What life is like for people using this service:

People who used the service were supported safely whilst staff promoted their independence and inclusion within the community. People were supported by caring and compassionate staff who promoted choices in a way that people understood, this meant people had control and choice over their lives.

People were supported by safely recruited staff who had the skills and knowledge to provide effective support. Effective care planning was in place which guided staff to provide support that met people’s diverse needs and in line with their preferences.

Systems were in place to monitor the service, which ensured that people’s risks were mitigated and lessons were learnt when things went wrong. There was an open culture within the service, people and staff could approach the manager who acted on concerns raised to make improvements to people’s care.

The service met the characteristics of Good in all areas; more information is available in the full report below.

Rating at last inspection:

Good (report published 24 August 2016)

About the service:

150 Community Drive is a is a residential care home that accommodates up to eight people living with learning disabilities or autistic spectrum disorder. At the time of our inspection there were six people living at the home. 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.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found improvements had been made since our last inspection and the service has met the characteristics of Good in all areas. The overall rating is Good.

Follow up:

We will continue to monitor the service through the information we receive.

We inspected 150 Community Drive on 20 June 2016. The inspection was unannounced. The service is registered to provide accommodation and personal care for up to eight people. People who used the service had a learning disability. At the time of our inspection there were seven people who used the service.

The service had 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 and associated Regulations about how the service is run.

We found that some improvements were needed to ensure people were protected from risks associated with medicines management.

People were kept safe because staff understood how to recognise possible signs of abuse and the actions they needed to take if people were at risk of harm.

People’s risks were assessed in a way that kept them safe whilst promoting their independence.

We found that there were enough suitably qualified staff available to meet people’s needs in a timely manner. The registered manager made changes to staffing levels when people’s needs changed.

Staff were trained to carry out their role and the provider had safe recruitment procedures that ensured people were supported by suitable staff.

Staff had a good knowledge of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The MCA and the DoLS set out the requirements that ensure where appropriate decisions are made in people’s best interests where they are unable to do this for themselves.

People’s capacity had been assessed and staff knew how to support people in a way that was in

their best interests. We found that where people were able they consented to their care and treatment.

People were supported with their individual nutritional needs and were able to access other health services with support from staff.

People told us and we saw staff were kind and compassionate. Staff treated people with respect, gave choices and listened to what people wanted.

People’s preferences in care were recorded throughout the care plans and we saw that people were supported to be involved in hobbies and interests that were important to them.

The provider had a complaints procedure that was available to people in a format that they understood.

Staff told us that the registered manager was approachable and led the team well. Staff had clear

values and were enthusiastic about their role and what their support meant for people.

People, relatives and staff were encouraged to provide feedback on the service provided. The registered manager had systems in place to assess and monitor the quality of the service provided.

This inspection was carried out by a CQC inspector. We spoke with five people who used the service, three relatives, three staff members and the registered manager. We also reviewed records relating to the management of the home which included three care records, daily care records, incident reports, staff training records and minutes of staff and residents meetings. We used the information to answer the five questions we always ask:

Is the service safe?

A robust safeguarding procedure was in place. Staff used imaginative ways of involving people in awareness of safeguarding to ensure they were safe.

People gave consent to the care and treatment provided for them. Complex decisions had been made with people who knew them well and able to act in their best interests. A relative told us they had been involved in a complex medical decision. They told us, "Staff are superb, they have supported us through a very difficult time." The provider had acted in accordance with the Mental Capacity Act 2005.

We monitor the operation of the Deprivation of Liberty Safeguards (DoLS) that apply to hospital and care homes. The service had procedures in place and the manager knew how to apply for this authorisation. We found that applications had been made under DoLS procedures for three people who used the service. The service was waiting for replies from the best interests team of the local authority in relation to their applications. No one at the time of our inspection was subject to DoLS.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. We observed that staff had positive engagement with people and understood their support needs. People led active lives with a focus upon community involvement. A relative told us, "Staff encourage X to join in activities. They have the time and there are always enough staff on duty." Another relative told us, "I could not fault them (staff) at all. I would be confident if no-one was around that they would care for X with dignity, care and concern."

Is the service caring?

Staff were able to describe the good practices they used to ensure that people's privacy and dignity were respected. We observed that staff engaged in meaningful conversation with people. Each person received the same caring responses from staff and were always included in conversations.

A relative told us, "My relative has been in hospital. Staff phone daily and encourage us in planning (their) return home. They provide dedicated, thoughtful care."

People using the service, their relatives and friends completed an annual satisfaction survey. They expressed high levels of satisfaction across the service including relationships with staff.

Is the service responsive?

We saw from the reviews of people's care needs that plans of care had been adapted when there had been a change in the persons needs or wishes. People's goals and objectives in their annual review had been reviewed each month throughout the year to ensure they were met.

People had activities and contacts with relatives and friends that were important to them. Staff supported them to maintain those relationships.

If people's health needs changed external health professionals had been contacted. Their advice had been recorded and treatment plans put into place.

We saw that the service had responded to information from people using the service, their representatives and staff. This improved the service.

Is the service well-led?

Regular staff meetings had been held. Staff told us they had been able to raise any concerns they had. We saw that regular supervision and appraisals were part of the support that staff received. They told us that they were listened to and were well-supported by the manager and colleagues.

Staff told us that the registered manager worked alongside them and they could raise areas of concern at any time. There was an after-hours on-call system. Staff said they could speak directly with a manager out of normal office hours.

The service had a quality assurance system and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

We spent time watching how care and support was provided and how staff communicated with people. Everyone received the same caring attention from care staff and were included in the activities and conversations taking place.

Every person had an individual plan of care, based on their learning disability and other health needs. People were involved in making decisions and choices about their care and support. One person told us about their key worker and said, “They sit with me and we talk about how I am.”

There were no set routines in the home and people were supported to have the freedom to make choices about their day to day lives. One person told us, ““I do not know what I want to do today, I might clean my room. I have been out already to get some beers.”

Our observations on how staff supported people showed that care staff were experienced in supporting people who had a learning disability. Bank and agency staff had been used to maintain staffing levels. The same bank and agency staff had been used to ensure people were familiar with the staff supporting them.

We found that important records about the care and support provided to people were usually complete and up to date. The quality of the recording of people’s medicines meant that we could not always check that the balance of medicines held agreed with the recorded balance of medicines. The reasons for giving people medicines that were only required from time to time was not always recorded.

At our last inspection, we found that the quality of recording in respect to people’s medicines and people’s ongoing care needs did not provide adequate information. This made it difficult to check their care needs were being met .We also could not evidence that controlled drugs were always given to people under the management of two staff, as required by the law.

At this inspection, we found that records provided a clear and accurate account of people’s care. The recording of medicines received into the home and given to people was also much clearer. We found that clear instructions had been issued to staff that all controlled drugs should be given to people at all times by two members of staff. The staff we spoke with had a clear understanding of this procedure.

The home did not know we were coming to complete our inspection. We met everyone living at the home and all the staff on duty. We had a number of conversations with three people and three members of staff. We reviewed care records and other documents, and observed how people were supported to make decisions, choices and live their life.

The people living at the home had been together for a number of years. We found everyone was comfortable and relaxed in each other’s company and close friendships had been established.

The atmosphere at the home was relaxed and homely. We observed positive and respectful interactions between people and staff throughout our inspection. People living at the home were supported to be involved in all aspects of their life and, as much as possible, in decisions about their care or treatment. We found that people were supported to maintain their interests and lead a full a life as possible. People’s care plans and daily records showed that everyone was involved in a wide and varied programme of activities. One member of staff told us that, “It is not like coming to work.”

We spoke with two members of staff who had a good understanding of the types of concerns that could constitute abuse and their responsibilities to help protect and keep people at the home safe. They were clear about the steps they would take if they had any concerns and were confident that these concerns would be investigated or reported. Staff also told us that the training and support provided ensured that they were able to look after and meet the needs of people living in the home. The recruitment and selection processes ensured staff were suitable to be working at the home.

As part of our inspection, we looked at the arrangements for the storage, recording and handling of medicines. We found that care plans provided clear and up to date guidance to staff to support the safe administration of people’s medicines.

The general quality of record keeping needs to be improved to ensure that a complete and accurate record of events, discussions and decision making is held. This included the quality of record keeping for medication. We found it was sometimes difficult to check that people’s medication was being administered in accordance with their prescription.