We carried out an unannounced comprehensive inspection on 7 April 2018.

Dorset Learning Disability Service - 56 Maiden Castle Road provides care and accommodation for up to four people with learning disabilities. On the days of our inspection there were three people living at the care home.

There was 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. At the last inspection on the 1 June 2016, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated good:

We met and spoke to all three people during our visit and observed the interaction between them and the staff. People were not able to verbalise their views and staff used other methods of communication, for example sign language or visual choices.

People remained safe at the service. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. Staff confirmed there were sufficient numbers of staff to meet people’s needs and support them with activities and trips out. Staff said people were safe because; “There are always two staff on shift and a third when we have one to one planned trips.”

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments had been completed to help ensure people could retain as much independence as possible. People received their medicines safely by suitably trained staff.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff had completed safeguarding training and 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 end of life wishes were not currently documented, however staff confirmed they were currently discussing this subject due to one person’s deteriorating health. People's healthcare needs were met and their health was monitored by the staff team. People had access to a variety of healthcare professionals.

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 upheld and consent to care was sought. Care plans were person centred and held comprehensive details on how people liked their needs to be met, taking into account people’s preferences and wishes. Information recorded included people’s previous medical and social history and people’s cultural, religious and spiritual needs.

People were observed to be treated with kindness and compassion by the staff who valued them. The staff had built strong relationships with the people they cared for. Staff respected people’s privacy. People or their representatives, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs and provided personalised care and support. People had complex communication needs and these were individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and the registered manager said any complaints received would be fully investigated and responded to in line with the company’s policy. Staff knew people well and used this to gauge how people were feeling. The policy was not provided in an acce

The inspection took place on the 1 June 2016 and was unannounced.

56 Maiden Castle 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.

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.

There was a positive culture within the service. The registered manager had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people. Individualised care was central to the homes philosophy and staff demonstrated they understood and practiced this when talking to us about how they met people’s care and support needs. They 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 processes in place and carried out checks when they employed staff to help ensure they were safe. Staff undertook appropriate and regular training and had opportunities to discuss and reflect on practice.

The atmosphere in the home was warm and welcoming. We saw people laughing and smiling and the interactions suggested people had formed positive and trusting relationships with the staff supporting them. Professionals we spoke with said they always experienced a feeling of ‘homeliness’ when they visited.

People’s support plans included clear and detailed information about people’s specific needs and preferences. Staff were familiar with this information and could tell us in detail about people’s daily routines and how they liked to be supported. People had their health and dietary needs met. Staff monitored people’s health and well-being and supported people to access health services when required. People had their medicines managed safely, and received their medicines in a way they chose and preferred.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom. 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.

People were supported to lead a full and active lifestyle. Activities and people’s daily routines were personalised and dependent on people’s particular choices and interests. Staff recognised the importance of family and friends and supported people to maintain these relationships.

A system was in place to regularly review the quality of the service. This included a range of regular audits of people’s medicines, personal finances and the environment. Learning from incidents, feedback, concerns and complaints were used to aid learning and help drive continuous improvement across the service.

We were unable to speak with people who lived in the home due to their complex needs. We spoke with three relatives of two people who lived in the home, via the telephone and in person. People's relatives told us that they felt positive about the quality of care people received and with their relationships with the staff.

We observed residents moving freely around the home and interacting with the staff in a relaxed way.

People's relatives told us that the people who lived in the home 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's relative told us, "She can communicate her consent. She can let them know. We are all working together. I am included in decisions."

The home had procedures in place to ensure that people received their medicines as prescribed. Medicines were handled in a secure way. A person’s relative told us, “There haven’t been any errors with her medication.”

We found that there were sufficient numbers of staff, with the right competencies. A support worker told us, "Leonard Cheshire are very good at promoting staff getting qualifications. That was one of the reasons I came here.”

The home was taking account of people's comments or complaints. People’s 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 people using the service because the people using the service had limited speech and difficulties with communication related to their disability. We saw that each person had a personal care plan which expressed important information about how they liked to be treated and what was important to them. We observed staff frequently talking and listening to people or using gestures or touch to reassure, that took account of people’s ability to communicate.

We saw examples of how people were encouraged to be involved in events and activities inside and outside the home. One member of staff told us ‘we try to help people do things for themselves’. Staff demonstrated skill and sensitivity about how change was handled, for example, helping the residents start to adjust to a new person due to move in.

We found that individual risk assessments took account of people’s capacity and ensured safety. Staff coordinated care with relatives and other professionals for the benefit of people.

Staff were trained in safeguarding and demonstrated that knowledge and skills in this area.

Staff told us they felt supported and we saw that they received training, and supervision . There were systems and procedures for identifying and managing risk and we found examples of learning from incidents.