About the service:

New Dawn is a residential care home that was providing care and support to 17 people who had learning disabilities, complex communication needs and physical disabilities.

People’s experience of using this service:

The service was safe and people were protected from harm. Staff were knowledgeable about safeguarding adults from abuse and knew what to do if they had any concerns and how to report them. Risks to people who used the service were assessed and their safety was monitored and managed, with minimal restrictions on their freedom. Risk assessments were thorough and personalised.

The service ensured there were sufficient numbers of suitable staff to meet people’s needs and support them to stay safe. Records confirmed that robust recruitment procedures were followed.

Medicines were stored, managed and administered safely. Staff were trained, and their competency checked, in respect of administering and managing medicines.

People who used the service were supported to have sufficient amounts to eat and drink and maintain a balanced diet. People enjoyed their meals and were supported to choose what they wanted from the menus and options available.

Staff demonstrated a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff understood the importance of helping people to make their own choices regarding their care and support. People who used the service were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible

Staff treated people with kindness, respect and compassion. People also received emotional support when needed. People were involved in planning the care and support they received and were supported to make choices and decisions and maintain their independence as much as possible. Information was provided to people in formats they could understand.

Care plans were personalised and described the holistic care and support each person required, together with details of their strengths and aspirations. Information also explained how people could be supported to maintain and enhance their independence and what could help ensure they consistently had a good quality of life. People’s comments and concerns were listened to and taken seriously. The service also used any comments or complaints to help drive improvement within the service.

People who used the service and staff spoke highly of the management team and told us they felt supported. The Care Quality Commission's (CQC) registration requirements were met and complied with and effective quality assurance procedures were in place.

Rating at last inspection:

At our last inspection (report published 4 August 2016) all the key questions were rated Good and the service was rated as Good overall. This rating has not changed and the service remains Good.

Why we inspected:

This was a planned inspection based on the date and the rating of the last inspection.

Follow up:

We will continue to monitor the service through the information that we receive.

This inspection took place on 27 and 28 June 2016 and was unannounced.

Care Management Group - New Dawn provides accommodation and support to a maximum of 20 people with a learning disability or autistic spectrum disorder. It does not provide nursing care. At the time of our inspection there were 20 people living in the home.

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.

Risks to people, including those from the premises, were identified and managed. Incidents and accidents were assessed and discussed so action could be taken to minimise the likelihood of a reoccurrence. There was a firm emphasis on safeguarding people living in the home. Staff understood their responsibilities and how to report any concerns.

Safe recruitment practices were in place. There was mixed feedback regarding staffing levels; however the service ensured shifts were fully covered through the use of agency staff. There were appropriate measures in place to ensure agency staff were supported and understood people’s support needs.

Medicines were managed and stored safely. There was guidance in place so staff knew how to administer medicines and they received regular training and assessments of their competency in the administration of medicines.

Staff were supported to deliver effective care through comprehensive training and good team work. Staff were encouraged to provide care in the least restrictive way. They understood the importance of providing choice and supporting people to make decisions.

People’s individual dietary needs and preferences were catered for. Meals were seen as an opportunity to enhance people’s quality of life. Staff worked closely with health care professionals to ensure people’s nutritional and health care needs were met.

People were supported by staff who cared for them and knew them as individuals. People living in the home had complex communication needs. The service understood the importance of promoting an understanding of non-verbal communication and had utilised different systems to help people communicate.

Staff supported people to maintain important relationships and access the community. Activities were varied and tailored to people’s individual needs and preferences.

The care provided was responsive and timely, it met people’s individual needs and preferences. The service had received no complaints in the last year. Relatives told us they knew how to complain and felt comfortable and able to do so.

Team working was encouraged in the service. Staff felt listened to and able to contribute ideas. There was good leadership and management in the home, staff understood their role and the registered manager took action to address areas for improvement.

Care records did not always contain sufficient information. There were effective quality audits in place which had identified this was an area for improvement. The provider and registered manager were committed to delivering a good quality service and the registered manager took action to drive forward a quality service.

People living in the home had complex needs and were unable to tell us verbally what they thought about their care and how effective the service was at meeting their needs. They were also active in different parts of the home except at lunch time. For this reason, we were not able to use a formal, structured observation session but we did spend time listening and looking at what was going on for people.

We found that staff tried hard to involve people in making choices and decisions and that efforts were made to communicate with them. This included using pictures and 'objects of reference' so that people could be supported to understand what was happening in the home or with their care. A visitor told us how they were involved in reviewing care for someone who could not communicate and that the service was responsive to that person's needs.

People's needs were assessed and kept under review so that the service could respond to any changes. Assessments took into account the risks to which people were exposed and how they were to be managed and minimised. Our observations showed that staff were aware of particular risks, such as those associated with eating, drinking, mobility and behaviour.

People had access to other professionals who could help to keep them well, for example the dietician and doctor. People received the support they needed to eat and drink and risks of poor nutrition were assessed. Staff knew who needed specific diets to help maintain a healthy weight, avoid risks associated with swallowing or to deal with allergies.

We found that the home was generally kept clean so that risks of spreading infection were minimised. Minor improvements, for example to address accumulations of dust and develop a structured schedule, were discussed during our inspection but did not impact upon the health of people at the time of our visit.

There were enough skilled staff employed to meet people's needs, including their needs for support with personal care and accessing the local community or for activities and holidays.

Appropriate records about people's needs and their care were maintained, as were records about the staff employed. These were secured properly and located promptly when we needed to look at them.

People were not able to tell us verbally what they thought. They were also active in different parts of the home or the adjacent day service, except for lunch time. For this reason, we were not able to use a formal, structured observation session but we did spend time listening and looking at what was going on for people.

We found that staff shared their time with everyone who was present, trying to engage them in activities or supporting them with their food and drink. We saw that staff sat alongside people, making eye contact and encouraging them. We heard people laughing and observed them smiling when staff were working with them. We saw one person playing ball with staff, others were engaged with puzzles or craft activities and one person received one to one support for manicuring their finger nails. We concluded from people's behaviour and expressions that no one was ill at ease with staff.

Records showed that people had access to health professionals to help keep them well and to promote their well-being. Staff within the home were knowledgeable about the care and welfare of people they supported and about different ways of trying to communicate. They were aware of the difficulties people had and of the importance of raising any concerns on behalf of people who were not able to make complaints for themselves. The provider took care to ensure that, as far as possible, the staff recruited were suitable to work with vulnerable adults.

People living in the home have complex needs and difficulties with communicating verbally. Because of this, they were not able to tell us what they thought about the home and how they were supported. We needed to use other ways to gather information.