What life is like for people using this service:

There were enough staff to support people safely. We made a recommendation for the provider to review their contingency plans in place to deal with staff absences. People were supported by safely recruited staff who had the skills and knowledge to provide effective support.

People who used the service were supported safely. People had opportunities to access the community and be involved in interests they enjoyed. People were supported by caring and kind staff who promoted choices in a way that people understood. Information was available to people in an accessible format. People’s dignity was maintained and their right to privacy was respected.

Effective care planning was in place which guided staff to provide support that met people’s diverse needs and in line with their preferences. The design and layout of the service was adapted to meet people’s needs. People received support in their best interests and in the least restrictive way possible.

Systems were in place to monitor the service, which ensured that people’s risks were mitigated and lessons were learnt when things went wrong. People and staff could approach the manager who acted on concerns raised to make improvements to people’s care. The manager understood the responsibilities of their registration with us.

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 31 December 2015)

About the service:

60 Holdcroft Road 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:

The inspection was partly prompted by a notification of an incident following which a person using the service sustained a serious injury. This incident may be subject to a criminal investigation and as a result; this inspection did not examine the circumstances of the incident. The service continued to meet 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 this service on 26 October 2015. This was an unannounced inspection. Our last inspection took place in May 2014 and at that time we found the home was meeting the Regulations we looked at.

The service is registered to provide accommodation and personal care for up to six people with a learning disability and/or mental health needs. At the time of our inspection six people were using the service.

The provider had notified us of the absence of the registered manager, to manage another service owned by the provider. However, another registered manager from another service owned by the provider was redeployed to manage the service until a permanent registered manager was employed. They were 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 and associated Regulations about how the service is run.

People were cared for by staff who knew what safeguarding was, how to identify the different types of abuse and what actions to take if they suspected potential abuse. There was guidance on display for people who used the service and staff on how to raise safeguarding concerns. The provider took appropriate action when abuse was suspected. We observed that people were cared for safely and protected from harm.

People had risk assessments and management plans and these plans were reviewed regularly and updated when people’s needs changed. There were adequate numbers of staff to meet people’s needs. People’s medicines were managed safely.

People told us that staff knew them well and understood their needs. Staff demonstrated a good understanding of people’s care needs and knew how to care for and support them. They had completed training to enable them to provide safe and effective care.

Legal requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) were followed when people were unable to make certain decisions about their care. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.

People were supported to eat and drink suitable amounts of food and drink of their choice. Advice given by professionals was followed in respect of special diets. People were supported to attend health appointments as required.

People were cared for and supported by staff who were kind, friendly and compassionate. Their dignity was respected at all times. Staff ensured that people were comfortable at all times and took appropriate action when people expressed signs of distress.

Care was provided to meet people’s individual needs and preferences. Care plans detailed how people wished to be cared for and supported. People were involved in assessments and planning of their care. The views of their families were obtained about their preferences and likes and dislikes.

Information was provided in easy- to-read formats to enable them raise concerns. Their relatives were given opportunities and supported if they wished to raise concerns or make complaints about the service. The provider had systems in place to deal with and monitor complaints made about the service.

There were systems in place to monitor and assess the quality of the service provided. The interim registered manager understood the requirements of their registration with us and they and the provider kept up to date with changes in health and social care regulation. There was a positive and open atmosphere within the service. Staff and relatives told us that the interim registered manager was approachable and supportive.

The inspection was carried out by a CQC inspector. All but one of the five people we met who lived at the service were unable to answer direct questions about the care they received. We gained information about the service from reviews of care records and discussions with; four relatives, three care workers and the service manager. Below is a summary of what we found.

Is the service safe?

All of the relatives we spoke with told us they trusted service staff and had not had any reason to raise concerns about the care and treatment provided. Staff understood how to recognise and report concerns they had about people’s safety and understood the role of the local authority in investigating adult abuse.

We saw staff received training in adult safeguarding and had the skills and knowledge required to ensure people’s health and safety in areas such as moving and handling.

We looked at systems to ensure people’s health and safety including cleaning schedules and the management of fire risk and evacuation. We saw these issues were carefully monitored and reviewed on a regular basis.

Systems to ensure consent was sought in relation to the care people received were in place. Where important decisions were required but people lacked the capacity to make these decisions for themselves the right people were consulted including family members and health and social care professionals. We saw these decisions were effectively recorded and reviewed in order to ensure the care people received remained appropriate and in their best interests.

The manager understood their legal duty and knew how to refer people who might be at risk of receiving inappropriate care, for independent assessment under a law called the Deprivation of Liberties Safeguards (DoLS).

Records showed the service worked effectively to reduce the likelihood of people experiencing harm in relation to accidents.

We saw the service encouraged comments and complaints and effectively addressed complaints raised.

Is the service effective?

Relatives told us they were happy with the service provided. One told us the service was, “Brilliant” and they, “Have never regretted” the decision to support their relatives move to the care home.

Another relative told us about the improvements in their relative’s health, wellbeing and access to community activities since moving to service.

Assessments of need were written in ways that helped people understand and participate in planning their own care. They included photographs, pictures and language that was straightforward and free from jargon.

Staff told us about people’s assessed needs and plans of care. We saw from records and observations they delivered care effectively in ways described in plans of care.

Plans of care and associated risk assessments were well written and reviewed regularly. Records showed staff worked well with community professionals to ensure people’s health and care needs were met and reviewed regularly.

Relatives we spoke with said they were consulted appropriately by the manager and staff.

Is the service caring?

We observed staff offering people respectful and patient support. One relative told us the staff, “Were absolutely fantastic and go the extra mile” in supporting people. Staff we spoke with had a good knowledge of the needs of the people as described in assessments and care plans. They spoke in a compassionate and caring way about people’s experience of illness or disability.

One relative told us the staff and manager kept them, “Well informed”, contacting them appropriately to update and discuss appropriate care issues.

The service carried out a survey in November 2013 seeking the views of families and friends about the quality of the service. Further opportunities for relatives to meet the manager and staff have included an open day and plans for a barbeque in August. Another relative told us they felt welcome and included by the manager and staff.

Care records we looked at included well written personal histories which conveyed a sense of what was important to the person. We saw these wishes reflected in the way staff interacted with people and the way their care was provided.

Is the service responsive?

Staff told us about work they did to identify and address changes in people’s care needs. We saw the need to organise a specialist assessment in relation to a person’s mobility was clearly described in care records. We noted this work was completed in a timely fashion ensuring the person’s needs were effectively met.

The manager told us about ways the service was checked to ensure people received good quality care. We saw from records each person’s care needs were discussed daily. Identified problems were confirmed in written records. Plans to address these problems were discussed with senior staff and community professionals as promptly as required, in team meetings and in staff supervision sessions.

The way service staff provided care and dealt with problems was assessed by the manager in monthly service reviews. Ideas and action to improve the service were communicated to staff in team meetings and supervision sessions. We also saw that independent health and safety reviews were carried out. We saw from records identified needs for improvement in the way care was provided and the safety of the service were addressed by the manager and staff

Is the service well-led?

The manager told us about the work they had done to improve the morale and effectiveness of the service since coming into post. Staff we spoke with said they were enjoying their work and felt well supported by the manager and deputy.

One relative told us there had been a, “Vast improvement in the care and environment” since the new management team came into post.

The service reviewed and evaluated a range of health and safety systems to ensure the care home was clean, well maintained and safe for people to live and work in. We saw that improvements were carried out following these reviews.

These included recent refurbishments and improvements in cleanliness.

We saw systems to manage complaints, accidents and incidents that could impact on the wellbeing of people were well designed and well managed.

You can see our judgements on the front page of this report.

There were six people living at the home on the day of our inspection. People had difficulty communicating verbally with us due to their complex health needs. We observed the care and support people received, spoke to five members of staff and one relative. The relative told us, “Staff are kind and caring to X. On the whole, a lot of the staff think the world of X”.

We saw that staff understood people’s needs and people received support from staff in a caring, compassionate and professional manner. We saw that people were kept safe from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

We saw that the provider had effective recruitment procedures in place and that the service was well led. On the day of our inspection a new manager had started to work at the home and the provider had provided a period of hand over between the old and the new manager. We saw that the provider had effective systems in place to regularly assess and monitor the quality of the service provided.

There were five people living at the home on the day of our inspection. People had difficulty communicating verbally with us due to their complex health needs but we observed the care and support they received. We spoke with two relatives of people who lived at the home and five staff that supported them. One relative told us, “They care for her very well. I am really happy that she is happy”. Another relative told us,” I am always involved in the decisions and choices made with X. The staff phone me and keep in touch”.

We observed that people were cared for in a sensitive and warm way and the care they received was as described in their care plans. People were treated with respect and the care that was provided maintained their dignity.

The provider had appropriate arrangements in place to manage medicines which meant that people were protected against the associated risks. We observed that there were enough qualified and experienced staff and staffing levels were reviewed to reflect the needs of the people living at the home. Records were kept securely and could be located promptly when needed.

One person told us that they liked living at Holdcroft Road, had considered moving to another home, but decided to stay having established a friendship with another person using the service.

Someone told us that they were sometimes "bored and like to go out more and do other things". This person liked to be occupied and does enjoy some of the activities arranged in the home.

Another person who had come to live at Holdcroft Road a few months previously seemed to have settled well into the home. The person went out to the pub for lunch on the day of our visit and said she liked going out and told us with enthusiasm what she had chosen for lunch and how much she had enjoyed it.

We observed people unable to express a view about the service and found that non-verbal communication with staff was good. Staff supported them with respect and dignity and their responses were very positive.

We found that there were limited opportunities for people to access the community and develope social contacts and skills. There was no evidence of accessing community facilities in the evenings or social contacts within the home in the evenings