We carried out this unannounced inspection to Camberley Cottage on 9 March 2018. Camberley Cottage is registered to provide accommodation with personal care for up to six people with physical and learning disabilities. 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. At the time of our visit four people lived at the service.

At out last inspection, the service was rated Good. At this inspection we found the service remained Good.

People were supported by a sufficient number of skilled and trained staff to meet their needs. Risks to people had been identified and as such staff took appropriate steps to help mitigate any risk of harm or injury to people. Staff were aware of their responsibilities in safeguarding people from abuse and supported people to access health care professionals to ensure they remained healthy.

Staff received supervision and appraisal with their line manager to support them in their roles. Staff were knowledgeable in relation to infection control and what to do in the event of a fire. Should the service have to close there were arrangements in place to ensure people’s care would not be interrupted.

People were supported to make their own decisions about their care and encouraged to be independent as much as they could. Staff had followed legal guidance in order to help ensure any restrictions to people were agreed in conjunction with those involved in the person. Staff worked with external agencies to support people and before people moved into the home their needs were assessed in order to help ensure staff could care for them in the way they needed.

People received support from staff who knew them well and positive relationships had developed. Staff treated people with kindness and were aware of their preferences. Staff demonstrated a good understanding of people’s communication styles. People received the medicines prescribed to them and staff provided people with nutritious food of their choosing.

People’s care records were person centred and completed in detail and people had access to a range of individual activities in line with their interests. The manager planned to develop activities further to give people additional opportunities.

People lived in an environment that was homely and adapted for their needs. The service was clean and hygienic and people had access to communal areas, a garden and their own bedrooms which were individualised.

Systems were in place to monitor the quality of the service provided and ensure continuous development. People and staff were involved in the running of the home and relatives played an active role. The service had a new manager (herein known as the manager) who had submitted their application to register with the Care Quality Commission. The manager had a clear vision on where she wanted to develop the service and the introduction of an electronic records system and use of technology was already benefitting staff and people. Staff felt supported and valued by the management team.

This inspection was carried out on the 2 October 2015 and was unannounced. Camberley Cottage opened in October 2007 to provide specialist care for six people with learning and/or physical disabilities between the ages of 18 and 65 years. Camberley Cottage has been adapted to cater for people with severe physical disabilities with wheelchair access throughout the service which included a purpose-built lift. All bedrooms are for single occupancy and all six bedrooms have en suite wet room facilities. On the day of the inspection there were six people living at the service.

There was a registered manager in place. 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. On the day of our visit the registered manager was on leave. The deputy manager and the regional manager supported us on the day.

People told us they felt safe, we found that where there was an identified risk to people this had been identified and action taken by staff. Staff had a clear understanding of how to safeguard people and knew what steps they should take if they suspected abuse.

There were enough staff working to meet people’s needs. Staffing levels were such that people were not kept waiting when they needed care and support. There was an effective recruitment process that was followed which helped ensure that only suitable staff were employed.

Medicines were stored securely and administered by staff who had been trained and assessed as competent to do so. Medicines were reviewed regularly to ensure people with complex needs received them appropriately.

People said that staff understood them. People had access to external health care professionals such as physiotherapists which had improved their independence. People’s communication difficulties had improved with the input of staff that were well trained and knowledgeable about people’s needs.

Staff were well trained and had a good understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Consent was sought from people appropriately by staff in a number of different ways as not everyone was able to verbally communicate.

Staff had received an induction when they started work and had on-going training to help ensure that they had the necessary skills and knowledge to meet people’s needs. People had access to the food and drink they liked and were involved in how meals were prepared. There was regular monitoring of people’s nutritional intake and advice was sought from specialists such as dieticians if a concern was identified or advice was needed.

People told us that the staff were always caring and the atmosphere felt like that of a family home. People were made to feel important by staff who knew them extremely well and who had a good rapport with them which helped promote positive relationships between them. We observed friendly and good natured discussions taking place between people and staff and the atmosphere was warm and relaxing. People were involved in their care planning and told us that they always felt listened to by staff.

Staff consistently went the extra mile to ensure that people’s needs were met. Where people wanted to have support to be more independent this was given in a sensitive and caring manner which was appreciated by people and those that mattered to them. We saw that people’s privacy and dignity was maintained by staff who had great respect for people and what mattered to them.

Care planning was individualised and person-centred and detailed people’s likes, dislikes and personal history so that staff would have an understanding of how to meet their needs and understand them as a person. People’s care needs had been assessed prior to them moving into the service to ensure that they could be met.

The service was flexible when it came to meeting people’s needs and staff ensured that if a change occurred this was responded to quickly. People were supported to make choices about what they did and when and were given information by staff to help them make informed decisions. Where people wanted to take part in activities these were facilitated by staff wherever possible in a way that was not set in a particular routine which people told us suited them. Activities were extensive and people had been supported and encouraged by staff to be part of the community by raising money for a local charity.

People were able to make a complaint if necessary but had not done so in a formal way. They all said the deputy manager and the staff were very approachable which allowed concerns to be dealt with before they became problematic.

People, visitors and staff were positive about the leadership of the home. One person said “(The deputy manager) is nice.” Staff said they felt valued by the management team and enjoyed working at the home.

Senior staff communicated through team meetings, through supervision meetings and in recruiting staff to promote the values of the service. There was a culture within the service that valued the individual and placed caring for people at the centre of what they did.

Staff (including the deputy manager) were encouraged and supported to develop their skills and to undertake additional qualifications.

There was a comprehensive system of quality assurance in place that included residents meetings, staff meetings, questionnaires and a detailed auditing system. Any shortfalls that were identified were actioned.

We saw that the deputy manager and the regional manager were present and visible around the service throughout the inspection.

The last inspection was on 31 May 2013 where no concerns were identified.

There were four young people living at this service on the day of the site visit. We spoke with three people separately. Each person was articulate and able to converse in a meaningful way. Two of the three people we spoke with went out to work.

People said they were fully involved in all aspects of their care. People told us, “We are involved in setting our goals and in the review of our care with the help of the registered manager or our support worker”. People told us their treatment included their total involvement in their care. People said, “We like the support we receive from our support worker, and the registered manager”.

We found that the service sought people’s consent prior to providing them with care and support. We saw systems in place that ensured that when information about people's treatment, care and support needs had been passed to another service, team or individual, this was organised so that the information included everything that the service, team or individual needed to ensure the needs of the person who used the service were met safely, even when the transfer of information was required urgently.

People told us they were happy with the cleanliness of their house in general.” They told us they had help in keeping their bedrooms clean and tidy.

We found that staff had not had all the relevant checks carried out prior to commencement of employment. Also the services complaints policy and procedure was not suitable for the service

There were six young men living at the home on the day of our site visit. Three of whom had gone out on their various activities. Of the three people at the home at the time of the site visit, one person said “I have nothing to say to you”. The information contained in this report under the heading what people told us was gathered mainly from two people who used the service.

People told us the staff were respectful of their privacy and dignity. One person said “I always have my personal care carried out behind locked doors and no one is allowed to enter the room except the staff who are caring for me.” People told us they and their family were involved in their care. They said they made the decisions about their care with help and support of their carer.

One person told us “My faith is very important to me and I am supported to attend Church every Sunday and I take Holy Communion. This is very important.”

People told us they loved their home, they did things they wanted to do and they had to obtain special permission to do some things because the manager wanted them to be safe.

One person told us “I love baking and I hold cake sales for my charity.” People told us “each member of the service suggests a main evening meal and the others vote for the one they prefer.”

People told us they felt safe and well looked after by staff. They described their relationships with staff as very good.

Two of the people who used the service whom we spoke with told us the staff always spoke to them in a calm and respectful manner.

One person told us they were encouraged to give their opinion on how the home was being run. For example, regular residents meetings took place. People said suggestions they had made were acted upon.