This inspection was unannounced and took place on 10 and 11 January 2017. East Court is a care home for 17 adults with learning disabilities aged between 18 and 65 years of age. At the time of the inspection there were 16 people living in the home. The home sits in its own private grounds and has several outbuildings, some of which are used to provide workshops. The home provides day services for people from sister homes nearby, so people could take part in a range of activities and social occasions.

There is 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.

People told us people were kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.

Systems, processes and standard operating procedures around medicines were reliable and appropriate to keep people safe.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring.

Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and families were involved in making decisions about their care.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Staff told us the registered manager was accessible and approachable. People and staff felt able to speak with the manager and provided feedback on the service.

The manager and provider undertook audits to review the quality of the service provided and made the necessary improvements to the service.

The inspection was carried out by one inspector, who answered the five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found the service to be safe because people were treated with respect and dignity by the staff. People were involved in making decisions about any risks they may take.

When people were at risk, staff followed effective risk management policies and procedures to protect them. Staff supported people to take informed risks with minimal necessary restrictions to as far as possible protect their welfare.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The manager was in the process of re-assessing the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) for people who use the service and was having discussions with local authorities about this. This meant that people were protected from discrimination and their human rights were protected.

The service followed safe recruitment practices. The service followed clear staff disciplinary procedures when it identified unsafe practice.

Is the service effective?

We found the service to be effective because there was an advocacy service available if people needed it, this meant when required people could access additional support.

Care plans reflected people’s current individual needs, choices and preferences. People’s health was regularly monitored to identify any changes that may require additional support or intervention. Referrals were made quickly to health services when people’s needs changed.

People’s identified needs were monitored and managed.

Is the service caring?

We found the service to be caring because people were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. Staff responded in a caring way to people’s needs when they needed it.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. Appropriate professionals were involved in planning, management and decision making.

Staff knew the people they were caring for and supporting. Staff showed concern for people’s well-being. People were as independent as they wanted to be. People told us, “We have a choice of activities. I like drama, college and I play drums on Saturday” and “They give me options, I have three choices.” Staff told us, “People can choose their own holidays and day care activities” and “People choose their daily activities and also choose their meals for the week.”

Is the service responsive?

We found the service responsive because, where appropriate, a person’s capacity was considered under the Mental Capacity Act 2005. When a person did not have capacity, decisions were always made in their best interests. Advocacy support was provided when needed.

People had their individual needs regularly assessed and met. There were arrangements in place to speak to people about what was important to them.

People completed a range of activities in and outside the service regularly. People had access to activities that were important and relevant to them and were protected from social isolation.

Is the service well-led?

There was a registered manager in post on the day of our visit and all other conditions of registration were met.

There was a clear set of values that included involvement, compassion, dignity, respect, equality and independence which was understood by all staff. Staff were motivated, caring, well-trained, supported and open.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Robust quality assurance and governance systems were in place and used to drive continuous improvement.

Concerns and complaints were used as an opportunity for learning or improvement. The management team enabled and encouraged open communication with people, those that matter to them and staff. Staff knew and understood what was expected of them. People told us, “I’d tell a member of staff if I wasn’t happy” and “I can tell staff if I don’t want to do anything.”

When we inspected 17 people were living in East Court and nine people were attending day care services. We spoke with 14 people, four care staff, the manager, deputy manager and the provider’s chief executive.

We observed people were free to make their own choices regarding all aspects of their day to day living. One person said “Within reason I can do what I want”.

People said they were happy with the care and support they received. One person said “Staff look after me and take away my worries”. Another person said “Staff support me to do what I want”.

Care and treatment was planned and delivered in a way that ensured people’s safety and welfare. There was a much wider range of risk assessments and associated management plans in place than at our last inspection.

Care staff received training in the safe administration of medicines. They said they always checked to ensure the correct prescription and dose was given.

Staff told us they received ongoing training which gave them the skills and knowledge to safely support people. Many of the care staff had national vocational qualifications in health and social care. This meant people had access to staff with the skills and qualifications to meet their needs.

The provider had a complaints policy in place for ensuring complaints were recorded and fully investigated. We found most issues were resolved informally to the satisfaction of the person concerned.

We observed people being supported and looked at nine out of 17 people's care plans. We spoke to people being supported and members of staff. We found that people's privacy, dignity and independence were respected. We saw and were told that people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

In the care plans we looked at we saw that individual assessment of need and risk assessment was not comprehensively carried out. This meant that people's needs were not assessed and care and treatment was not planned and delivered in line with their individual care plan.

Safeguarding policies and procedures were up to date and in place. Staff were trained in safeguarding and knew how to raise any concerns. People told us they liked living at the service with one person also saying "staff are easy to talk to" and "if I didn't like the staff I'd say".

We found there were enough qualified, skilled and experienced staff to meet people's needs. We were told by people supported "I like the staff" and "the staff are nice".

The provider had systems in place to assess and monitor the quality of service that people receive. We found that these systems were used and that people's views were taken into account. We found the provider was learning from incidents and investigations, making changes where needed and implementing those changes.