We inspected the service on 1 December 2017. The inspection was announced. Blair House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to provide both nursing and personal care for 27 younger adults and older people who have a learning disability. There were 25 people living in the service at the time of our inspection. Most of them had special communication needs and expressed themselves using single words, vocal tones and sign-assisted language. The 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.

The service was run by a company who was the registered provider. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At our last inspection on 3 June 2015 the service was rated overall as being, ‘Good’. However, we found that improvements were needed to ensure that people were fully supported to express their individuality by pursing their hobbies and interests. In addition, we found that people needed to be given more support to readily be able to use the service’s complaints procedure should they need to do so. Furthermore, we found that some care records were not being kept in the right way so that there was a clear account of all of the assistance each person had received. As a result of these shortfalls we rated our domain ‘responsive’ as, ‘Requires Improvement’. At the present inspection we found that these shortfalls had been addressed. Therefore, we rated our domain ‘responsive’ as, ‘Good’.

Also, at our present inspection our overall rating for the service remained as, ’Good’.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Most risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. In addition, medicines were managed safely. Suitable arrangements had been made to ensure that sufficient numbers of suitable staff were deployed in the service and background checks had been completed before new nurses and care staff had been appointed. People had benefited from the prevention and control of infection and lessons had been learnt when things had gone wrong.

Some areas of the accommodation were not designed, adapted and decorated in a way that met people’s needs and expectation. However, nurses and care staff had been supported to deliver care in line with current best practice guidance. This included supporting people when they became distressed. People received the individual assistance they needed to enjoy their meals and they were helped to eat and drink enough to maintain a balanced diet. In addition, suitable steps had been taken to ensure that people received coordinated and person-centred care when they used or moved between different services. Furthermore, people had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support.

People were supported to have maximum choice and control of their lives and nurses and

We inspected Blair House on 3 June 2015. The inspection was unannounced. The last inspection took place on 18 June 2013 and the registered provider was compliant with the outcomes we inspected at that time.

Blair House provides nursing and personal care for up to 28 people with complex needs related to learning disabilities. The home is located within the Billinghay area of Lincolnshire. One the day of the inspection 26 people were living within the home.

There was no registered manager in post at the time of the inspection. The current manager had taken up post in post since 16 March 2015 and had applied to be registered with us. 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection four people who used the service had their freedom restricted and the provider had acted in accordance with the Mental Capacity Act, 2005 DoLS.

People were safe living in the home and they were treated in a warm, caring and dignified manner. Their rights to privacy and expressing their views and opinions were respected and supported.

They had access to appropriate health care services and their nutritional needs and wishes were met. They were supported to make their own decisions and choices where they were able to do so. Where they were not able to do so there were systems in place to ensure decisions were made in their best interest.

People were involved in planning their care. Staff were knowledgeable and understood their needs and wishes and were trained and supported to deliver appropriate care. However, people’s care records did not always accurately reflect their current needs or risks associated with their care. Although they were supported to engage in a range of activities and interests they wanted more personalised and varied options to be available to them.

There was a positive and open culture within the home. People were able to raise concerns or make complaints and were assured they would be listened to. There were systems in place to regularly monitor the quality of the services provided for people and take action to make improvements where needed.

During the visit we spoke with eight people who lived at the home, four members of staff and a visiting social care professional.

Due to the complex needs of some of the people who lived at the home we also used a number of different ways to help us understand their experiences. For example, we spent time observing the care people received and we looked at a range of records kept in the home. The records we looked at included people’s care files and information about how the home operated.

People told us they were happy living at the home and staff supported them in the way they wanted. We saw people were treated with respect and dignity and could make their own choices and decisions where they were able to.

The right arrangements were in place to order, store, administer and dispose of medications. We saw people were given their medication at the right times and medication records were completed in the right way.

There were enough staff on duty to provide the level of care and support each person needed. Staff showed us they had a detailed knowledge of people’s needs and knew how to provide care and support for them.

There were arrangements in place for people to raise any concerns they had or say if they were not happy with anything. The arrangements included support and different ways for people who could not express themselves verbally.

We used a number of different ways to help us understand the experiences of people who used the service. This was because some people had complex needs which meant they were not able to tell us about their experiences.

We saw that people who lived in the home received individualised care and support from staff who were knowledgeable about their needs, wishes and preferences.

Staff clearly understood each person’s way of communicating their needs and wishes. They supported them to make choices and decisions about their lifestyles wherever they could do so.

Staff were well trained and supported to deliver the care and support each person needed and wished to have.

Visiting professionals were complimentary about the service and felt staff communicated well with them. They told us they were always made to feel welcome, they thought people looked well cared for, that staff were helpful and friendly, and it was a “nice place.”