The inspection was carried out on 12 June 2018, and was an unannounced inspection.

Damascus House does not conform to Building the Right Support and Registering the Right Support guidance. However, people were given choices and their independence and participation within the local community encouraged. The service accommodates up to 12 people in one adapted building. At the time of our inspection 12 people were in residence.

At the last Care Quality Commission (CQC) inspection in 10 March 2016, the service was rated Good.

At this inspection we found the service remained Good.

People continued to be safe at Damascus House. People were protected against the risk of abuse by staff who understood their responsibilities to keep people safe. Medicines were managed safely and people received them as prescribed. The registered manager needs to ensure the temperature of the room where medicines are stored is monitored to ensure they are within manufactures' guidelines.

Staff followed appropriate guidance to minimise identified risks to people's health, safety and welfare. There were enough staff to keep people safe. The provider had appropriate arrangements in place to check the suitability and fitness of new staff.

People had their care plan’s reviewed and they reflected the support they needed. Staff received regular training and supervision to help them to meet people's needs effectively. Training reflected people’s changing needs.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Staff were caring and treated people with dignity and respect and ensured people's privacy was maintained. People were supported to make choice and decisions over their lives. Staff supported them in the least restrictive way possible.

Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

The provider had a complaints procedure in place. It was made available to people to enable them to make a complaint if they needed to. Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.

The registered manager provided good leadership. They supported staff positively and promoted an open culture which focussed on people experiencing good quality care and support. People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.

Further information is in the detailed findings below.

We inspected the service on 10 March 2016 and the visit was unannounced.

Damascus House provides accommodation for up to 12 people who have a learning disability. At the time of our inspection 12 people were using the service. The service is on two floors accessible by stairs. There are two lounges and dining areas for people to choose from. There is also access to a large garden area for people to use should they choose to.

It is a requirement that the home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 service had a registered manager in place at the time of our inspection.

People told us that they felt safe living at the home and staff knew how to protect them from harm and abuse. Accidents and incidents had been investigated and analysed to try and prevent them from reoccurring. Risks to people had been assessed and the regular checking of equipment within the home had taken place. There were plans available to staff on how to keep people safe during emergencies.

People were supported to keep safe by the provider having adequate staffing numbers available at all times. Staff were checked prior to working for the provider to make sure that they were suitable for their role. This helped the provider to make safer recruitment decisions.

People received their medicines as prescribed by their GP. The provider had made arrangements for the safe storage and administration of medicines. The registered manager told us that they would review some of their guidelines when considering the use of as and when needed medicines. This was because the current practice of staff was not always documented.

People received effective support from staff that had the rights skills and knowledge. Staff had undertaken regular training and there were plans to enhance their skills further. For example, training in fire safety was due to occur within the next month.

People received support from staff who knew the requirements of their role. Staff had received an induction when they had started to work at the service and met regularly with the registered manager.

Staff understood the Mental Capacity Act (2005) and could describe the importance of gaining people’s consent prior to carrying out care and support with them. People were being supported to make their own decisions where possible and their understanding of specific decisions had been assessed.

People had enough to eat and drink and were being supported to maintain a healthy lifestyle. People had been involved in planning the menu and the food offered was based on their preferences.

People had access to healthcare services when they needed to. Information about people was available to healthcare staff in order to support people appropriately when, for example, they needed a hospital admission.

People were supported by staff who cared. Friendly relationships between people and staff had developed which people spoke positively about. People’s dignity and privacy had been respected and their sensitive and private data was being kept secure.

People’s preferences and interests were known by the staff team. Staff had taken care to make sure that care and support offered was in line with these. People took part in activities that they enjoyed and that were important to them.

People and their relatives had contributed to and been involved in planning and reviewing the care and support provided. People’s support plans were individual to each person and in such detail that staff had thorough information about how to provide good support. People’s independence was being encouraged and relationships that were important to them had been maintained.

People did not have info

We inspected four outcomes areas: Care and welfare, meeting nutritional needs, management of medicines, supporting workers and found all these outcome areas were compliant. We spoke with four people who used services. They told us they were happy living at Damascus House. Three people told us staff were good to them. One person said they enjoyed going out each day and were looking forward to the summer holiday trip with people from the home. We saw people walking around the back garden on the paved area and sitting outside in the garden with drinks. We saw people leaving the home to go out for the day to college and daily activities. We saw some people eating breakfast in the dining area, they appeared relaxed and were eating and drinking independently. They told us they could choose their breakfast with any cereals or toast with a variety of spreads, and fruit juice or a pot of tea. In the weekends they could have a cooked breakfast.

People who live at the home told us they were treated well by staff and liked living at Damascus House. When we visited staff were organised and worked as a team to ensure people's care and social needs were met. One person told us they were going to the cinema with staff in the evening. We saw people leave in the morning to go off on their daily pursuits. People were going to daycentres, shopping and to the fair. Two people were seen cleaning the communal areas of the home with the assistance of staff. We saw people making hot drinks (where agreed in their care plan) and strolling in the rear garden. One person told us." I have lost 5lbs in weight." (This was through a new healthy eating plan). Another person told us "I like it here the staff are good to me."

During our visit we observed people going out on daily pursuits, undertaking light housework tasks, interacting with staff and making their own hot drinks and preparing lunch.

People told us,

“I go to residents meetings and we talk about what we want in our home.”

“I can complain if I want to. I feel safe here.”

“I make my own breakfast and sandwiches for lunch. Staff make the dinner. There is always choice and fresh fruit.”