About the service:

Bilton Grange Road is a care home that provides accommodation and personal care for one person who has a learning disability and mental health needs.

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.

People’s experience of using this service:

The person using the service continued to receive safe care and staff knew how to keep them safe from harm. The provider had a recruitment process to ensure they had enough staff to support the person safely. The person received their medicines as prescribed. Staff usually followed infection control guidance and had access to personal protective equipment. Issues around cleanliness of the kitchen were addressed following our inspection visit.

The person using the service continued to receive effective care. Staff were supported and had the skills and knowledge to meet the person’s needs. The provider followed the principles of the Mental Capacity Act (2005). The person’s nutritional needs were met and they accessed health care when needed. The environment met the persons needs but refurbishment was needed of some areas. We were informed this was planned for the coming new year.

The person using the service continued to receive care from staff who were kind and caring. Staff supported and encouraged them to be involve in how decisions were made about their support. Staff respected their privacy, dignity and independence.

The person using the service benefitted from consistently responsive care. Their support needs were assessed and planned with their involvement to ensure they received the support they needed. They were supported to take part in activities of interest and their preferences, likes and dislikes were known to staff. The culture in the home focused on high-quality, person-centred care. The provider had a complaint process which people were aware of.

Aspects of leadership and management needed improvement. Spot checks and audits were taking place to ensure the quality of the service was maintained but some improvement was needed. The registered manager and provider had not ensured all required notifications had been submitted.

Rating at last inspection:

Rated Good (Report published August 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remained Good overall.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We inspected this home on 20 July 2016. This was an announced Inspection. The registered manager was given 24 hours’ notice of our visit to ensure someone would be at home when we arrived. The home was registered to provide residential care and accommodation for one person. At the time of our inspection one person was living at the home.

A registered manager was in post and was present throughout our 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.

The one person using this service told us they felt safe. We observed the person looking relaxed and at ease within the home, and with the staff who were supporting them. Staff understood their roles and responsibilities to protect people from the risk of potential harm. Staff were aware of the provider’s processes for reporting any concerns. There were enough staff to support the person safely and recruitment checks were in place to help ensure staff that were employed were safe to work with people.

Staff had been trained to support people effectively. This included learning about the specific needs the person lived with. Staff told us that they received regular supervision and felt supported. Senior staff were always available for them to seek advice and guidance.

There was a variety of food and drink available which the person had chosen and enjoyed. The person was supported when necessary to access a range of health care professionals.

Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be unable to make their own decisions. We observed staff working consistently in line with care plans when restrictions or safeguards had been agreed. Staff worked in an inclusive way that promoted the person's liberty as far as possible.

We observed positive, compassionate interactions between the person and the staff who were supporting them. Health professionals we spoke with praised the positive regard and commitment that the staff team showed to the person, which in their opinion had enabled them to settle in this home, and improve their well-being.

There were systems in place if people wished to make a complaint. The registered manager was aware of his responsibilities and had the skills and experience required to enable them to effectively lead this service.

We visited this service unannounced to follow up an area of non- compliance after our last inspection In September 2013. We spoke with the person who lived in the service and the staff and manager who were on duty.

Since our last inspection there had been significant improvements in how medication was managed and checked.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We spoke with the person who used the service, their advocate and a health professional who supported the person. The person told us: "I am well looked after." People who provided support to the person using the service advised that they had seen an improvement in the person’s motivation and agreement to receive support when needed since their admission. The person told us: "I can go out when I want to, I go to the cinema, the pub, bowling, shopping and go out for meals." Care plans and risk assessments were in place to ensure that care was given consistently. The person was receiving appropriate care.

Staff showed knowledge about the person’s preferences and the risk management plans in place. There were sufficient staff to ensure the person had access to activities and to work with them when they were upset. Staff had appropriate training to meet the needs of the person they were caring for. Reasonable steps to identify the possibility of abuse and prevent abuse from happening had been undertaken. The home's layout and design and had been considered to meet the person's needs.

However, the administration, storage and recording of medicines needed to be improved to lessen the likelihood of errors.