This inspection took place on 4 May 2017 and was unannounced. At our last inspection on 4 July 2015 the service was rated ‘Good’ in all key questions and overall.

Care Management Group Limited (CMG) is a national provider of services for people with learning disabilities, physical disabilities and mental health needs. There is support to the registered manager and staff from a regional management team and a team of trainers. 101, Cheam Road is registered to provide care and accommodation for up to seven people with a learning disability and autism. The aim is to help people to live with more independently in the community. Since the last inspection a new annexe has been specially designed and built in the back garden of the property for people who were more independent than those people living in the main house. There were seven people using the service when we visited.

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 the associated Regulations about how a service is run. The registered manager took a leave of absence and returned to manage this service at the end of March 2017.

We found that the premises were not always maintained adequately to ensure people continued to live in a well- maintained and pleasant environment. Several areas of the home were not in a very good state of redecoration or were in a state of disrepair and needed to be made good to ensure people’s quality of life was not adversely affected by the quality of the environment they lived in. The registered manager told us there was a plan in place to ensure the refurbishment was carried out as required.

Over the course of the last year we found that most of the health and safety audits and risk assessments had been updated, except for the service's manual handling risk assessment. The registered manager told us this risk assessment would be reviewed immediately to ensure compliance with policy and procedures.

People told us they continued to feel safe with the service they received. There were arrangements in place to help safeguard people from the risk of abuse. The provider had appropriate policies and procedures in place that staff were well informed about. People who used the service and their relatives were encouraged to report suspected abuse so appropriate action could be taken.

People had risk assessments and risk management plans to reduce the likelihood of harm. Staff knew how to use the information to keep people safe and work with them positively to help them be as independent as possible.

The provider ensured there were safe recruitment practices to help protect people from the risks of being cared for by staff assessed to be unfit or unsuitable.

Safe medicines management processes were in place and people received their medicines safely.

People continued to be supported by staff who received appropriate training and support. Staff had the skills, experience and a good understanding of how to meet people’s needs. We saw that staff encouraged people to make their own decisions and gave them the encouragement, time and support to do so.

People were supported to eat and drink sufficient amounts to meet their needs. People had access to a range of healthcare professionals to support them with their healthcare needs.

The staff were caring. The atmosphere in the home was calm and friendly. Staff took their time and gave people encouragement whilst supporting them. Throughout the inspection we saw that people had the privacy they needed and were treated with dignity and respect by staff.

People’s needs were assessed before they stayed at the home and support was planned and delivered in response to their needs. People could choose the activities they li

This inspection took place on 8 July 2015 and was unannounced. At our last inspection on 30 April 2014 the service met the regulations we inspected.

Care Management Group Limited (CMG) is a national provider of services for people with learning disabilities, physical disabilities and mental health needs. There is support to the registered manager and staff from a regional management team and a team of trainers. 101, Cheam Road is registered to provide care and accommodation for up to six people with a learning disability. The aim is to help people to live with more independence in the community. There were six people using the service when we visited.

The service had 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.

People and their relatives told us they felt safe with the service they received. There were arrangements in place to help safeguard people from the risk of abuse. The provider had appropriate policies and procedures in place that informed the manager and staff, as well as people who used the service and their relatives about how to report suspected abuse.

People had risk assessments and risk management plans to reduce the likelihood of harm. Staff knew how to use the information to keep people safe and work with them positively to help them be as independent as possible.

The provider ensured there were safe recruitment practices to help protect people from the risks of being cared for by staff assessed to be unfit or unsuitable.

Safe medicines management processes were in place and people were supported to self-medicate where they were able to do so.

People received effective care because staff were appropriately trained and supported to do their jobs.

All but one of the people living in the home had the capacity to make decisions for themselves. Staff had received appropriate training and had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure people are only deprived of their liberty in a safe and correct way.

People were encouraged and supported by staff to become more independent by developing the knowledge and skills to do so. This included eating well and staying healthy. When people needed care and support from healthcare professionals, staff ensured people received this promptly.

People had care plans outlining the goals they wished to achieve whilst living in the home and what support they required from staff to achieve them. People were involved in planning their care and their views were sought and planned for as a central and important part of the process. The service regularly monitored people’s changing needs and involved them in discussions about any changes that needed to be made to their care plans.

We observed many examples of people really being listened to by staff, asked for their views and actively involved in their daily care. We saw minutes of house meetings where people were able to discuss any issues they wanted including to do within the home or outside the home, such as their preferences for holidays this year. We also saw the minutes had been written up by people who lived in the home and when we spoke with them they said they were proud to have done so.

Care workers respected people’s privacy and treated them with respect and dignity.

People were encouraged to maintain relationships with the people that were important to them. Relatives and other visitors were made to feel welcome and told us they were free to visit people in the home without restrictions.

The service was responsive to people’s changing needs and people’s preferences were taken into account so they received personalised care. Each person’s needs were assessed; people, and their relatives, were involved in these assessments. People were encouraged to express what was important to them at their monthly meetings with their designated staff member.

From the care files we inspected we saw each person had an up to date and comprehensive care plan in place. We saw that people had contributed to the process of their care planning. The care plans we saw identified each person’s needs and their short and long term goals. Information was included in people’s records about what people could do for themselves, their strengths, and how staff could support people to achieve the identified goals. Care plans had been recently reviewed involving all the appropriate people.

People and their relatives knew how to complain and regular contact with the staff about any updates or concerns that existed helped everyone to keep informed about what was going on and how things were resolved.

People gave positive feedback about the management of the service. The registered manager and the staff were approachable and fully engaged with providing good quality care for people who used the service. The provider had systems in place to continually monitor the quality of the service and people were asked for their opinions via feedback surveys. Action plans were developed where required to address areas that needed improvements.

When we visited Cheam Road there were six people using the service. We spoke with three of the people using the service, the registered manager and two members of staff. We reviewed three people's care plans and three staff files.

We considered our inspection findings to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Was the service safe?

People who use the services were treated with respect and dignity by the staff. They told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Staff had been trained to understand when an application should be made and the process for submitting an application. This meant that people were safeguarded as required.

Recruitment practice was safe and thorough. The registered manager ensured there was sufficient staff on duty who were appropriately qualified to meet the care needs of people who used the services. This helped to ensure that people’s needs were met.

Was the service effective?

People who use the services health and care needs were assessed with them, and they were involved in their care and support planning. People told us that they had been involved in their care and support plans and that the plans reflected their needs. We inspected three people’s care files. They included essential information about the person, needs and risk assessment information, service delivery plans, a “my plan”, records of health care appointments, a “my health care booklet” as well as records of keyworker meetings.

Staff received regular and appropriate training and supervision to ensure they were able to meet the specific needs of people using the service.

Was the service caring?

People who use the services were supported by kind and attentive staff. We saw that support workers showed patience and professionalism and gave appropriate encouragement when supporting the people who use the services. The three people we talked to said the staff treated them well and respected their privacy. One person said "The staff are nice, they help me where I need it", and another told us "I like my key-worker we’ve just been out shopping together, she helps me do my shopping”.

People who use the services told us they attended regular house meetings where they were able to discuss relevant issues and make decisions about what they wanted to do. We saw from reading the minutes of these meetings that meeting the wishes and prefences of people where appropriate was the main priority. This reflected the caring environment that we found on the day of the inspection.

Was the service responsive?

People who use the services met regularly with their keyworker to review their care and support. This was important as this helped staff understand what people wanted or needed or how they were feeling.

All the people who use the services we spoke with knew how to make a complaint. There was an appropriate complaints procedure in place and although no complaints had been made since the last inspection staff indicated that they would be supportive of anyone who needed to complain. People can therefore be assured that complaints would be investigated and action taken as necessary.

Is the service well-led?

We saw that the service worked well with other agencies and services to make sure that people were supported in a co-ordinated way. It was clear that the main objective was to support people in relation to maintaining and developing their independence.

The manager carried out regular checks to assess and monitor the quality of services provided and took appropriate action to address any issues or concerns raised about service quality.

The views of people who use the services, their representatives and staff were listened to by the manager. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. This helped to ensure that people received a good quality service.

We observed that people were encouraged to be involved in making decisions about their care and treatment. Staff were aware of the importance of obtaining people's permission and agreement before providing care. People we spoke with said ''the staff ask me what I want and let me do things when I want. Sometimes I like to go to bed a bit earlier so I ask them for my medicines and if it’s not too early I can usually have them.''

Peoples received safe and appropriate care and support to meet their needs and enabled them to achieve a degree of independence. A relative we spoke with said ''I'm over the moon with the care they provide. It's so good to have peace of mind and know my daughter is being well cared for.''

Medicines were handled safely securely and appropriately. Staff had access to guidance about medicines and there were controls in place to ensure appropriate use and administration of medicines.

There were sufficient levels of staff with the appropriate skills and competencies to provide safe effective care. There were effective arrangements in place to ensure the provider could respond to unplanned absences such as sickness or emergencies.

We saw that people’s records were well maintained and fit for purpose. Records were retained and stored securely to ensure confidentiality and meet regulatory requirements.

On the day of our inspection we met five people who lived at the home. People told us they liked living at 101 Cheam Road. One person said “this is the best home” and another person told us “staff are nice”.

People we met told us how they were able to make choices about how they live their lives. We were told about regular monthly resident meetings with the staff where people had the opportunity to talk about the things they wanted to do and things they wanted to change. One person told us she wanted her room painted and that staff helped her to choose what colour paint and curtains she wanted.

We were told that the staff that worked at the home were always kind and caring, and listened to what people had to say. During our inspection we saw that staff always treated people with respect and dignity.

During our inspection we saw staff encouraged the people they supported to be independent and to learn new skills. For example, we saw people involved in household activities such as cleaning, laundry and cooking. We were told that people always choose the food they want to eat, regularly go food shopping with staff, and that everyone is expected to take their turn cooking the main meal once a week.

On balance we received a lot of positive feedback from the people who use this service about their experiences of living at 101 Cheam Road. Typical comments people made, included: “I am very happy living here”, “I have lived here for years…it’s really nice”, and “I get on well with all the ladies that live here”.

It was evident from the comments we received from the people we met that service users feel they can influence how their home is run and able to make informed choices about how they live their lives. Typical feedback people made, included: “We have lots of meetings with everyone here to talk about where we want to go on holiday and what we like to eat”, “We tell staff we want to go bowling or to the pictures, and they help us arrange it”, and “I can have a bath when I want and I always buy my own clothes when I am out shopping with staff”.

All the people we who live at 101 Cheam Road told us the staff that worked there always treated them well and respected their privacy. Comments we received from people we met, included: “Staff are all very friendly…we have got the best staff here”, “I have my own key to my bedroom so i can lock it and sometimes I use my front door key as well”, and “Staff always knock on my bedroom door before coming in”. All the people we met who live at 101 Cheam Road were very complimentary about the staff. It was also clear from the way the people who use the service interacted and spoke about the staff team that good working relationships had built up between everyone who lived and worked at 101 Cheam Road.

People who use the service also told us staff help them develop their independent living skills. Typical feedback we received from people we spoke with, included: “The best thing about living here is the staff who help me do lots of things for myself”, “I help the staff cook the meals and do my laundry sometimes”, and “I polish and do the vacuuming, and sometimes I cook for everyone. i had to do this the other day because it was my turn”.

We also received a lot of positive feedback from the people who use the service about the opportunities they had to pursue their social interests and participate in leisure and recreational activities they enjoyed doing. Typical comments, included: “I never get bored here”, “I am an outdoor person so I go out a lot…my favourite thing to do is go bowling, see my friends, go to the pub, and go shopping”, and “I am going to play bingo today after I have been shopping with staff”.

We received a number of positive comments from the people who use the service about their care plans. Typical feedback, included: “I have my own care plan, which I keep in my bedroom” and “Staff help me write my care plan, and sometimes they read it to me as well”.

The feedback we received from people who live at 101 Cheam Road about the quality and choice of the meals there was also very complimentary. Typical comments made, included: “I go food shopping with staff so I can buy the things I like”, “Its sandwiches for lunch today…I like cheese and ham so I will probably choose that”, “The food is very nice here”, and “On Friday I am going to choose my favourite food, which I know is on the menu”.

Everyone we asked about whether or not they felt safe living at 101 Cheam Road told us they did. People we spoke with also told us that if they were unhappy about anything at their home they felt able to talk to staff about their concerns. Typical feedback we received, included: “I feel safe living here” and “I would tell my key worker or the manager if I was unhappy…They listen to me”.

Finally, all the people we met who use the service told us they were happy with the physical layout and internal décor of their home. Typical comments we received, included: “I like the way they have decorated the place…it looks good” and “I chose the colour my bedroom is painted”. All the bedrooms we viewed contained lots of personal affects that seemed to reflect the unique tastes of the individuals who occupied these rooms.