We carried out an unannounced comprehensive inspection on 14 April 2018.

Dorset Learning Disability Service – 23 Birch Way provides care and accommodation for up to four people with learning disabilities. On the day of our inspection there were four people living at the care home. In relation to Registering the Right Support we found this service was doing all the right things, ensuring choice and maximum control. Registering the Right Support (RRS) sets out CQC’s policy registration, variations to registration and inspecting services supporting people with a learning disability and/or autism.

The service did not have a registered manager; however a manager had been appointed and was in the process of submitting their application to the Commission. 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. At the last inspection on the 2 June 2016, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated good:

People were not able to fully verbalise their views and staff used other methods of communication, for example pictures or visual choices. We met and spoke with three people during our visit and observed the interaction between them and the staff. One person was away with family.

People remained safe at the service. People were protected from abuse because staff knew what action to take if they suspected someone was being abused, mistreated or neglected. Staff, were recruited safely, and checks carried out with the disclosure and barring service (DBS) ensured they were suitable to work with vulnerable adults. People had their needs met by suitable numbers of staff.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe.

Risk assessments were in place to help support risk taking, and help reduce risks from occurring. People who had behaviour that may challenge staff or others had risk assessments in place which gave good guidance and direction to staff about how to support the person, whilst taking account of everyone’s safety. People received their medicines safely by suitably trained staff.

People were supported by staff who had received training to meet their needs effectively. Staff meetings, one to one supervision of staff practice and appraisals of performance were undertaken. Staff completed the Care Certificate (a nationally recognised training course for staff new to care). Staff confirmed the Care Certificate training looked at and discussed the Equality and Diversity and the Human Right needs of people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's health was monitored by the staff and they had access to a variety of healthcare professionals. The manager worked closely with external health and social care professionals, to help ensure a coordinate approach to people’s care.

People’s end of life wishes were not currently documented, however staff told us how they had supported one person during their end of life last year. This included offering support when this person was admitted to hospital to help ensure they had people familiar to them at the end.

People’s care and support was based on legislation and best practice guidelines; helping to ensure the best outcomes for people. People’s legal rights were up held and consent to care was sought as much as possible. Care records were person centred and held full details on how people liked their needs to be met; taking into account people’s preferences and wishes. Overall, people’s individual equality and diversity pref

The inspection took place on 2 June 2016 and was unannounced.

23 Birch Way provides care and accommodation for up to four people. On the day of the inspection four people lived within the home. 23 Birch Way provides care for people who have a learning disability.

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.

On the day of our inspection there was a very calm, friendly and homely atmosphere. People were relaxed and happy. People’s relatives all spoke positively of the care and support staff provided. One relative commented, “[…] is really happy, the environment has a brilliantly homely feel. They are one big, lovely family unit.”

Staff encouraged people to be independent and promoted people’s freedom. The building had been carefully thought out and took account of people’s needs. People moved freely around the building and its grounds as they chose.

Care records were comprehensive and written to a good standard. They contained detailed, personalised information about how individuals wished to be supported. People’s individual method of communication was taken into account and respected. People’s risks were well managed, monitored and regularly reviewed to help keep people safe. People had choice and control over their lives and were supported to take part in a variety of activities both inside the home and in the community. Activities were meaningful and reflected people’s interests and hobbies.

People had their medicines managed safely. People were supported to maintain good health through regular access to health and social care professionals, such as GPs, physiotherapists and speech and language therapists.

Staff exhibited a kind and compassionate attitude towards people. Strong relationships had been developed. Staff were creative in finding ways to overcome obstacles that restricted people’s independence, and had a good appreciation of how to respect people’s individual needs around their privacy and dignity.

The service had an open door policy. Relatives and friends were always welcomed and people were supported to maintain relationships with those who mattered to them.

Staff received a comprehensive induction programme. There were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively. The service followed safe recruitment practices to help ensure staff were suitable to carry out their role.

People were supported by staff who had a good understanding of how to keep them safe. Advice was sought to help safeguard people and respect their human rights. All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated. The manager had sought and acted on advice where they thought people’s freedom was being restricted.

Staff described the management as very supportive and approachable. Staff talked well of their jobs. Comments included, “I love my job, I just love what I do and being with the guys. I really enjoy it” and “I’ve been here a long time and I still love it, I enjoy coming to work”.

The service had a very open and transparent culture. The registered manager had set values that were respected and adhered to by all staff. Staff were encouraged to suggest ideas to improve the quality of care people received. Staff felt listened to and were confident to communicate ways they felt the service could raise its standards.

There were effective quality assurance system

During our visit we spoke with three people who lived in the home.

The registered manager was on sickness leave at the time of our visit. A team leader, from one of the provider's other homes, was in attendance on the day of our visit to assist with our inspection.

We spoke with the relatives of two people who lived in the home, via the telephone. People's relatives told us that they felt positive about the quality of care people received; and with their families relationships with the staff. We observed residents moving freely around the home and interacting with the staff in a relaxed way.

People and relatives told us that they were asked for their consent when making choices and decisions about their daily lives; and that people's choices and decisions were respected by the staff. A person told us, "The staff ask me what I would like."

The home had procedures in place to ensure that people received their medicines as prescribed. Medicines were handled in a secure way.

We found that there were sufficient numbers of staff, with the right competencies. A support worker told us, "We have regular medications and first aid training.” A person’s relative told us, “There always seems to be enough staff.”

The home was taking account of people's comments or complaints. People who lived in the home, and their relatives, told us that they could be sure that their comments were listened to, and responded to appropriately.

During our visit to the service on 13 March 2013 we met with all of the four people who lived at 23 Birch Way Charlton Down. They were all able to communicate with us although some people were keener to do so than others. Throughout our visit we saw the people using the service had a good relationship with the staff and were included in all that was going on.

One person said, "I like all the staff, they are fun." We observed staff interacted well with the people who used the service and supported them to be as independent as possible. People indicated they felt safe living at 23 Birch Way and the staff were familiar with their responsibilities to protect people and keep them safe. One person said, "I like the paper sheets in my bedroom so I know what I am doing and what staff are sleeping in." This was a reference to his individual activity plan that he had displayed in his bedroom to inform him what activities he could participate in and what staff were supporting him each day.

The staff we spoke with told us there was always sufficient staff on duty to meet the needs of the people using the service. We were able to confirm staff were correctly selected and recruited.

Care records indicated staff understood the importance of documentation and keeping records current to ensure care was provided correctly and in line with a persons assessed needs.

There were three people at the house at the time of our visit and two people were able to speak with us. They told us they liked living at the house. They were pleased to show us their home and their individual, personalised bedrooms. Their holidays, outings and activities were displayed in their bedrooms and as photos and art work around the house.

People had choices in their everyday activities and were able to express their preferences. One person told us they had found the day centre boring so staff had helped them find alternative activities. They now really enjoyed their involvement in art class, drama group and drama productions. Another person showed us their care plan which contained photos of them involved in activities and outings.

People were encouraged to be as independent as possible and were involved in household chores and running the house. They were involved in shopping, cleaning, preparing meals and also grew vegetables in the garden. They told us that they enjoyed working at the local farm; this provided skills development opportunities for people with learning disabilities.

We observed that people were respected and treated sensitively as individuals by staff.

People told us they felt safe living at the house. However, they told us they sometimes got upset, when one of the people living at the house shouted at staff. Staff were very supportive to people and provided them with regular reassurance that they would always make sure they were safe.

Staff had been trained and knew how to recognise safeguarding situations, but these had not always been reported to the local authority