This inspection was unannounced and took place on 20 June 2017.

23 Mount Pleasant provides accommodation and personal care for up to eight people who have a learning disability. On the day of the inspection five people were living there.

The home had a registered manager who was present on the day 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 were protected from the risk of potential abuse because staff were aware of their responsibility of safeguarding them. Staff’s practices and systems in place protected people from the risk of harm. People were supported by staff to take their prescribed medicines safely. People were cared for by sufficient numbers of staff who were recruited safely.

People were cared for by skilled staff who were supported in their role by the registered manager. People’s human rights were protected because staff had adopted the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards in their work practice. People were supported to eat and drink sufficient amounts to promote their health. People were assisted to access relevant healthcare services when needed.

People were cared for and supported by staff who were caring and attentive to their needs. People were present when their care needs were discussed and reviewed. People’s right to privacy and dignity was respected by staff.

People did not have the capacity to be involved in their care assessment but were present when discussions took place about them. People were provided with opportunities to pursue social activities. Staff were able to recognise when people were unhappy and action would be taken to explore this and resolve any concerns.

People’s families were encouraged to have a say in how the home was run on behalf of people who used the service. The management team were proactive in providing a safe and effective service and staff felt supported by the registered manager to provide a good service. The provider had systems in place to monitor the quality of service provided to people.

This inspection took place on the 9 September and was unannounced. At the previous inspection in June 2014 no issues were identified and the provider was compliant with the regulations.

23 Mount Pleasant is a home for eight people who need long term care and support because of their learning or physical disability. At the time of the inspection seven 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 Mental Capacity Act 2005 (MCA) is designed to protect people who cannot make decisions for themselves or lack the mental capacity to do so. The Deprivation of Liberty Safeguards is part of the MCA. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The provider followed the guidelines of the MCA to ensure that people were not being unlawfully restricted of their liberty and decisions were made in people’s best interests.

People were kept safe as the provider and staff followed the correct procedures when they suspected abuse had taken place. Staff had received training in safeguarding and knew what constituted abuse.

Risks to people health and wellbeing were regularly reviewed and minimised and people’s independence was promoted.

There was enough staff to keep people safe and support people to maintain their independence and access the community. Safe recruitment procedures had been followed.

Medicines were managed safely. All staff had received training in the safe management of medicines. The provider had systems in place to safely store medicines.

People and their representatives were involved in decisions relating to their care, treatment and support.

People were supported to have a healthy diet dependent on their assessed individual needs.

People had access to a range of health professionals and staff supported people to attend health appointments when necessary.

People were treated with kindness and compassion and their privacy was respected.

People had opportunities to be involved in the community and to participate in hobbies and interests of their choice.

Staff were supported to fulfil their role effectively through regular support and supervision and training applicable to their role.

The provider and registered manager had systems in place to continually monitor the quality of the service and implemented action plans to ensure continuous improvement.

We spoke with the seven people using the service, three relatives, six members of staff and the registered manager. We used the information to answer the five questions we always ask;

• Is it safe?

Robust safeguarding procedures were in place. Staff were well-trained, understood their role and how to protect people from potential harm.

There were systems to identify, assess and monitor risks. Risk management strategies were in place to reduce risks. This meant the provider took steps to ensure that people received safe and appropriate care and treatment.

We monitor the operation of the Deprivation of Liberty Safeguards 2009 (DoLS) that apply to care homes. Applications had been approved to ensure that people were protected from self-harm. Two people were each monitored closely throughout the day on a 1:1 basis to ensure their health, safety and wellbeing. Correct policies and procedures were in place and staff knew how to make applications.

• Is it effective?

Where people did not have capacity to make complex decisions about their care, relatives were involved to ensure their best interests were followed. An Independent Mental Capacity Advocate (IMCA) had been appointed concerning a complex decision, together with the person, their relative and other professionals.

People’s needs had been assessed and recorded in their care and support plans. Plans were reviewed regularly. We found that any changes or concerns had been recorded and actioned. This meant staff had the necessary information to meet people’s current needs.

• Is the service caring?

Each person had a communication plan. Staff told us that people used body language, facial expressions, signs, sounds, vocal tones and hand and feet gestures to express themselves. We saw positive engagement between people and staff throughout our inspection

We spoke with three relatives who told us they very satisfied with the service provided at Mount Pleasant. This reflected the responses we had seen in the annual questionnaires completed by relatives. One relative said, “I am absolutely thrilled with the care that X has been given. Staff are well-trained, they know how to manage X and keep me informed of their progress.

• Is the Service responsive?

When people’s health care needs changed, external health professionals had been contacted. Their advice had been sought, recorded and actioned.

Residents meetings had been held. Actions had been taken to improve people's quality of life. Regular staff meetings also identified changes that would improve the service and we saw several examples of this.

Contacts with relatives had been promoted. Some people were taken for home visits by staff to ensure on-going contacts were maintained.

• Is the service well-led?

The service had a quality assurance system, records seen by us showed that identified shortfalls had been addressed promptly. As a result the quality of the service was continuously improving.

Staff we spoke with had detailed knowledge about people’s needs and told us they felt confident in their ability to meet people’s needs. This ensured that people received a good quality service at all times.

Staff told us the manager had consulted with them before implementing changes to the management of the home and their views had been taken into consideration.

The service worked well with other agencies, including health professionals to make sure people received their care in a joined up way.

The home provided a welcoming, comfortable and homely living environment. We spent time watching how care and support was provided and how staff communicated with people. Everyone received the same caring response from care staff and were included in the activities and conversations taking place. One relative told us, “Staff treat and see XX as a person.”

The provider ensured people were familiar with the staff supporting them and that staff were experienced and skilled to look after people. All the staff we spoke with were positive about working at the home. One member of staff told us, “I have been really well supported and this is a great place to work.” We found that adequate background checks had been completed as part of the recruitment of staff.

There were no set routines in the home and people were supported to have the freedom to live their life as they wanted to. People were involved in the planning of the support they received and the risk management plans in place. They were also actively involved in making day to day choices and decisions.

We found that important records about the care and support provided to people were complete and up to date. Every person had an individual plan of care, based on their specific needs. People were supported to eat a balanced and healthy diet.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming.

Some people were unable to tell us about their experiences due to their learning disability, so we spent time observing the support they received from staff. We also spoke with three members of staff, the registered manager and a relative.

We saw people received the care and support that met their individual needs. We saw that people looked relaxed and comfortable in their home and staff interacted with people in a positive and respectful manner.

Care records were written with people using the service and reflected their wishes. Information was provided to people in a format that supported them to understand and people were encouraged to make their own choices.

We found that people using the service, their relatives and staff were able to express their opinions regarding the quality of the service. Audits of the service were completed to enable the registered provider to monitor and improve outcomes for people using the service.