About the service: Care Services (UK) Limited - 20 Talbot Street is a residential care home providing personal and nursing care to five people with a learning disability at the time of the inspection.

Registering the Right Support has values which include choice, promotion of independence and inclusion. This is to ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen. The home was meeting the principles of this policy.

People’s experience of using this service:

People did not always have clear risk assessments and documented plans to manage the risks.

People received care from staff who were well trained and supported to meet their needs and provide safe and effective care.

People received support from staff that were kind and compassionate and understood their preferences. People could make choices and were supported with communication. People were encouraged to be independent and their privacy and dignity was respected.

People had support to do things they enjoyed and could access the community. People were involved in their care and support and their preferences were understood by staff. There was a complaints policy in place and people were listened to and responded to.

Systems to monitor the quality of care were effective and picked up on any areas for improvement with plans put in to place to ensure action was taken.

The registered manager and staff created a positive culture and there were systems in place to review and learn from incidents.

The service met the characteristics of Good in most areas;

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

Rating at last inspection: At the last inspection the service was rated Good (report published 7 September 2016).

Why we inspected: This was a scheduled inspection based on the previous rating.

This inspection visit took place on the 9 August 2016 and was unannounced. At the last inspection on 4 May 2014, the provider was meeting the regulations that we checked.

20 Talbot Street is registered to provide accommodation and or personal care for up to five people with a learning disability or autistic spectrum disorder. There were five people living at the service at the time of our visit.

There was a registered manager at the service. 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.

The manager had systems in place to monitor the safety and quality of the service but improvements were needed to ensure people’s medicines were recorded in accordance with good practice and to ensure accidents and incidents were effectively monitored to prevent reoccurrence.

Staff gained people’s consent before providing care and support and understood their responsibilities to support people to make their own decisions. Where people were restricted of their liberty in their best interests, for example to keep them safe, the manager acted in accordance with the legal requirements.

Staff understood their responsibilities to keep people safe from the risk of abuse. There were systems and processes in place to protect people from the risk of harm. Staff received the training and support they needed to meet people’s needs and an induction programme was in place to prepare staff for their role. There were enough staff to meet people’s needs and checks were made to confirm staff were suitable to work in a care environment. People were supported to take their medicines when they needed them.

People were supported with their dietary needs and had a choice of food and drinks that met their preferences. Staff monitored people’s health to ensure they had access to other health professionals when needed.

Staff had caring relationships with people, supported their privacy and dignity and encouraged them to maximise their independence. Staff knew people well and encouraged them to have choice over how they spent their day. People had opportunities to engage in activities that met their individual needs and were supported to follow their interests both at home and in the local community. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes. People’s care was reviewed to ensure it remained relevant and relatives were invited to be involved.

There was an open and inclusive atmosphere at the home. People and their relatives knew how to raise any complaints and their views were sought on how the service could be improved. Staff felt supported by the management team and were encouraged to give their views on the service to improve people’s experience of care.

As part of our inspection we spoke with five people who used the service, two relatives, the manager and staff working at the service. We also looked at care plans and other records. A summary of what we found is set out below.

Is the care safe?

We spoke with the relatives of two people who used the service. One told us their relative seemed to have improved every time they visited. They said the person “Seemed calmer when they saw them and they were happy to return to the home after a trip”.

We spoke with a Personal Advisor who had come to see someone on the day of our visit. They told us they worked for the local authority and their role was to support someone who had recently moved from another service to this one. They said the person had made more progress than they had expected and seemed to have really settled in to their new environment.

Records showed there were care plans in place including healthcare plans designed to meet individual needs and ensure people’s welfare and safety.

We found there were good systems in place for ensuring people were provided with access to specialist health services and advice. Some people’s care was reviewed every three months by a specialist who visited one person at home to assess them. This meant staff accessed the advice of specialist healthcare professionals and used this to provide improved support for people.

There were good policies and systems in place to support people with their medicines. These protected people against the risks associated with the unsafe management of medicines.

The manager told us some people were not always able to fully understand and make decisions relating to their care. We found examples of reference to decisions made in someone’s best interest recorded in care plans. The service had obtained the advice of a specialist about protecting someone who used social networking and was vulnerable to abuse. The advice the service had received had been incorporated into the person’s care plan. This meant arrangements were in place to meet the requirements of the Mental Capacity Act 2005 (MCA). This is a law that provides a system of assessment and decision making to protect people who do not have capacity to make decisions for themselves. No one using the service was subject to an authorised deprivation of liberty. People's rights were protected and there were arrangements in place to make decisions a person's best interests.

There were personal evacuation plans in place for use in the event of an emergency which were designed to keep people safe.

Is the service effective?

The manager reviewed people’s care plans and agreed any changes to these including risk assessments.

Each person had their own key worker who met with them regularly to review their care plan. We saw peoples’ care plans had been updated to reflect changes in the person’s needs. This included developing new risk assessments if the person was carrying out a new activity or changes to existing ones if the nature of the risk had changed. The service worked in co-operation with specialist healthcare teams to obtain advice and ensured this advice was incorporated into the care provided.

We saw there were guidelines in place for ordering, receipt, recording, storage, handling and disposal of medicines. We reviewed these and found medicines were managed in accordance with the guidelines. This meant the service protected people against the risks associated with the unsafe management of medicines.

Is the service caring?

We observed care staff provided support and saw they had a good rapport with the people they cared for. The staff we spoke with understood people’s needs and treated them as individuals.

A relative we spoke with told us it had been difficult to find a service they felt could provide appropriate care. They said they had been concerned about finding a suitable service because their relative’s previous experiences had made them feel insecure. They told us the manager had visited the person and reassured them they could provide appropriate care. They told us they were happy with the service. They said “Care staff have persevered and there are signs of improvement”.

Is the service responsive?

Each person who used the service was supported by a key worker. The key worker discussed the person’s needs and the care provided every month and adjusted the person’s care plan.

Relatives told us they were involved in care reviews and care staff asked for their views on how care should be provided.

People who used the service discussed their food choices with care staff every week and we saw the menus reflected peoples’ choices.

We saw people’s bedrooms were personalised to reflect their hobbies and interests. We also saw people were provided with prompts for personal care and other tasks.

Is the service well led?

Staff told us the manager provided them with good feedback and made their expectations clear about the quality of care required. Someone external to the service visited every month to carry out a quality assurance review of the service. We saw records of these visits and the quality checks they had completed.

We also saw the manager checked people’s care plans regularly and approved any change’s the key workers had made following discussion with the person they supported. The records of care staff meetings showed the individual needs of people who used the service were discussed. Care staff told us their manager discussed ways of improving the service at supervision meetings. They also told us the manager involved staff in planning the care to be provided when someone new was moving to the home. They said this helped them to know how to provide appropriate care.

We saw people had been asked to provide feedback on the care provided. A questionnaire had been designed using pictures to help people to respond to the questions.

We inspected 20 Talbot Street as part of our scheduled inspections to check on the care and welfare of people who used this service. The visit was unannounced, this meant that the registered provider and the staff did not know we were coming.

During our visit we met all four people who lived at the home. Because of their complex needs most people were unable to share their experiences with us. We therefore used a number of different methods to help us understand their experiences. This included speaking with staff, people's relatives (who were visiting the home), observing care and reviewing relevant information made available to us.

We received positive comments about the home from the relatives of people who used the service. These included: “We are very happy with the service. Our relative is doing more for themselves and going out more into the community. They seem to be enjoying life. They are more settled here than we have seen for quite a while”.

Staff understood people's care and treatment needs and helped to support their independence. Staff also supported people in making 'every day' decisions about their care.

The home was well maintained, decorated and furnished. It was suitable in design and layout and met the needs of people who used the service.

Staff received sufficient training opportunities to enable them to work with and support people with their individual needs.

Systems were in place to monitor the quality and safety of the service.

We found evidence that the people who use this service are well supported in a person centred approach and that every effort is made to ensure participation is encouraged into life choices. People using the service told us that they enjoyed living at the home and that they were supported to maintain their independence. We saw evidence that people using the service have autonomy over their activity choices have also been supported on holidays. The staff at the service are sufficiently trained and experienced to ensure that the needs of the people who use the service are met.

The provider does not have a robust system in place for monitoring quality and service provision. The people using the service were not routinely asked for their feedback about the quality of the service. This means risk is not identified properly and the service do not get the right level of support that they need.

We reviewed this service to check that people were being cared for safely.

People were being supported to receive health care both from the local GP and from specialists. We saw that people's personal care needs were being met. People were dressed appropriately in clothes they had chosen.

People were not able to tell us much about living at the service. One person told us that they worked in a shop and another said they were happy. We saw that people were well supported by the staff and that they communicated well with them. We saw that there was a good use of symbols and pictures to help people to understand things.

People's views about the service were sought through weekly meetings. They were asked about the things they wanted to do and what they wanted to eat. People were involved in a range of tasks around the home. These included helping to keep their room clean and tidy, doing the shopping and planning meals.

People took part in activities they liked doing. For example one person did some voluntary work and had attended an art class. Another person enjoyed playing football and we saw them and a staff member having a kick around in the garden. Everyone had the opportunity to go on holiday and out for day trips.