This was a comprehensive inspection which took place on 10 July 2018 and was unannounced.

At the last inspection of 10 December 2015, we rated the service good in all key questions and overall. At this inspection, we found the service remains good.

The service provides care and support to people living in a 'supported living' setting, so that they can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. The service is for four adults with profound and multiple learning disabilities, communication difficulties and complex healthcare needs. They live together in a bungalow and receive support from staff 24 hours a day. The service is provided by Care Management Group Limited, a national provider of care services. At the time of our inspection, four people were using the service.

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.

The people using the service could not tell us about their experiences but all of their representatives told us that people were happy. They said that they were relaxed, comfortable and well cared for. People had good relationships with kind and caring staff. People were given support to stay healthy and the staff worked closely with external healthcare professionals to make sure people accessed the right care and treatment. People's nutritional needs were met.

The staff found ways to empower people. They got to know them well and understood how people expressed their choices. They always offered them choices and involved them in the daily activities of the service, such as shopping and cooking; as well as supporting them to take part in a wide range of leisure activities.

The staff were happy working at the service. They felt supported and praised the registered manager and the way the service was run. They told us they had a range of training which enabled them to carry out their roles and helped them to understand about people's needs. The staff spoke about the ''family'' atmosphere at the service; and consistently demonstrated their dedication and care for the people there, both through how they spoke about people and how they interacted with them.

People were safely cared for. They had the right equipment to meet their needs. Risks to their safety had been assessed and planned for. Where restrictions were in place, the provider had assessed the least restrictive practices and had made decisions in people's best interests along with their representatives. There were procedures for making complaints, reporting abuse and dealing with accidents and incidents. The staff and people's representatives were aware of these and felt confident that action would be taken to put things right if something went wrong.

There were effective systems to monitor the quality of the service and to make improvements. The provider and staff at the service carried out regular audits. These included action plans where improvements were needed. There were enough staff to care for people safely, although there were a number of staff vacancies which the provider was trying to recruit to. The recruitment procedures ensured that only suitable staff were employed. They were given an induction into the service and opportunities to get to know the people who they were caring for. The registered manager and staff worked with other agencies and managers within their organisation to develop best practice for people with profound and multiple learning disabilities.

Chandon is a supported living service for up to four adults with who require nursing or personal care. It is situated in a residential area of Ashted, Surrey. At the time of inspection, there were four people living at the home. Extensive alterations had been made to the home to assist with peoples mobility support needs. People who live here had a high level of communication and mobility support needs.

There was not 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. The new manager had started in October 2015, and had begun the application process to become the registered manager for the home.

The home was well decorated and adapted to meet people’s needs. Flooring was smooth and uncluttered to aid with people’s mobility needs. Mobility equipment such as ceiling hoists were in place, as were wide doorways to make it easy for people who used wheelchairs to get through. Even with all the adaptations the home still retained a homely feel and reflected the interests and lives of the people who lived there.

The inspection took place on 10 December 2015 and was unannounced. At our previous inspection in March 2013 we had identified no concerns at the home.

There was positive feedback about the home and caring nature of staff from people and relatives. One person gave a wide smile when we asked if they liked living here. A relative said, “It’s the caring, they really do care for people in everything they do.” An advocate said, “The continuity of care is good here, they know my friend and their needs.”

People were safe at Chandon. There were sufficient staff deployed to meet the needs and preferences of the people that lived there; Although on the morning of our visit there was a short period of time when there were less staff on site than there should have been, due to staff sickness. A relative said, “There are always at least two staff whenever we visit, and we have never had any issues with our family members needs not being met.”

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks, without restricting people’s freedom. A relative said, “They go out of their way to make life as pleasant as possible.” An advocate said, “I think they manage risk well here, they do have health and safety in mind, but they put what they enjoy doing at the top.” Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency.

The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received a comprehensive induction and ongoing training, tailored to the needs of the people they supported.

People received their medicines when they needed them. Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Staff were heard to ask people for their permission before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and received support from staff where a need had been identified. An advocate said, “They do home cooking here, and my friend looks well on it.” Specialist diets to meet medical or religious or cultural needs were provided where necessary.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. When people’s health deteriorated staff responded quickly to help people and made sure they received appropriate treatment. People’s health was seen to improve due to the care and support staff gave.

The staff were kind and caring and treated people with dignity and respect. A relative said, “They are very friendly and caring; very welcoming when we visit.” Good interactions were seen throughout the day of our inspection, such as staff holding people’s hands and sitting and talking with them, even though the people may not have been able to talk back. People looked relaxed and happy with the staff. People could have visitors from family and friends whenever they wanted.

Care plans were based around the individual preferences of people as well as their medical needs. They gave a good level of detail for staff to reference if they needed to know what support was required. People received the care and support as detailed in their care plans. Details such as favourite foods, or choice of toiletries recorded in the care plans matched with what we saw on the day of our inspection.

People had access to activities that met their needs. An advocate said, “My friend has a range of activities and has been on holiday abroad twice this year. They actively look for things they enjoy to do.” A large proportion of the activities were based in the community giving people access to friends and meeting new people. The staff knew the people they cared for as individuals.

People knew how to make a complaint. The policy was in an easy to read format to help people and relatives know how to make a complaint if they wished. No complaints had been received since our last inspection. Staff knew how to respond to a complaint should one be received.

Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. Records for checks on health and safety, infection control, and internal medicines audits were all up to date. Accident and incident records were kept, and were analysed and used to improve the care provided to people. The senior management from the provider regularly visited the home to give people and staff an opportunity to talk to them, and to ensure a good standard of care was being provided to people.

People had the opportunity to be involved in how the home was managed. Surveys were completed and the feedback was reviewed, and used to improve the service. A relative said, “I really can’t speak more highly of them; I can’t think of anything they could do better.”

We were not able to speak with people however we spoke to one relative and one advocate of people who used the service. They told us that before any care was given the service contacted them to gain consent.

We found that the care that was provided to people was in line with their individual needs. One relative we spoke with told us that they were “Very happy” with the care that their family member had received. One member of staff we spoke with told us “Every person has their own ways and we understand them.”

We found that the service was clean and tidy. We saw that staff wore gloves where necessary. Staff had an understanding of the infection controls and the need for them. The relative and the advocate that we spoke with told us that the service always looked clean.

The service handled medicines in a safe, secure and appropriate way. The staff we spoke with told us that they would always explain to people what they were giving them before any medicine was administered.

The manager told us that each person, relative and advocate was given a copy of the services complaints procedures. We found that the service had an effective system that recorded complaints and actioned any changes to the service if needed.

We were not able to speak to people using the service because they had complex needs which meant they were not able to tell us their experiences.

We spoke to two relatives and one advocate of the people who were using the service who told us that they liked living in the home. One said that the staff there had a “Wonderful understanding of their relatives needs.” Another told us that the staff are “Very good.”

One relative said that they were “Blown away” with their relative’s room and how this had been personalised to suit their relatives taste.