The inspection took place on 26 April 2016. The home was last inspected on 3 April 2014 when it was compliant in all areas and no concerns were identified.

The home is located in the village of Stonebroom in Derbyshire and provides personal care and support for up to five adults with a learning disability or autistic spectrum disorder. Some people may have associated conditions that included sensory disability, epilepsy and behaviour that can put themselves or others at risk. At the time of our inspection five people were living at Broom Cottage.

The service had a registered manager. 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.

People were happy, comfortable and relaxed with staff and said they felt safe. They received care and support from staff who had the skills and knowledge to meet their individual needs.

Safe recruitment procedures were followed and appropriate pre-employment checks were carried out by the provider. Staff were supported by the registered manager to provide care to the people they provided care for.

There were caring and compassionate relationships between the people who used the service and staff. People were happy with their care and they were supported to express their views and be actively involved in making decisions about their care.

People's nutritional needs were assessed and records were accurately maintained to ensure people had a balanced diet. People were involved in decisions about what meals they ate on a daily basis.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure medicines had been stored, administered, audited and reviewed appropriately. People were able to access health and social care when required.

People were encouraged and supported to make their own life choices. Best interest decision making was undertaken where people could not make their own decisions. The registered manager and staff understood the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People were always consulted before care was given.

People were encouraged and supported to express their views about their care and staff responded to their concerns and wishes. Relatives and professionals involved with the home were able to influence what happened to individuals where this was appropriate.

There was a person centred culture in the home which had been developed with the people who used the service, their relatives and staff. The registered manager and staff were aware of their responsibilities.

There were five people living at Broom Cottage. We spoke with three people receiving care, one senior care staff, the manager and providers. Below is a summary of what we found about the service.

Was it safe?

Staff supported people safely. The provider regularly checked people's care and safety and the records required for this were kept up to date. This meant that people were not being placed at unnecessary risk. Staff followed the Mental Capacity Act 2005 and knew how to report abuse. This meant people were safeguarded from harm and abuse.

Was it caring?

People experienced care that met their needs and protected their rights. One person said, I am very contented, I feel safe here.” Staff understood people's needs and ensured their rights.

Was it responsive?

The provider agreed people's care with them and acted according to their wishes. Where people could not consent to their care, the provider acted in accordance with legal requirements. People’s lifestyle preferences, routines and goals were detailed in their care records. Care plans were provided in alternative formats, such as picture signs and symbols to help people to understand and agree them. One person said, “I choose the activities I want to do, they’re not chosen for me here; they help me to try new things.”

Was it well led?

The manager and senior staff ensured that families, advocates and health and social care professionals were involved in people’s care. This helped to make sure people received the right care when they needed it. We found that improvements had been made made since our last inspection in November 2013. These included developing more person centred activities and the revision of medicines and care planning policies for staff to follow to ensure they met with recognised guidance. Staff, were regularly consulted about people’s care and were confident to raise any concerns they may have.

At the time of our visit there were five people living at Broom Cottage. We spoke with three of the people. One person said, "I like it here; the staff are all nice; I am having a good day today." Another person said they were, "fine, thank you," and told us they were pleased because they had been supported to do their Christmas shopping.

The accommodation was appropriately designed and adapted to meet the needs of the people living there and risks within the home had been assessed. The home was clean and was personalised to the people who lived there. Staff recruitment systems were robust.

People's support plans and risk assessments were not up to date and in some cases not in place. Staff did not provide care to the people with reference to support plans. Therefore, care and treatment was not planned in a way that could ensure delivery of appropriate and safe care to the people who lived at the home. People were not always protected against the risks associated with medicines because the provider did not have wholly appropriate arrangements in place to manage medicines.

We spoke to people in the home and their relatives. One person told us that their relative had moved to the home following the closure of their previous home. They told us that they were very happy with the care provided and that their relative was calm since they had been living there. Previously whilst living in the other home they had always been agitated. They told us they were encouraged to visit any time and always found their relative happy and well presented.

We spoke to one person who told us about their plans for their fiftieth birthday later in the year. They told us who they were inviting and about the barbecue that was planned. They also told us they were very happy in the home.

We spoke to a visiting healthcare professional who told us they had visited the home on a number of occasions and believed that people were treated with dignity and respect.

At our visit we were able to speak with one person about their views of the care and services they received out of a total of four people living at the home. This was due to people’s given mental capacities. We also spoke with three relatives who had close involvement with service users there and an outside mental health care professional involved in one person’s admission to the home and for their ongoing monitoring there.

The service user told us about arrangements made with them to visit the home, including overnight, to help them to decide whether they wanted to move there permanently. They said, ‘I liked it a lot and did not want to leave.’

Two people’s relatives told us, ‘They were fantastic when he moved there, inviting him to say overnight and informing us all the way.’ Another said, ‘We can visit whenever we want and are always made to fell really welcome. We take the dog as he loves to see him.

The same service user expressed satisfaction with the care and support they received and said that activities were regularly organised that they chose and enjoyed. They were particularly happy being provided with privacy for quiet time when they felt they needed it and also with their meals provided, which they said was important to them. Telling us, ‘My brain works better since I came here. It’s because of the good food I get, I feel better in myself.’

The outside healthcare professional referred to above said they had been very impressed with the home. Telling us, ‘They have managed his care really well, ensuring a personal and structured approach that meets with recognised practise concerned with his medical condition.’

People’s relatives spoken with expressed their high regard for the home and the time, care and support given to people by the providers and staff. All told us about improvements they had seen in their person’s health status since their admission to the home from other services. Some examples of their comments included,

‘He is in much better health now. They’ve sorted out his medication and he is settled, safe and happy there.’

‘The care is really good. In fact I’d say excellent. We can’t praise the home enough. They are dedicated in ensuring the best qualify of life for him and I know I don’t have to worry any more like I used to.’

‘The home is 100 percent, absolutely fantastic. I can’t fault anything. His dental health is much better since living at there. They keep me up to date with changes and any hospital appointments and I know I can speak with them any time I need to.’