Dramsdon is registered to provide accommodation and personal care for up to five adults with learning disabilities, autism and associated health needs. At the time of our inspection there were five people living in the home. The service is one of many, run by the White Horse Care Trust, within Wiltshire and Swindon.

At the last inspection the service was rated good overall with one requires improvement in the Responsive domain. We found that people’s care and support plans did not always reflect people’s current needs and identify how care and support should be provided. This meant that people could be at risk of inconsistent care and/or not receiving the care and support they need. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook a full comprehensive inspection on 21 March 2017. After the previous inspection the provider wrote to us with an action plan of improvements that would be made and meet legal requirements in relation to the law. We found on this inspection the provider had taken all the steps to make the necessary improvements.

At this inspection we found the service had made all the necessary improvements and remained Good.

A registered manager was employed by the service and was present throughout our inspection. 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.

Care plans were personalised and contained information about the person’s preferences, likes, dislikes and what was important to them. Staff were knowledgeable about people’s care and support needs and acted in accordance with the guidance in their care plans. People had a range of activities they could be involved in. People were able to choose what activities they took part in and suggest others they would like to try.

People’s dignity, privacy and independence were promoted and people were treated with respect.

People were treated with compassion and kindness in their day to day care. Staff had a good understanding of people’s needs including how they expressed their individual needs and preferences.

People were protected against the risks of potential harm or abuse. Staff had received relevant training and understood their roles and responsibilities in relation to safeguarding people from abuse and harm.

Risks to people and their safety had been identified and actions taken to minimise these. Risk management plans were in place to ensure people received safe and appropriate care.

People’s medicines were managed safely. People’s health care needs were managed effectively.

People were supported to have a meal of their choice by organised and attentive staff.

Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way.

People were supported by sufficient staff with the right skills and knowledge to meet their individual needs. Safe recruitment practices were followed to ensure staff were of good character and suitable for their role.

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.

There were quality assurance systems in place which enabled the provider and registered manager to assess, monitor and improve the quality and safety of the service people received.

Further information is in the detailed findings below.

The inspection took place on 23 April 2015. This was an unannounced inspection. During our last inspection in September 2013 we found the provider satisfied the legal requirements in the areas that we looked at.

A registered manager was employed by the service. 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.

Dramsdon is a provider of residential care for adults who are 18 and over and who have autism, learning disabilities and other associated health needs. They provide accommodation and personal care for up to five people. At the time of our inspection there were four people living in the home. The service is one of many, run by the White Horse Care Trust, within Wiltshire and Swindon.

We found that people’s care and support plans did not always reflect people’s current needs and identify how care and support should be provided. This meant that people could be at risk of inconsistent care and/or not receiving the care and support they need. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Autism affects people in different ways which can include difficulties with interacting socially and the development of language and communication skills. Where people behaved in a way that may be seen as challenging to others, staff managed the situation in a positive way which respected and protected people’s dignity and rights. Staff sought to understand and reduce situations that may cause people distress and put them and others at risk of harm.

People received care and support from staff who knew and understood their likes, dislikes, preferences and needs. Staff responded to each person’s needs in a caring and compassionate manner. We observed people receiving support in a way which demonstrated staff respected their privacy and dignity at all times.

Staff managed medicines safely which included storing them correctly and having procedures in place to dispose of them appropriately. Staff kept accurate records which showed that people received their medicines as prescribed.

People were involved in decisions about what they ate and drank. They had access to snacks in-between meals and were supported to maintain a balanced diet that promoted healthy eating and included their preferences.

There were always enough competent staff on duty. The registered manager ensured recruitment systems were robust and that the right people were recruited to keep people safe.

Relatives spoke positively about the care and support received by their family member. They said that staff knew the people they were supporting well and they could raise any concerns they may have. There was a management structure in the home that provided people with clear lines of responsibility and accountability. The provider had an effective system to regularly assess and monitor the quality of service that people received and an effective complaints system.

Staff had the confidence to question practice and report concerns about the care offered by others. The registered manager explained that staff would be supported and their concerns fully investigated. Staff were knowledgeable about the procedures in place to recognise abuse and how to report their concerns.

People who used the service did not use verbal speech but communicated by using gestures, body language and facial expression. Due to this, we were not able to gain detailed feedback about people’s experiences of the service. We observed peoples’ overall wellbeing and their interactions with staff as a means to make a judgement about service provision.

People were relaxed in their surroundings and looked well supported. Staff interacted with people in a friendly manner and were attentive to their needs. People were able to participate in varied social activities in relation to their individual needs and preferences. There was an emphasis on people receiving healthy, balanced meals of their choice.

The home was homely, clean and safe. Bedrooms were personalised and reflected people’s individual interests and preferences. Systems such as clear procedures, audits and staff training were in place to minimise the risk of infection.

The staff team were committed, well supported and trained to do their job effectively. Many staff had worked at the home for many years and knew people well.

People had detailed support plans, which identified their needs and the support they required. Other records demonstrated a range of management systems within the home. Records were up to date, well written, organised and stored appropriately.

Three people lived at Dramsdon when we visited. Because of their complex needs they could not give their views on living there. The manager told us families advocated for their relatives in the home and assisted decisions about consent and best interest.

We saw staff and people in the home were at ease with each other and communicated successfully in many ways. We saw staff provided patient and gentle care. Each person had a health action plan, which was up to date. They received annual health checks from a GP who knew them. Person centred plans enabled people to have goals for each year, such as tailored holiday plans.

When we visited in February 2012 we found written records did not accurately reflect the care people received. This time we found record keeping supported and reflected people’s experience of care and support.

Staff we spoke with understood how they would recognise signs of possible abuse and how to report concerns. A rota showed the provider made a manager available on call out of office hours.

Staffing needs were kept under review. Shift timings overlapped to give staff time for good quality handovers of information. The people in the home received consistent care from experienced staff who knew them well.

Care plans, individual goals, health checks and fire safety procedures were reviewed in a planned and timely way. However, when a person had moved in, the home had not worked out an evacuation plan for them as a priority.

We spent time with the people who lived at the home but they had limited capacity to provide meaningful feedback about the service and could not communicate verbally. We observed that people were clean, well presented and appropriately dressed, and they were happy and relaxed in the company of staff that they knew.

We spoke to some relatives who were visiting and others by telephone. They were confident that their family members’ needs were met and that they well cared for at Dramsden. One person told us: “X is happy and content. The staff are very caring”. Another relative described the home as “wonderful”, saying that it had “made a huge difference to Y’s life and mine”. They told us that they were always made to feel welcome in the home and enjoyed the homely, relaxed atmosphere.