This unannounced inspection took place on 5 and 6 March 2017. Ceely Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ceely Road provides care for up to six adults with learning disabilities in one adapted building. At the time of the inspection six people lived in the service.

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.

Ceely Road has a registered manager in place. 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.

Improvements had been made in the area of infection control since our previous inspection in November 2015. An infection control audit along with other audits such as health and safety were in place to monitor the quality of the service provided.

At the time of the inspection, the number of staff available to support people was not always sufficient. Following our inspection we were told this had been remedied and staffing levels would be increased to meet the demands of the service.

Trained staff administered medicines to people. Most medicine records were up-to-date and accurate. Where records were not accurate these were amended before the end of our inspection.

Staff recruitment was carried out safely; this was to prevent unsuitable people from working with the people at Ceely Road. Staff were trained and received support to ensure they had the skills and knowledge to carry out their roles. They were encouraged to feedback ideas to assist with the improvement of the service, through supervision, meetings and general discussion.

Staff were trained to identify signs of abuse and how to report concerns. Where people required additional support with maintaining their health, professionals such as psychologists and GPs were consulted.

Where people were not able to make decisions for themselves, their mental capacity was assessed and the best interest process was followed. 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.

People and their relatives spoke positively about the caring nature of staff. We observed how staff supported people with their care in a dignified and sensitive way. People’s communication needs were identified and staff had the skills and knowledge to work in an inclusive way with each person.

People’s relatives told us where appropriate they were kept up to date with changes to people’s needs and their day to day lifestyle choices. Relatives told us there was an honest and open culture in the service.

People were supported to remain as independent as possible; involvement in the community was encouraged. Activities were available to people to protect them from the risk of social isolation.

Care plans and risk assessments were in place to ensure staff knew how to support people appropriately and safely.

People, relatives and staff spoke positively about the registered manager and the staff. Staff understood the aim of the service and worked together to accomplish providing good quality and effective care.

This inspection took place on the 30 November and 1 December 2015 and was unannounced. The last inspection of this service took place in 2013. The service was found to be meeting the requirements of the regulations at that time.

Ceely Road provides residential care to six adults with a learning disability. It is a requirement of the registration of Ceely Road that there is a registered manager in place. At the time of the inspection a registered manager was in place but was overseeing the care provided in another service. An acting manager was covering in their absence. The registered manager and the acting manager were both present throughout the two days of the inspection. 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's relatives told us they were sure the service was safe, it was well managed and people were well cared for.

Some areas of the running of the home required some improvements, for example, infection control audits had not been completed. Although systems were in place to ensure the risk of infections were minimised, these were not always checked and documented. We have made a recommendation about how the home manages infection control. Other areas included the number of staff available to ensure people's needs were consistently met. Because staff were required to undertake domestic tasks such as cleaning and cooking, they were not always available to support people. We have made a recommendation about the staffing levels in the home.

Medicines were safely stored and administered. Records were up to date and showed people received their medicines at the time they needed them. Records related to homely remedies which are medicines bought over the counter did not always include documented evidence of agreement with the GP or pharmacist. This was not in line with the provider's policy but was being addressed by the acting manager.

Staff knew about the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Where restraints had been put in place to keep people safe, authorisation had been applied for from the local authority. People's mental capacity had been assessed for some decisions, and where appropriate the opinions of others including family members and professionals had been sought to ensure decisions made were in the person's best interest.

Care plans and risk assessments were in place to ensure people's needs were identified and care was both appropriate and safe. Records showed people were appropriately supported with their food and fluid intake. Where specialist advice had been sought to ensure people could eat and drink safely this had been carried out by staff.

Staff knew how to keep people safe and how to identify and report concerns of abuse. They also understood how to respond to complaints and recognised the people living in the home may not be able to make verbal complaints. Where they felt through the interpretation of people's behaviour or body language they were complaining, they followed the same complaints procedure as for others. Action plans were drawn up to ensure complaints were learnt from and changes were appropriate were made.

People's relatives told us they thought the staff were knowledgeable and skilled to carry out their roles. Staff received induction, training, supervision and appraisals. They were supported by the senior staff who were available and accessible.

Communication with people was a focus within the home. The provider trained staff to equip them with the skills to carry out positive interactions with people. Signage around the home facilitated further communication with people, through the use of sign language, photographs and objects of

We had a tour of the building and found the home was in a good state of repair and adequate maintenance of the building and utilities had taken place.

We met six members of staff and we read documentation relating to staff induction, training and supervision. We noted that staff had been adequately supervised and trained to carry out their role in a way that supported people’s care needs.

We found people using the service were unable to give their opinion of their care at the home. This was due to the complexity of their disabilities. We spoke with five of their relatives. One relative told us in relation to people's care and the people who used the service “They (staff) are absolutely wonderful; they take enormous care over their wellbeing, diet and appearance. They do everything they can for them. I can’t fault them.”

We looked at the diet and nutrition provided to people. We examined the files of two people who used the service in relation to food and diet, and how the provider met their nutritional needs. We observed how the evening meal was managed. Consideration was given to the individual needs of people and staff were informed of these needs. One relative told us “They all eat a healthy diet.” They told us how a person changed their diet, which resulted in improved health. As a result the person’s independence and dignity had also improved.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs. This meant they were not able to tell us their experiences. We observed interactions between staff and people who used the service. We also observed staff interacting with people using sign language. People were able to understand because they responded with a thumbs up sign.

We observed a staff member interacting with a person. They asked them if they wished to have the television turned on so that they could look at their favourite programme. We observed a staff member encouraging and involving a person using the service to participate in preparing the evening meal.

We observed staff provided people with clothes protectors and plate guards to help them manage their meal independently. We observed staff assisting people with personal care in the privacy of their bedroom.