87 Bouncers Lane is a care home without nursing care for three people with learning disabilities and autism. People who use the service may have additional needs and present with behaviours which can be perceived as challenging others. There are two communal lounges and a kitchen/ dining room. There was registered manager. 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.

One relative told us they felt the home was a very safe place to be. Staff were trained to identify any abuse and take appropriate action. Safeguarding incidents had been thoroughly investigated and reported in writing to the commissioners and the local authority safeguarding team. The correct action was taken by the registered manager to prevent further incidents between people. We have made a recommendation the registered manager ensured all notifications were also sent to CQC.

Individual risk assessments were completed which minimised risk for people helping to keep them safe and as independent as possible. All accidents and incidents were recorded and had sufficient information to ensure preventative measures were identified.

We observed staff responding to people in a calm and compassionate manner consistently demonstrating respect. Staff knew peoples individual communication skills, abilities and preferences. Staff supported people to choose activities they liked. People had taken part in activities in the community and holidays with staff. People were supported by sufficient staff and they were able to access the community with them.

Staff were aware of the Mental Capacity Act 2005 (MCA) to protect people when they needed support for certain decisions in their best interest. Care plans included people’s mental capacity assessments and identified how choice for each person was displayed by them. Most people made everyday decisions as staff knew how to effectively communicate with them. The service was working within the principles of the MCA and Deprivation of Liberty Safeguards (DoLS) and conditions on DoLS authorisations to deprive a person of their liberty were being met.

A range of social and healthcare professionals supported people. They told us the staffs’ attitude was excellent and they were knowledgeable and communicated well with people and their relatives. Medicines were well managed and given safely. People’s care plans identified how people liked to take their medicines. People were supported by staff that had the skills and knowledge to meet people’s needs. Special diets were provided to maintain and improve people’s health and wellbeing. People had a choice of meals and went shopping every day for fresh produce they could choose.

Quality checks were completed and examples told us that action plans identified where changes were made to address any shortfalls. Relatives and health and social care professionals were asked for their opinion about the service. The registered manager was accessible and supported staff, people and their relatives through effective communication.

We used a number of different methods to help us understand the experiences of people using the service. Some people had complex needs which meant they were not always able to tell us their experiences.

Staff we spoke with understood the need to report safeguarding concerns. Staff had completed all mandatory training relating to safeguarding except conflict management. The manager was addressing this gap. People’s support plans contained relevant information about any physical interventions that may be needed to protect them or others.

The home was clean and bright. Systems had been put in place to ensure cleaning was undertaken. This was supported by regular checks and audits by the registered manager and an external company. We saw evidence that remedial actions were identified and followed up to keep the home clean and hygienic.

There were appropriate protocols to help staff know when and how to administer “as required” medicines. These were kept up-to-date. Medicines were stored safely and the cabinet temperature was monitored to ensure medicines were stored at the recommended temperature. All staff had regular competency checks and training to ensure they followed medicines procedures.

The registered manager now had a system in place to monitor the training needs of staff. Almost all mandatory training had been completed. Staff told us the service was progressing well and they met regularly with their manager to discuss their training needs and performance.

As part of this inspection, we were following up outstanding compliance actions from an inspection in November 2012. The people living in the home were not able to communicate fully with us. As a result, we spoke with two relatives and four staff, reviewed care plans and observed care provision.

One relative said “they are absolutely fantastic. They are not perfect but if we have any issues they are dealt with immediately”. Support plans were person centred and were followed by the staff. Staff were knowledgeable about people using the service and sought to maintain their independence. One relative commented on how each person was catered for as an individual.

The provider could not verify that all staff had received safeguarding training although staff demonstrated that they knew the relevant policies. Restraint guidance was not clear enough in care records to ensure staff only used approved techniques.

Staff understood the procedures around the storage and administration of medication, except the need to monitor medication cabinet temperatures. One medication protocol was missing and others had been updated without date or name.

The provider had good systems in place to monitor quality. Relatives felt well listened to and communicated with. Although record keeping had improved, we found some important inaccuracies in care records that needed correction.

We used a number of different methods to help us understand the experiences of people using the service, because people had complex needs which meant they were not able to tell us their experiences. We spoke with four members of staff and reviewed all three people's care records and care diaries. We also observed care being provided.

Staff were very positive about the support that they received although we found some gaps in training. The people in the home seemed comfortable with staff and we saw some very positive interactions. We saw people being involved in decision making and being encouraged to be active and involved in activities in and out of the home.

Although staff knew people’s needs and preferences well, this was not always reflected by the care plans. One in particular needed updating. The provider was not able to show us evidence of having sought feedback about the service.

The cleanliness of the home was not of a high standard. This was not helped by some outstanding maintenance work.