About the service: Care Management Group – 290 Dyke Road is a residential care home providing personal care to five people living with learning and physical disabilities at the time of the inspection. The home is single storey with access to a garden at the rear. There is a shared lounge and conservatory area.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

•At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

•The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence and inclusion. People’s support focussed on opportunities to gain new skills and maintain current independence and work toward more independence.

•Staff knew people, their needs, wishes and abilities well.

•People were treated with kindness and compassion and received personalised care.

•People’s independence was promoted. Staff supported people to use assistive technology to increase their independence. For example, a large touch button in place of a doorbell.

•People’s needs and any risks were assessed and planned for. Staff had a positive approach to risk, and balanced this with ensuring people had opportunities suitable for them.

•People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the systems in the service supported this practice.

•People, their relatives, staff and other professionals were involved in the development of the service.

•Specialist needs that people had, such as health conditions or nutritional needs, were supported. Staff had training to ensure they could meet people’s needs, and their competency to do so was assessed.

•Staff were recruited using safe recruitment practices. When joining the service, they were supported with induction, and this support continued with regular training and supervision.

•Staff worked in partnership with health and social care professionals to ensure people received the right support.

•The quality assurance framework supported the registered manager to continuously learn and improve.

Rating at last inspection: At the last inspection the service was rated Good (22 April 2016).

Why we inspected: This was a planned inspection to confirm that this service remained Good.

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Good.

We inspected Care Management Group - 290 Dyke Road on the 1 March 2016. The service provided accommodation and support to people living in a residential area of Brighton. The service supported five people aged in their 20’s and 30’s. It provided 24 hour support for adults with profound and multiple learning disabilities and complex health needs. Care Management Group services include providing residential care, supported living and day services at locations across the south of England and Wales.

The service had a registered manager. A registered manager is a person who has registered with the 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.

We saw people were supported by staff who knew them well and gave them individual support. People appeared happy and relaxed with staff. Health care professionals spoke positively of the service. One professional told us, “Staff are extremely responsive to residents' needs. Communication is excellent and they have had to deal with some potentially difficult health issues with residents. At the same time they manage to make it feel like a family home and are always looking to open the residents to new experiences.” Relatives commented on the care provided, “I feel very comfortable that he is there and I would hate him ever having to leave as he gets the best care and is loved there.” Staff respected people’s privacy and dignity and their individual preferences.

The service had safeguarding policies and procedures in place. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place. This helped protect people from the likelihood of abuse or neglect. When staff were recruited, their employment history was checked, references obtained and a comprehensive induction was completed.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one. Where people lacked the mental capacity to make specific decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Staff received training to support them with their role on a continuous basis to ensure they could meet people’s needs effectively. One member of staff said, “There is non-stop training, here [provided by the local authority] and refreshers are done when they are due.” The provider was seen as one that offered career opportunities. A member of staff told us, “I have seen people progress and I hope to do likewise.”

People received regular assessments of their needs and any identified risks. People’s weight and nutritional intake were regular monitored by a dietician and we saw that referrals were made to Speech and Language Therapists (SALT) if people’s nutritional intake reduced, or staff had any concerns. People had up to date health action plans which gave an overview of the person's health needs.

People were supported as individuals and encouraged to explore ways they could maintain and extend their independence. People were provided with opportunities to take part in activities ‘in-house’ and to regularly access the local and wider community. A relative said, “They seem to tailor his activities/outings to suit him, he has a classical musical collection. He loves being outside and staff have taken him to classic concerts which he really enjoyed. They also support him to buy and listen to tapes and DVD’s. He loves the Sealife Centr

We spoke with the deputy manager and support workers, relatives and met with people who used the service. We looked at people's care plans, staff files and the service's policies and procedures.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We found that people's needs were assessed and reviewed regularly. Care was planned and delivered in line with individual care plans. One relative told us, " The support [my relative] receives is first class. They are very good at keeping us informed and involved".

We saw there were enough qualified, skilled and experienced staff to meet people’s needs.

People were cared for in a clean, hygienic environment. During our inspection, we viewed people's bedrooms, communal areas, bathrooms and the kitchen. We saw the equipment the service used was clean and well maintained.

There was a complaint policy and procedures in place, the relatives and visitors to 290 Dyke Road and staff who worked there knew the steps to follow should they wish to complain. People told us, “The manager keeps their door open and we can always go in and talk with them if we had a concern or complaint either for the people we support or ourselves."

There were five people living in the home at the time of the visit. Three people were out at day care activities. Two people that we spoke with indicated that they were happy living in the home. We determined this by our observation of their body language and their interaction with the staff supporting them

Each person living in the home had a detailed plan of care in place that included people’s individual needs and wishes and also recorded people's physical and emotional healthcare needs.

The home’s staff worked with a variety of healthcare professionals including the learning disability team and people had the specialist equipment they required.

We spoke with staff and reviewed records which showed us that people were protected from abuse and their care was planned and delivered in a safe manner.

People attended a variety of day care and social activities that were tailored to their individual choice.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

A family member told us. “The home is first class and staff are very dedicated and meticulous in their care.”

There was a regular cycle of quality audits undertaken and recorded in order to ensure that the home was kept under review.

During our visit, we found that people living in the home appeared settled and well cared for. This was reinforced by positive comments received and also evident from direct observation of effective interaction and of individuals being supported in a professional, sensitive and respectful manner.

Despite people’s complex needs, including a total lack of verbal communication, we were informed that independence and individuality is promoted within the Home. In accordance with their wishes and individual support plans, people are encouraged and enabled, as far as practicable, to make choices about their daily lives.

Although we were told that the management changes had had minimal impact on people living in the Home, it was clear that the effect on members of staff had been more significant. One lead support worker, spoken with during our visit, described the last two years as: ‘a rough ride’, which had seen staff morale plummet and their trust and confidence shaken.

However, among the positive aspects to emerge from all this has been a core of dedicated staff who have ‘stuck it out for the sake of the service users’. This has demonstrated their loyalty and commitment to the welfare of people living in the Home and should be acknowledged.

Staff also spoke very positively about the newly appointed manager who they described as ‘strong’, ‘decisive’ and ‘approachable’. They also felt that she had restored confidence to the staff team and had certainly improved morale: ‘People actually look forward to coming into work again and enjoy being here with the guys’.