independence, offering people choices which were respected.

We looked at recruitment records for four members of staff. We saw that the provider had effective recruitment and selection procedures in place.

As part of our inspection we carried out a tour of the premises and reviewed records in relation to maintenance of the building including health and safety. We found that the provider's management monitoring systems ensured that people lived in a safe, well maintained environment.

We spoke with one of the four people who used the service. Two of the people were on home leave and another was preparing to go out during our inspection. The person spoken with told us that they were consulted about the care that they were provided with and that the staff treated them with respect and listened to them and acted on what they said. They commented, "I get on well with the staff."

We looked at the care records of four people who used the service and found that they experienced care, treatment and support that met their needs and protected their rights.

In this report the name of a Registered Manager, Adele Irons, appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We spoke with one person who used the service who told us that they felt that the staff treated them with respect and listened to their choices about what they wanted to do in their life. They said that they were happy living in the home and that they were supported to achieve their goals.

During our visit we saw a person who used the service working with a staff member in preparing their menu for the week. The person chose their meals from pictures in a recipe book and the staff member asked which day they wanted the meal and recorded it on a menu. This showed that their choices were sought and listened to.

At the time our visit it was the first day of half term and people were on holiday from college and day placements. The people who used the service and the staff went out on an arranged shopping trip during our visit. This showed that people were provided with the opportunity to participate in activities in the community which promoted their independence by shopping for their chosen items.