About the service: Cotswold House is a large detached bungalow situated in the extensive grounds of Somerset Court.

The home accommodates up to six people who have autism and complex support needs. The home comprises of the main building and three self-contained flats attached to the bungalow.

During our inspection there were three people living in the main part of the home and three people living in each one of the flats. People living at Cotswold House can access all other facilities on the Somerset Court site, which include a day service facility and gym.

The care service had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This guidance was implemented in 2017 after the service had registered with us. This was because there were five other registered care homes set in the grounds of Somerset Court in close proximity to Cotswold House. In total 37 people with learning disabilities were living at Somerset Court. It would be unlikely that we would register this model of services now when considering applications for services for people with a learning disability and/or autism.

People’s experience of using this service:

The values set out in the Registering the Right Support 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. This location may not be ideal for some people who would want to access the local community independently due to the rural area. However, people were given choices and their independence and participation within the local community was encouraged.

Staff knew what action to take if they suspected abuse. Relevant risk assessments had been completed to ensure people’s safety. Medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or themes.

People were supported to make choices and had control of their lives. Staff supported people in the least restrictive way as possible. This was kept under review. Staff were aware of the legislation to protect people’s rights in making decisions.

People were cared for in a way that respected their privacy, dignity and promoted their independence. Staff knew people well enabling care to be delivered effectively, responding to people’s changing needs.

Staff interactions with people were kind and caring. People were supported by staff that were familiar to them taking into their consideration their preferences. People had a core group of staff within the team that supported them on a day to day basis. This enabled people to build effective relationships and enable the staff to get to know them.

People received personalised care, their support needs and preferences were detailed in their care plans. People were supported to lead meaningful and fulfilled lives through activities of their choice. The provider had a complaints policy and process in place. Relatives said they would have no hesitation in speaking with the registered manager or staff. Staff knew people well and recognised when they were not happy with the care and support and made the necessary adjustments.

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, where people and staff could approach the registered manager, who acted on concerns and suggestions to make improvements to people’s care.

People were provided with a safe, effective, caring and responsive service that was well led. The organisation’s values and philosophy were clearly explained to staff and there was a positive culture where people felt included and their views were sought. The registered provider was aware of the importance of reviewing the quality of the service and was aware of the improvements that were needed to enhance the

Cotswold House is a large detached bungalow situated in the extensive grounds of Somerset Court. The home accommodates up to six people who have autism and complex support needs.

The home comprises of the main building and three self-contained flats attached to the home. During our inspection there were three people living in the main part of the home and three people each living in one of the flats. People living at Cotswold House can access all other facilities on the Somerset Court site which include various day services.

The service was last inspected in February 2014 and was compliant with the standards we inspected. This inspection was unannounced and took place on 24 and 25 August 2016.

There was a registered manager responsible for the service; at the time of our inspection the registered manager was absent from the service. 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 provider had arranged for a temporary manager to cover in the registered manager’s absence.

There were sufficient staff available to enable people to take part in a range of activities according to their interests and preferences. The majority of people required a minimum of one to one staffing to help keep them safe. Staff duties were clearly allocated so people received the support they needed.

A recruitment procedure was in place and staff received pre-employment checks before starting work with the service.

Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and they knew the procedures to follow if they had concerns.

People lived in a safe environment and were supported by a staff team who had the skills and experience to meet their needs and help to keep people safe.

People received their medicines when they needed them. Staff had received training in the management and administration of medicines and their competency in this area had been regularly reviewed to ensure their practice remained safe.

People’s health care needs were monitored and met. The home made sure people saw the health and social care professionals they needed and they implemented any recommendations made. Staff were skilled at communicating with people, especially where people were unable to communicate verbally.

Where restrictions were placed on people, these were not always regularly reviewed to ensure they were the least restrictive option. People’s privacy was not always considered. People were asked for their consent before staff assisted them with any tasks.

People were supported by a caring staff team who knew them well. Staff morale was good and there was a happy and relaxed atmosphere in the home.

Routines in the home were flexible and were based around the needs and preferences of the people who lived there. People were able to plan their day with staff and they were supported to access social and leisure activities in the home and local community. There was an emphasis on enabling people to be as independent as they could be and to live a happy and fulfilling life.

There were effective systems in place to monitor and improve the quality of the service provided.

Because of people's complex needs and varied communication abilities we were not able to speak with people who used the service. However we spoke with three parents and four members of staff.

There were appropriate arrangements in place to assess people's capacity to make specific decisions such as a need for medical treatment. People were empowered to make choices about their daily living arrangements. Where people were assessed as not being able to make informed decisions best interests meetings had been held. Decisions had been made on their behalf in consultation and discussion with other professionals and people's representatives. People had access to independent advocates to help them in making decisions and ensuring decisions had been made in people's best interests.

Comprehensive assessments had been completed to ensure people received a consistent and reliable service. Parents we spoke with were all very positive about the care provided by the service. The service had a positive approach to risk. Assessments were in place to address potential risks to people's health and welfare and provide support to staff in responding and alleviating identified risks.

There were appropriate and safe arrangements for the administering and management of people's medicines. We saw there were individualised plans in place for the effective administering of medicines.

There were effective systems in place to monitor and review the quality of the service. The provider was proactive in learning from incidents and seeking support from professionals to alleviate risks to people.

People who lived in the home had communication difficulties so we were not able to ask most people about life in the home. We observed communication and interaction between the people who lived in the home and the staff who supported them. All of these interactions were kind and considerate.

People had a wide range of care needs. They were supported by a number of health and social care professionals. One person confirmed they were happy living at the home and felt well cared for. When we asked them who chose the things they did they said “I do”. They said they “liked the staff” who worked in the home.

People chose what activities they wish to take part in both inside and out of the home. They were supported to access a range of activities, outings to places of interest and to choose and attend holidays.

We saw that people were comfortable with the staff who supported them. None of the staff we spoke with had any concerns about any person being at risk and told us they felt the home was a “safe place” for people to live. People who lived in the home could become distressed, anxious or present aggressive behaviour. Staff used approaches which were the least restrictive which helped to keep people’s anxieties to a minimum.

The provider had various systems in place designed to monitor the quality of the service provided to people and to ensure people remained safe. Changes or improvements were made where possible. People’s views were sought and listened to.