About the service: Cranleigh is a care home service. It is registered to provide personal and nursing care for up to eight younger adults who are living with a learning disability. At the time of our inspection eight people were living in the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include choice, control, and independence. People using the service received planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

People’s capacity to make decisions had not been assessed. However, people were being cared for in line with the Mental Capacity Act 2005.

People were positive about the care they received. People’s care was individualised and they were supported to maintain their independence.

People were involved in making decisions about their care and treatment.

People felt safe and were cared for by staff who understood how to safeguard people from the risk of abuse.

Individual risks to people and environmental risks had been identified and planned for.

People’s medicines were managed safely by staff who had received the appropriate training.

Staff were safely recruited and received support and training relevant to their role.

The service had good links with the local community and people were supported to maintain their interests and hobbies.

There were systems in place to monitor and assess the quality of service being delivered.

People were encouraged to provide feedback about the service and attended regular meetings about the running of the service.

Rating at last inspection: Good (report published 6 October 2016)

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to inspect as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 11 August 2016 and was announced.

Cranleigh provides accommodation and care for up to eight people with a learning disability. At the time of our inspection eight people were living in the home.

A registered manager was 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 registered manager was also one of the partners in the business.

We found that there were no systems in place to monitor the quality of care being delivered and environmental risks were not formally audited.

We have made a recommendation about improving the effectiveness of the governance of the service.

People living in the home felt that the home was well led and felt safe living there. Staff also felt that the management were supportive and approachable. People were cared for by staff who had received training relevant to their role. Staff were knowledgeable in their role and knew the potential signs of abuse and how to report this. Appropriate checks were carried out before staff started working at the home.

Medicines were stored and administered safely in the home but there were no records to show how staffs’ competency was assessed in the safe handling and administration of medicines.

People were supported to make their own choices about their care and were involved in the planning and review of their care. People’s care plans were person centred and took in to account their needs and preferences. Care plans were reviewed regularly and updated accordingly. People were supported to access activities of their choice and to maintain links with their community.

People’s nutritional needs were being met and people were able to choose their meals and prepare them with the support of staff. Referrals were made to relevant healthcare professionals where there were concerns around a person’s health or wellbeing.

People felt able to raise a complaint if needed and knew who they would speak to if they wanted to discuss a complaint. Staff knew how to support people in making a complaint.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on our discussions with five people who used the service, three staff members and two family members. In addition we looked at three people's care and support plans.

Is the service safe?

Risk assessments were in place to ensure that, as far as possible, people were safe in the home and that staff were safe in their working environment. Where risks to people had been identified measures had been taken to minimise or remove them. Appropriate vetting of staff combined with on-going staff support and appraisal meant that the provider took reasonable steps to ensure that vulnerable adults were protected from the risk of abuse. We looked at staff rotas and found that there were enough qualified, skilled and experienced staff to meet people's needs throughout the day and night. Staff were up to date with their safeguarding training.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to all care services. At the time of the inspection no applications had needed to be submitted. Proper policies and procedures were in place so that people who could not make decisions for themselves were protected. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service caring?

People we spoke with said that staff treated them with respect and consideration. They felt that staff listened to them and took time to explain things. People also told us that they were consulted about the care and support they received. We observed that people received encouragement, had questions answered politely and were given time to think about what it was they wanted to say or ask.

People’s needs were assessed and care and support was planned and delivered in line with their individual care plans. The care plans we looked at were personalised and detailed and provided a good level of information for staff providing the care.

Is the service responsive?

The provider had a system in place to deal with concerns or complaints. We found that these had been dealt with in a timely manner. People knew how to make a complaint if they were unhappy. The complaints process was displayed in the entrance hall, making it easily accessible to people and visitors. Where shortfalls or concerns were raised these were addressed by the provider.

People told us that the provider responded to their changing needs in a timely manner. People's needs were assessed and reviewed on a monthly basis or as and when needed. Where changes occurred, the service referred to health professionals for advice and guidance if required. All changes were well documented and recorded.

One person we spoke with told us, "It's uniqueness is its family environment, it has a warm and inviting atmosphere."

People who used the service and their family members or representatives, were asked for their views about the care provided and these were acted on by the provider.

Is the service effective?

People using the service that we spoke with said, or indicated to us, that the care and support provided was of good quality. From our observations we saw that care and support was effective and consistent. The staff demonstrated an in-depth knowledge of people living in the home.

People were supported to be as independent as possible. One person told us, "I'm off on holiday tomorrow, [the carer] helped me pack my bags and made sure I didn't forget anything."

We saw that staff knew the people they were supporting and caring for and that the people receiving the care and support were at ease in the presence of staff. We noted that if something was not right that staff responded quickly to resolve matters.

People told us, or indicated to us, that they liked living at Cranleigh and that staff were kind and caring.

Staff explained how they were able to communicate with people who were not able to express themselves verbally.

Is the service well led?

Views of people using the service and, where possible, their families were obtained. Staff told us that they felt supported and had received sufficient training to carry out their role effectively. They added that if they felt they needed further or additional training or support that they were confident this would be arranged by the provider.

There were quality monitoring systems in place and audits and spot checks took place to ensure that people received a good service.

Staff were clear about their roles and responsibilities. They spoke of how they worked as a team with the needs of the person central to the work they did.

We spoke with six people living in Cranleigh. They told us they were well looked after and were happy living there. One person who had lived in different homes told us, “This is the best one.” Another person said, “I love it here.” A third person told us, “Staff are wonderful. It’s a big family.”

People had been involved in discussing their care needs as they had signed risk assessments and plans to minimise risks identified, for example, when crossing the road or using public transport. This showed that matters had been discussed with people and their consent had been obtained about how best to ensure their safety.

We saw plans in place for the management of challenging behaviour. These were different for different people. This told us that care was planned on an individual basis. We saw that risk assessments and plans to support people were more regularly reviewed and where people’s needs changed, their support had been revised and care plans updated accordingly.

People were provided with a choice of suitable and nutritious food and drink. We noted a large bowl of fresh fruit available in the living room. The kitchen was accessible to people at all times so they could access snacks if they wished. We also saw that people had their own snacks in their rooms.

Sufficient staff were available to support people at all times.

A suitable complaints procedure was available should anyone wish to make a complaint.

The people using the service said they were very happy with it. One person said, “Cranleigh is the best place to live in the world”. Another person said, “Staff are wonderful, we’re like a big family”.

Care plans showed that people were involved in making decisions about how they wished to be supported, and their individual choices respected. Staff promoted people’s independence besides ensuring they were safe at all times. Care plans and risk assessments were regularly reviewed and updated. There was clear evidence that the care and support delivered by the staff was holistic and reflected all the needs of the person.

People’s privacy and dignity was respected and we observed staff speaking with people in a caring manner. People with communication difficulties were well supported and staff showed a clear understanding of individual needs.

People using the service told us that they felt safe and there were plenty of activities they could choose to take part in. One person said, “I love going to day camp to see all the animals. I help with the gardening”.

We saw that there were enough suitably trained and experienced staff to meet the needs of people using the service. Staff were well supported and had access to various education programmes to meet the needs of people.

This home had various methods that were used to ensure the quality of the care was assessed. Meetings, reviews and management audits were in place and records were available.

People who use the service told us that they were happy and felt safe living at Cranleigh. One person said, "I wanted to move here, I like it. I like all the staff, we're like a big family." Other people mentioned good relationships with the staff. One person told us, "The staff are very kind," and another person said, "The staff are very friendly and nice.

People told us that they received the care and support they needed. One person said, "The staff do lots for us." Another person said that staff understood their health care needs and looked after them.

Everyone with whom we spoke told us how much they liked the activities they did. They each had a daily programme, which included many activities in the local community. Two people said that they chose where they wanted to go on holiday.

People using the service told us they enjoyed the meals. Some were involved in shopping and cooking. Everyone helped with domestic chores and we saw that the house was clean and tidy. One person told us, "We've got a lovely home here."