Catherine House is registered to provide care and support to up to 5 people. The home specialises in the care of people with learning disabilities, autism and physical disabilities. The service is located in a traditional family style home on a residential road in Taunton. At the time of the inspection there were three people living at the home permanently and one person living there on a part-time basis.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

Following our last inspection in March 2017 we rated the service as Requires Improvement.

We asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good.

We found the provider had taken action and improvements had been made to all issues raised in the report. People’s independence was being promoted more effectively within the home and their local community. Specifically people were now able to access the kitchen freely.

There was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns.

At this inspection we found the service was Good.

People received care and support that was safe and personalised to their specific needs and wishes. People took part in a variety of activities according to their interests and abilities.

There was a warm and friendly relationship between people and staff who lived and worked at the home. Staff encouraged people to make choices and understood how to support people to make decisions for themselves

The provider had systems and processes in place to keep people safe and minimise the risk of abuse. People were supported by sufficient numbers of staff to meet their needs in a relaxed manner. Staff levels were flexible according to the people living in the home and the activities and social outings taking place.

People received effective care and support from staff who had the skills and knowledge to meet their needs. Staff were offered opportunities to review and up-date good practice in line with current guide-lines.

People had access to health care professionals to make sure their health care needs were assessed and met.

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

People's privacy was respected and everyone had access to their private rooms if they wished to spend time alone.

People lived in a home which was well managed by a competent registered manager and staff team that had a commitment to continuous improvement. Staff felt well supported and their morale was good which created a happy place for people to live.

Further information is in the detailed findings below

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Catherine House is a small home for five adults with a learning disability. The home is situated near a main road close to Taunton town centre. At the time of the inspection there were three people living there on a permanent basis and one person receiving a regular respite service.

The provider is also the registered manager of the service. There was a manager who had the responsibility of the day to day running of the service, and who was available on the day of the inspection. The registered manager joined the inspection at a later stage in the day.

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.

At the last inspection in November 2014, the service was rated Good. At this inspection people and relatives told us they felt safe however we found areas that required improvement. For example, although medicines were safely administered and stored by staff who had received specific training and supervision to carry out the tasks, we found when medication errors occurred the outcomes of investigations had not always been recorded. The registered manager reviewed their policy following the inspection.

Care plans contained risk assessments. However some risk assessments did not identify ways of supporting people to remain as independent as possible within the home and their local community.

People who lived at the home were able to make decisions about what care or treatment they received. However we found they had not been fully consulted about restrictions relating to access to areas of their home, staff were able to demonstrate knowledge and understanding about their responsibilities to follow the principles of the Mental Capacity Act (MCA) when making decisions for people in their best interests.

We recommend the least restrictive option is reviewed and discussions held with individual people regarding the management of the risks in regards the least restrictive practice.

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. Care plans were personalised to each individual and contained information to assist staff to provide care in a manner that respected their needs and individual wishes. People living at Catherine House told us they were happy with the care and support provided.

People were supported by staff who had undergone an induction programme which gave them the basic skills to care for people safely. In addition to completing induction training new staff had opportunities to shadow more experienced staff. This enabled them to get to know people and how they liked to be cared for. People told us they felt safe at the home and with the staff who supported them.

People accessed various activities in the local community. People were supported to maintain contact with the important people in their lives. A relative told us, “The staff all seem nice and have a chat when we visit”. People confirmed they received visits from family and friends.

The service had a complaints policy and procedure which was available for people and visitors to view. People said they were aware of the procedure and knew who they could talk with. People and staff said they felt confident they could raise concerns with the registered manager and they would be dealt with appropriately.

This inspection took place on 12 November 2014 and was unannounced.

The service provides accommodation and personal care for up to five people with a learning disability or autistic spectrum disorder. At the time of the inspection there were four people living in the home with mild to moderate learning disabilities. One person stayed there on a regular respite care basis.

People were able to carry out most of their own personal care routines but sometimes needed prompting or assistance from staff. They could all communicate verbally although some people had more limited language skills than others. Staff supported people when they went out to most events and activities. Staff sometimes dropped people off and collected them later when people wanted to go out with family or friends.

During the inspection we met the registered provider and the manager of the home. Registered providers are ‘registered persons’ who have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered provider was in day to day charge of the home and therefore was not required to have a registered manager as a condition of their registration.

People had choice and control over their daily routines. One person said “I have a shower every day. I get up at seven and go to bed at 10. That’s my decision”. Care plans contained records of people’s preferences including their personal likes and dislikes. This helped staff to provide care and support in a way that suited each person’s individual preferences.

Staff respected and acted on the decisions people made. We heard staff consulting people about their daily routines and activities and no one was made to do anything they did not want to. Staff adapted the way they communicated with people according to each person's needs. Where people lacked the mental capacity to make certain decisions about their care and welfare the provider knew how to protect people’s rights.

People were supported to be as independent as they were able to be. They helped staff with daily living tasks such as meal preparation and washing up. People were supported to visit relatives, access the community and participate in social or leisure activities on a regular basis.

During our inspection we heard a lot of friendly banter between people and staff. One person said “I get on well with all the staff. They are really nice”. The provider employed a small team of staff to support the people living in the home. This ensured consistency and meant staff and people got to know each other well. One person told us “I’ve never had any problems or needed to make a complaint”.

People felt safe and staff knew how to protect them from abuse. One person said “No one ever treats me badly”. Care plans included individual risk assessments to minimise the risk of avoidable harm.

People had contact with their relatives on a weekly basis which helped maintain family relationships. Relatives were encouraged to visit the home as often as they wished and did not have to make prior appointments.

Staff received appropriate training and were assessed by senior staff to ensure they supported and cared for people properly. Staff said they all worked together as a supportive team and a senior person was always available if they needed additional advice. Staff told us the management were very approachable and supportive.

The provider had established close links with local colleges of further education, private and local authority run resource and day centres and Mencap. These links provided opportunities for people to integrate better within the local community.

We found that people living at the home knew the staff well and were confident in speaking with them about any issues which affected their lives. Interaction and communication between staff and people at the home was warm, friendly and relaxed.

We met and spoke with all the people living at the home, also with five members of staff. Everyone said they liked living at the home and one person said ‘it’s brilliant here’. We were accompanied by two service users to look at their rooms, which were individual and had been personalised with all sorts of personal possessions which indicated their interests and preferences.

The house was well maintained, tidy and cosy. We were told by one person that they were going to a Halloween party the following night and by another that they were going out to buy a fancy dress costume for the party.

We saw that people were encouraged to live as independently as possible with support from staff, and were given lots of examples of people’s involvement within the home and in local community activities. One person had been encouraged and supported to pursue an interest in getting a job. This had resulted in a part time opportunity for a trial period, which had increased the person‘s confidence in their own ability.

People living at the home told us that their care, support and treatment had been discussed and agreed with them. Procedures were in place which gained consent for the support and care needed. Everyone said that they were happy about the support they received and that they had agreed to what was provided.

Staff were knowledgeable in their understanding of medication and in the processes followed in the event of refusal, which acknowledged potential risks of refusal, at the same time respecting human rights. The staff worked well as a team and all told us they enjoyed their work and were provided with ‘lots of training opportunities’.

No formal complaints were received during the year. Any informal concerns or niggles were resolved as quickly as possible. People told us they would have no hesitation in raising any concern in the confidence that the matter would be listened to and addressed. One person said, ‘I would just tell them what was wrong, and I do’.

We found that the home had been through a disruptive period following the Registered Managers resignation. There was an interim manager in post, initially contracted to conduct a needs assessment for the home. The interim manager and provider worked closely, to ensure continuity and consistency of care for people living at the home.

We spoke with the provider who lived locally and was active within the home. They told us their priority was to provide a homely community environment which recognised and understood the needs of people within their care which, encouraged independence and integration within the community.

People living in the home told us they enjoyed living there and felt very safe. People said that they were encouraged and supported to live as independently as possible. One person told us that they felt encouraged and supported to get out and about and do the things she liked to do, including things that they had not initially felt very confident about doing.

Throughout our visit we observed that staff and people living in the home interacted in a cheerful, friendly and respectful way. One person told us the staff were very good at explaining things to them.

We observed that people felt comfortable to approach staff, who responded promptly and in a friendly manner.

People said there were always enough staff on duty that understood their needs and were able to support them and their activities. Some people told us they had been involved in staff recruitment, and that their opinion was listened to and taken into account. People told us there were at least two staff on duty each day and at least one person sleeping in at night. People told us there were more staff on duty at different times of the day and evening depending on the level and number of activities going on. For example, we were told there were often more staff on duty in the evenings to support different outings. Some people attended college, others went to pubs, and discos. Others went out shopping or for walks. One person had been supported to see their favourite band play live.

People living in the home told us they were very happy living there and felt safe. Some said the staff team are “wonderful” and they “trusted” them. People told us they are treated respectfully and are involved in decisions about their lives. The home holds house meetings where people have the opportunity to contribute to the running of the home and express their views about the home. People told us they have key workers who spend regular one to one time with them going through their care plans, risks and activities. People are provided with copies of care plans and agreements. Some people’s support plans are provided in a pictorial format to help them understand it and remember it. People told us that staff members take their time explaining their care to them and they are able to consent to it if they wish. Some people said if they are not happy with any support or care they can express their views and staff will listen. One person told us they are happy to give their consent as long as they fully understand the reason for it. This person said the staff members are very good at explaining things to them.

People said they felt there was always enough staff on duty that understood their needs and were able to support them and their activities. Some people said they had the opportunity to meet new staff during the interview process; others were part of the interview panel. Some people said they felt their opinion was listened to. People told us there was at least two staff on duty each day and at least one person sleeping in at night. People told us that more staff members are on duty at different times of the day and evening depending on the activities going on. For example there is often more staff on duty some evenings because of outings people attend. Some people said the staff team support them to attend activities. Some people attended college, others talked about going to arts and crafts classes, pub outings, shopping and discos. One person was looking forward to going to see music band in June.

People said they liked the food provided in the home. They said they had the opportunity to plan, prepare and cook meals if they wished. People told us they are able to suggest menu choices but were always offered an alternative if they did not want what was on offer.

The majority of people living in the home do not manage their own medication. One person who did had lockable storage in their bedroom. They explained how staff members support them to manage their medication independently. They understood about keeping the medication locked and showed us how staff members regularly check the records and stock are correct.

People showed us their bedrooms which were homely, bright and clean. Some people told us they chose the decorations and furnishings to suit their tastes and preferences. Some told us that they are in the process of choosing decorations that they would prefer.

People told us they are able to gain access to most parts of the house unsupervised. The kitchen and front door has a coded key pad, some people are given the code. Those who don’t have the code can access the kitchen and front door with staff supervision. People’s records show that risk assessments have been completed and people told us they understood and agreed to access with supervision. People’s bedrooms are fitted with locks that are suitable to their needs.

During a visit to the home we looked around the home. All areas were clean, fresh and bright. Decoration and furnishings were of a good standard and created a homely atmosphere. People told us they felt the home met their needs in its layout and design.