About the service:

3 Cranford Avenue is a residential care home providing accommodation, personal care and support for up to four people with a learning disability. At the time of the inspection three people were living at the home.

The service is currently in the process of applying to the CQC to de-register as a residential care home and register as a supported living service. In supported living services people have their own tenancy agreements and a separate support package arranged according to their assessed needs.

The service had been developed and designed in line with the values that underpin the CQC 'Registering the Right Support' policy and other best practice guidance such as 'Building the Right Support'. 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 other citizen.

Rating at last inspection:

At our last inspection we rated the home as Good (published 21 July 2016).

Why we inspected:

This inspection was a scheduled inspection based on the previous rating.

People’s experience of using this service:

People who could speak with us told us they were happy at 3 Cranford Avenue. Each person indicated to staff that they were happy and enjoyed their company. Relatives felt their family members were safe and well cared for. Staff demonstrated a good understanding of the risks people faced in their day to day lives and the practical ways they could support them to minimise those risks to keep them safe. People received their medicines on time, at the correct dose and had regular reviews to ensure that they were not being over medicated.

People’s desired outcomes were known, and staff worked with people to help achieve these. Staff had received the necessary induction, competency checks and ongoing training to help them meet people’s specific needs. People were supported to retain their independence, develop new skills and interests and live their lives as fully as possible. 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 were actively encouraged to maintain contact with those important to them including family and other people living at the home. Staff understood the importance of these contacts for people’s health and well-being. Staff and people were observed enjoying meaningful, compassionate and mutually beneficial interactions. Staff knew people well and what made them individuals.

The registered manager was respected by the staff and promoted and open and transparent culture. Management and staff understood their roles and responsibilities. Staff felt supported and valued. Feedback surveys were undertaken to ensure that people, relatives and staff could express their views and contribute to what happened at the service. Meetings and presentations had been held with people’s relatives and relevant health and social professionals in relation to the proposed change from a care home to supported living accommodation.

Quality and safety checks by the registered manager and service manager helped ensure people were safe and protected from harm. This also ensured that practice standards were maintained and improved. Audits helped identify areas for improvement with learning from these shared with staff.

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

Follow up:

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

The inspection took place on the 28 June 2016 and was unannounced.

3 Cranford Road provides care and accommodation for up to four people. On the day of the

inspection four people were living in the home. The service provides care for people with a learning

disability and associated conditions such as Autism.

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 service provided good care and support to people allowing them to lead fulfilled and meaningful lives. Relatives and professionals said they felt people were safe and well cared for. The interactions between people and staff were positive. We heard and saw people laughing and smiling. People looked comfortable, relaxed and happy in their home and with the people they lived with. Relatives were welcomed into the home and had clearly formed positive and trusting relationships with the staff team.

There was a positive culture within the service. The registered manager provided good leadership and led by example. They said, “As well as being the manager I like to work with people. I enjoy spending time with the staff and people we support”. Staff had a good understanding of people’s needs and spoke in a compassionate and caring way about the people they supported.

There were sufficient numbers of staff to meet people’s needs and to keep them safe. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to help ensure people were safe. Staff were well trained and aspects of training were used regularly when planning care and supporting people with their needs and lifestyle choices.

People were supported by staff who had a good understanding of how to keep them safe. All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and were able to describe what action they would take to protect people from harm.

Staff encouraged people to be independent and promoted people’s choice and freedom. 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 were supported to take part in a range of activities both inside and outside 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 GPs and speech and language therapists. People’s dietary needs and any risks were understood and met by the staff team.

The manager and staff demonstrated a good understanding of the Mental Capacity Act 2005. People were supported where possible to make everyday choices such as what they wanted to wear, eat and how to spend their time. The manager was aware of the correct procedures to follow when people did not have the capacity to make decisions for themselves and if safeguards were required, which could restrict them of their freedom and liberty.

Staff described the management as supportive and approachable. Staff talked positively about their work and comments included, “It’s a good place to work, the team are committed to meeting the needs of the people who live here”. Staff were well supported through induction and on-going training.

The service had an open door policy. Relatives were always welcomed and people were supported to

During our visit we were unable to speak directly with most people who lived in the home due to their complex needs. We spoke with one person 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 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 are nice – Staff ask me what I would like.”

The service 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, "I’ve been here since the house opened – I can use some Makaton – I have NVQ 3."

The home was taking account of people’s comments or complaints. Relatives told us that they could be sure that their comments were listened to, and responded to appropriately.

We used a number of different methods to help us understand the experiences of four people who used this service because they difficulties with communication related to their disability. We observed people in their day to day environment. We gathered evidence from the care records and talking to the manager and staff.

There were spacious areas for the kitchen, living and dining room where people could share and each person had a dedicated bedroom and living room. This allowed people to have privacy and to interact with each other and staff if they chose.

We saw that care plans were highly individualised and observed how staff used this information to guide their involvements with each person and develop the overall service offered to people. We saw evidence that relatives’ views were valued and encouraged and influenced how the service was provided.

People were encouraged to be involved in regular activity inside and outside the home and that community involvement was strongly promoted. One person told us 'I like it here and I get help to cook'.

Staff demonstrated that they worked as a team to support people. Staff received training and were supported to develop professionally. There was a system of supervision and peer support.

We saw evidence of understanding and awareness of safeguarding and that procedures were followed for incidents.

There were processes in place for the service to self monitor and evaluate and learn from incidents.

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