This inspection took place on 15 and 17 November 2017 and was unannounced. At our previous inspection in October 2015 the service received an overall rating of ‘Good’.

Coombe Road provides personal care for up to eight adults with a learning disability. There were seven people living in the service at the time of our inspection. Coombe 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. Coombe Road accommodates up to eight people in one three story building. The ground floor and garden are accessible to people using a wheelchair.

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.

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 2008 and associated Regulations about how the service is run.

People were protected from abuse and neglect by a staff team that had been trained to identify and report abuse. People were provided with information to report any concerns they may have about their own safety. Staff assessed risks to people and implemented plans to mitigate them. The homes environment and equipment were safe and staff followed appropriate hygiene practices to protect people from infection. Robust recruitment practices were followed to ensure that staff were suitable to deliver care and there were enough staff available to keep people safe. Staff administered medicines in line with the prescriber’s and people were protected by the preparedness of staff to respond to an emergency.

People’s needs were assessed prior to their admission to the service and then reassessed periodically or when their needs changed. Staff were supervised and trained and their performances were appraised. People’s nutritional needs were met and they were supported to access the services of healthcare professionals whenever they were required. People were treated in accordance with the Mental Capacity Act 2005 and were supported with appropriate referrals when restrictions were required to keep them safe.

Staff were described as caring by people and they provided people with emotional support. People were encouraged to be as independent as possible and to develop their everyday living skills. Information was available in an accessible format for people. Staff respected people’s dignity and privacy and supported people around their culture and spirituality.

People received care that was personalised to their needs and preferences. Staff supported people to engage in activities at home and in the community. Procedures were in place to support and respond to people’s complaints and end of life care needs when required.

People and staff expressed confidence in the registered manager who encouraged an open culture. The registered manager sought and acted upon the views of people and involved staff in shaping the service. The quality of care and delivery was robustly audited and the service undertook partnership working with others.

The majority of people using the service had complex needs which meant they were not able to tell us their experiences. We used other methods to help us understand the experiences of people using the service. We reviewed people's records, observed the care provided and spoke with a relative of a person using the service.

We spoke to two people using the service about the food provided at the home. One person said “I like the sandwiches, I help to make them, staff do the cooking and it’s good. I also like Chinese food and we have that sometimes too”. The other person said “Sometimes I like the food and sometimes I don’t. I like the Shepherd’s pie. We say what we want to eat and the staff get it for us”.

A relative said “The home is meeting my daughter’s needs. The staff are terrific, they always let me know what’s going on. They often talk with me about the things my daughter likes to do and ask for my opinion”. They said they had recently completed a satisfaction survey and felt the home listened to what they had to say. They said they would contact the registered manager if they needed to make a complaint and they were sure that their complaints would be listened to and acted upon.

We saw that the home had been fitted with new windows and doors, toilets and bathrooms had been refitted and a new boiler had been installed. The registered manager told us the flooring was due to be replaced, the home would be redecorated and new furniture would be purchased.

We spoke to two people using the service. One person showed us some necklaces and bracelets they had made with beads and said “I am happy here because I get to make things I like”. They also said “I go to the pictures and go to MacDonald’s afterwards. I go out in the car for a drive and sometimes I go shopping”. The other person we spoke to said “I tidy my bedroom at the weekends and I like to read magazines”. They also said “I go out to the pub or the cinema or to a restaurant”. Both told us they had been on holiday to a Butlins holiday camp last year. They told us they had key workers. One person said “I have meetings with them to talk about things here and if everything is okay for me”.

One person said about the staff. “They are nice and kind and treat me well”. The other person we spoke to said “They’re alright I suppose”.

We spoke to one person who uses the service, they told us “the home is alright, I quite like living here, the staff are okay and I have a social worker who visits me”. They told us they knew they could speak to staff if they were not happy about things; they told us “staff listen to me I complained about food recently and this was talked about at the team meeting and the food had now improved”.

This inspection of Coombe Road took place on 1 and 5 October 2015. The first day of the inspection was unannounced. At our last inspection in September 2013 the provider met the regulations we inspected.

Coombe Road is a care home that provides accommodation and personal care for up to eight people with complex learning disabilities, communication needs and behaviours that may require a response from staff.

The home 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 2008 and associated Regulations about how the service is run.

Two people told us they liked living at Coombe Road and said staff were kind and caring towards them. There was a relaxed and friendly atmosphere when we visited.

There were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow these. Staffing numbers were sufficient to help make sure people were kept safe.

People received care in line with their wishes and preferences. Each person had an individualised support plan and activity schedule to make sure they received the support they required.

People were supported to have their health needs met. Staff at Coombe Road worked with other healthcare professionals and obtained specialist advice as appropriate to help make sure individual health needs were met. We saw that people’s prescribed medicines were being stored securely and managed safely.

Staff attended regular training which gave them the knowledge and skills to support people effectively. Staff had received training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People and their relatives said they felt able to speak to the registered manager or other staff to raise any issues or concerns.

The registered manager supported staff to deliver appropriate care and support. There were systems in place to monitor the quality of the service and obtain feedback from people and their representatives.