About the service: Care Management Group - Smitham Downs Road provides personal care and support for up to nine adults with learning disabilities or autism. Since our last inspection, everyone who previously lived in the home had moved to another service owned by the provider. At the time of this inspection six people were using the service.

People’s experience of using this service: At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

Smitham Downs Road had undergone complete refurbishment and redecoration since we last inspected. The provider had managed this in such a way to accommodate the needs of new people moving to the service. This included making sure people’s bedrooms were furnished according to their needs and choices before they moved in.

People needs were fully assessed before moving to the home so the provider knew whether they could meet the person's needs. Risks to people’s health and wellbeing were understood and staff had the information they needed to support people and keep them safe. Care plans were personalised to reflect individual needs and preferences. People’s needs were regularly monitored and reviewed and staff responded appropriately to changes in people's needs or circumstances.

People were protected from abuse and discrimination. Staff were trained to recognise signs of potential abuse and how to manage and report any situations in which people may be at risk. The provider followed safe recruitment practice to make sure staff were suitable to work in a care setting.

There were enough staff with the right skills and knowledge to meet people’s needs. Staff training included supporting people who presented behaviours that could result in harming themselves or others. Staff also learnt how to communicate effectively with people in their preferred ways, for example, where people did not use verbal communication.

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

Staff treated people with dignity and respect. People decided how they spent their time and staff respected their choices and independence. Information was made available in accessible formats to help people who needed support with communication. People took part in activities they liked or had an interest in and staff supported people to try new ones.

People received the care and treatment they needed to maintain their health and wellbeing. They had access to appropriate health, social and medical support when it was needed. Medicines were managed safely and people received their medicines as prescribed.

People maintained relationships with those that mattered to them. People and their relatives had opportunities to share their views and the provider listened to their feedback. Relatives knew how to raise concerns and told us they would be confident to do so. Arrangements were in place to monitor, investigate and respond to complaints.

There was an inclusive culture at the service where staff felt listened to and supported. The new manager showed effective leadership and knew what was working well and what needed improving in the home. Staff and relatives told us the manager had made positive changes since joining.

The provider had good oversight of the service and used effective systems to monitor quality and safety, keep checks on standards and develop the service. Where improvements were needed or lessons learnt, action was taken to make the necessary changes.

At the time of the provider’s registration, the care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as

7 Smitham Downs Road provides accommodation and personal support for up to nine adults with learning disabilities and mental health needs.

At the last inspection in October 2015 the service met all regulations but it required improvement in the Well Led domain. At this inspection the service met all regulations.

There has been a change of management. The provider had recently appointed an experienced manager for the service. The person appointed had submitted an application to register with the Care Quality Commission; the application had not been processed at the time this report was drafted. ‘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.’

People felt safe. The service had procedures and risk assessments in place which staff operated to reduce the risk of harm to people. Staff were trained in safeguarding adult’s procedures, they knew how to recognise the signs of abuse and how to report any concerns. Appropriate recruitment checks were carried out on staff to ensure they were suitable to work with people.

There was a strong emphasis on learning, with a comprehensive staff training and development programme in place. Staff had training and were assisted to develop the skills, knowledge and experience to care for people safely. Support networks ensured staff were effectively supported.

The home considered people’s needs and assigned sufficient numbers of skilled staff to support people and meet their needs. Staffing levels were flexibly arranged over twenty four hours to respond to the needs of people.

People’s medicines were managed safely. People who were able to self-administer their medicines were supported to do this safely. Those requiring assistance from staff were administered medicines as prescribed.

Support that staff provided to people was outcome-focused. There was evidence of staff working hard with individuals to develop strategies that helped people gain greater independence. As a result people were encouraged and enabled to learn new skills and become more independent.

Staff actively sought from people their consent to care and support. The manager and staff were aware of their role and responsibilities in providing support to people within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff provided meals to people, which met their personal preferences. People had a choice in meals they wanted to eat and assisted staff in their preparation. Staff knew how to support people with their nutritional needs for the maintenance of their health.

Staff identified and documented people’s personal histories, which helped them to understand their likes and dislikes. Care and support plans were person centred and people were cared for in a way that reflected their personal preferences, and choices. Staff were kind and compassionate; they continually encouraged people to achieve their goals and acknowledged their progress.

People were supported to maintain relationships with friends and relatives that mattered to them. People and their relatives contributed to reviews of their care and support needs. Activities were provided in and outside of the service and people had an opportunity to take part in them if they chose

People knew how to make a complaint and make comments about the service, care, or support they received.

The provider had systems in place that monitored, and reviewed the service to improve the quality of care to people. When any shortfalls were identified improvement plans were developed. Staff implemented any necessary changes in the service to ensure people received effective quality of care. People and staff were positive about the impact of the new man

People using the service told us that they like living there and that the staff treated them well. They knew how to complain and let staff know what they want. One person said he "buys my own clothes" and "I make my own breakfast". He said he had a keyworker. During our visit we observed a handover meeting where the previous shift was discussed including individual resident issues, health management and plans for Christmas. Staff spoke in a respectful way about residents, some of whom joined the meeting at various points. An audit of Person Centred Plans was about to take place and staff were implementing a new system for records which included personal files, health plans and daily notes. We looked at two of these in detail and found them to be well-maintained and up to date. They included, one page profiles, activity plans and relationship maps.

Staff described the process for assessments. care planning and review and the keyworker system. We found that care plans were comprehensive, accessible and up to date and there was evidence of the involvement of the people using the service in decision making.

Staff and people who used the service were aware of the risk of abuse and one resident told us that he "can tell staff if I have been assaulted". There were posters to advise people what to do if they suspected abuse displayed in the service and an up to date safeguarding policy.

The reader should note that ‘CMG’ represents Care Management Group who are the owning company and that ‘PCP’ stands for person centred plan. This is a plan of care that is developed with a person using the service or their representative.

At the time of our inspection there were eight men living at Smitham Downs Road and we met with all of them during the course of our visit.

People talked to us about their day to day lives and their experiences of the home.

People told us that they use the local community on a regular basis and described a variety of work and leisure activities as part of this. Their views can be summarised as follows, “we go to the cinema, some of us play football, we go on day trips and went to the London Aquarium a few weeks ago.”

One person said, “I am very pleased with CMG, the staff here are great.”

People told us that the staff cook “nice food” and they enjoyed the range of meals. They said they could always choose an alternative if they wanted and regularly went shopping to the supermarket. Two people told us they got good support to prepare and cook their own meals as well as learn about managing their money. They told us that staff respected their independence and only helped them where necessary.

We saw that people are provided with a range of personalised and varied activities. People can choose what they want to do regarding how they spend their time and organise their lives.

People told us that they felt safe and could tell staff if they were unhappy about something. One person felt that the recent management change had improved the service significantly. People told us that the deputy manager and staff are approachable and respect their views.

Staff told us that they were supported and were happy working at the home. They said that there was a good atmosphere and they had the training and information they needed to care for people.

Please refer to each outcome below and within the main report for more detailed comments about specific aspects of the service.

We would like to thank all those who took part in this review for their time, assistance and hospitality.

This inspection took place on 30 October and 2 November 2015. The first day of the inspection was unannounced.

7 Smitham Downs Road is owned by Care Management Group, a specialist provider of care homes for adults with learning disabilities and challenging behaviour. This service provides accommodation and personal support for up to nine adults with learning disabilities and/or mental health needs. The property includes a self-contained flat which can accommodate two people.

We last inspected in November in 2013. At that inspection we found the service was meeting all the regulations that we assessed. There were eight people using the service when we visited.

There was a registered manager in post at the time of our inspection. Since the inspection visit and the issue of the draft report the provider informed us that the registered manager had left their employment. 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.

Relatives told us they felt their family members were safe. Staff were trained and knew how to protect people if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing were assessed and staff were competent at minimising and managing risks appropriately in order to help keep people safe from harm or injury.

The staff team had experienced a turnover of staff in the past twelve months but the service had addressed this with an ongoing recruitment programme and by appointing suitably vetted staff in the home.

The service ensured there were enough suitably skilled staff on duty to meet people’s needs. Staff received training appropriate to respond to the people’s support needs. Staff were regularly supported and supervised by a senior member of staff to ensure they delivered appropriate support.

Staff interacted positively, and we observed warm conversations between staff and people at the service. People had their independence promoted with support that was personalised.

People had access to their local community and could choose to participate in a variety of in-house and community based social activities. We also saw staff encouraged and supported people to be as independent as they could and wanted to be. People’s records informed staff of people’s hobbies, interests and described what they enjoyed doing for leisure and recreation.

Records showed people were supported regularly to attend health related appointments. Examples of these included visits to see the GP, hospital appointments and assessments with other organisations such as the mental health team.

People received support that met their needs because staff regularly involved them in reviewing their care plans. Records showed reviews took place on a regular basis or when someone’s needs changed.

The service had quality assurance processes to identify shortfalls and to help drive improvements. The management of the service was not as effective as it should be and required improvements.