This inspection took place on 3 and 17 July 2018 and was announced. The inspection was announced to ensure people who used the service would be present.

Eastcliffe is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Eastcliffe accommodates ten people. At the time of inspection the service was providing support and care for ten people.

The manager had started their application to become the registered manager for Eastcliffe and the adjacent service Park Lodge. At the time of the inspection the manager was on annual leave and we were supported by the deputy manager. Following the inspection we spoke with the manager on their return from annual leave.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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, the service was rated as requires improvement. At this inspection we found the service had improved to good.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. 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 citizen.

Risks to people’s safety in the event of a fire had not been managed effectively. The deputy manager took immediate action following our findings ensuring this matter was addressed.

People were involved and consulted about their needs and preferences in regard to all aspects of their lives.

Staff understood what constituted abuse and what actions they should take to ensure people remained safe. Safeguarding concerns were fully investigated. The provider recorded, collated and analysed safeguarding concerns and accidents and incidents to identify any patterns or trends for lessons learnt.

Identified risks were assessed and managed to minimise the risk to people who used the service and others. Medicines were managed safely.

An effective recruitment process was in place. Suitably trained staff were readily available to support people. Staff received regular supervisions and an annual appraisal.

People's independence and choice was enabled by staff who knew them well. Staff treated people with dignity and respect.

People were supported to engage in activities and interests of their choice. People were promoted and supported in maintaining a healthy diet.

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.

The provider ensured people received care and support from healthcare professionals including GPs and community nurses. People were supported in maintaining a healthy and balanced diet.

Comprehensive care plans were available to staff. These were personalised and described how people preferred to be supported.

Relatives were aware of how to make a complaint. The provider had an effective quality assurance process in place.

The manager and deputy manager were supportive to the staff team and were both passionate about their role in ensuring people lived fulfilled lives.

The inspection took place on 13 and 15 February 2017. The first day was unannounced. The service was last inspected in October 2014 and was rated Good.

Eastcliffe is registered to provide residential care and support for up to ten adults with a learning disability or autistic spectrum disorder. At the time of our inspection there were ten people receiving a service living over three floors and in an independent flat within the grounds.

During this inspection we found the provider had breached a regulation. The registered manager failed to engage with relatives and inform them of changes to the service and staffing structure. Relatives felt communication with the registered manager was poor and they didn’t meet with or see them regularly when they visited. The registered manager didn’t hold resident and relative meetings but told us that they were exploring ways to improve communication. Eastcliffe is next door to its ‘sister’ home, Park Lodge. We found that the registered manager was present in the home during different times of the day but their office was based in Park Lodge. Quality audits were not always effective as they failed to identify that Mental Capacity Act 2005 assessments had not been completed in line with the Code of Practice.

Staff were trained in safeguarding and had a good understanding of how to respond to safeguarding concerns.

Risks to people and the environment were assessed and plans put in place to mitigate any identified risks. Policies and procedures were in place to manage medicines.

The provider ensured there were sufficient numbers of staff on duty to support people with their assessed needs. The provider followed safe and robust recruitment procedures.

The provider had an ongoing training plan in place to ensure staff were appropriately equipped with the right skills and knowledge to meet the needs of the people using the service.

Staff received regular supervisions and an annual appraisal to promote and encourage their personal development. People contributed to menu planning and were provided with a varied diet to meet their nutritional needs.

People had DoLS authorisations in place where required. However, MCA assessments completed by staff were not completed in line with the MCA Code of Practice as their capacity was sometimes pre-determined following stage one without always following the required two stage assessment process.

People were supported by staff in a caring, friendly, familiar manner. Staff maintained people’s dignity and were respectful to their wishes. Staff explained support they proposed to provide to people and gained permission prior to doing so.

Advocacy services (this is where vulnerable people and people lacking capacity are supported to make decisions by independent persons who will promote and act in the individuals best interests) were advertised in communal areas of the service and were accessible to people and visitors. This helped to ensure people’s rights were respected and their voice heard.

Staff knew people's individual preferences, interests and abilities. They also know how to communicate with each person in the most effective way to meet their needs.

The deputy manager was based at the home and was present throughout the inspection. Staff attended regular meetings in the home to discuss the people who used the service and identifying any potential improvements to the service.

We spoke to nine people who used the service who were present during our visit. Four people were able to communicate without staff assistance and told us how much they liked living here. Two people showed us their living space and how much they enjoyed being able to pursue their own hobbies and interests. We viewed all of the private living spaces and the communal areas in the home and found a safe, inviting and friendly atmosphere throughout. There was a large, bright and airy communal lounge and conservatory. There is also a large quiet space which is currently being refurbished and will provide extra space for people to relax in.

We spoke to seven members of staff who all spoke positively and without prompt regarding local management, training and working conditions.

We reviewed the comments and complaints file kept in the office. There had been no formal complaints in the five years preceding our visit. Five recent compliments had been received, including a family member who stated "Thank you so much for all you have done."

We spent time talking with some of the 10 men who lived here and the staff. We saw there was a positive, friendly interaction between people and the staff. People told us about all the activities they liked to do.

Some people found it difficult to express their views. We looked at the responses from relatives to a recent annual survey from the provider. One relative wrote, ”The staff and the home have made such a difference to his life - he is happy, respected and understood.”

The house was decorated and furnished to a good standard. The bedrooms were spacious, comfortable and individual to reflect the tastes of each person. People said they “liked” their bedrooms, and they spent time relaxing in their rooms.

We found the service made sure there were sufficient staff available to meet people’s individual needs. The people we spoke with said they “liked” the staff and we saw people appeared to enjoy spending time chatting with staff.

There was a copy of the complaints procedure in easy-read and pictures to help people understand it. This was not in an easy place for people to access and some of the details were out of date. There had been no complaints in the last year.

The people that used the service at Eastcliffe had an autism spectrum disorder and therefore not everyone was able to tell us about their experiences. To help us understand the experiences people had we spent time watching what was going on in the service. This helped us to record how people spend their time, the type of support they get and whether they had positive experiences.

We found that members of staff were very attentive to people’s needs. People looked well cared for and at ease with the staff members who were supporting them.

This inspection took place 28 and 29 October 2014. This was an unannounced inspection. We last inspected Eastcliffe in November 2013. At that inspection we found the provider was meeting all the regulations that we inspected.

Eastcliffe provides residential care for up to 10 people who have learning disabilities or autistic spectrum disorder. At the time of our inspection there were 10 people living at the home.

The home 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.

We saw that people were happy living at the service. They told us the service was "Good," and "It's lovely." People’s relatives were confident they were safe. One told us, "I just land on them and I have never found a negative environment. {My relative} is always smiling and he is very positive." Staff had been trained in safeguarding vulnerable adults and knew how to identify and report any signs of abuse. The provider identified risks to people and ensured staff knew what to do to help keep them safe.

The premises were well-maintained and safe for people and staff to use. We saw there were sufficient numbers of suitable staff to keep people safe and meet their needs. Relatives we spoke with were also confident about this. One relative commented, "There's more than enough staff. We're very happy with them. They feel like family." We found there were thorough recruitment procedures in place. This helped to protect people as checks had been carried out on potential staff before a decision was made to employ them.

We found people’s medicines were managed safely. Staff followed safe procedures which helped ensure people’s medicines were stored correctly, ordered in time and given to them when they needed them.

Staff told us they felt supported by the provider, by way of training, supervision and appraisal. This helped them provide effective care for people. Relatives we spoke with were confident the staff team had the skills needed to care for people well. One relative described what this had meant for their family member who lived at the service. "My husband and I cannot praise this provision highly enough. It is an excellent service provider with staff that have empathy and understanding and the skills, knowledge and experience to support our son. He is happy, well cared for and continues to make progress."

We found that the service provided good care for people. This had led to people becoming much more settled and happy over the years. For instance, one relative described how their family member had changed as a result of the care provided by Eastcliffe. They said, “His body language and body position is much more settled. He has gone from being a hyperactive boy to a very poised adult. They know his needs and always get his permission (to provide care)."

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Some staff could not explain the relevance of the Mental Capacity Act 2005 (MCA) and the DoLS in relation to their work, although they had been given training about this.

We found people were supported to eat and drink enough and maintain a balanced diet. Staff understood the individual needs of people in relation to eating and drinking and they monitored this. Relatives we spoke with told us this aspect of their family members’ care was managed very well. Staff supported people to maintain good health and to access healthcare services where necessary.

People and their family members told us they were well cared for and treated with dignity and respect. They said, “I am happy here.” “Staff listen to you.” A relative commented, “They are really caring. It’s like a big family.”

People were provided with individualised support which took account of their specific needs. Their needs and wishes were described fully in their support plans.

People and their relatives were very satisfied with the care provided. None of the relatives we spoke with had felt the need to make any complaint about the service. They were confident that if they had any concerns, the service would respond and deal with these appropriately.

There was an established registered manager who had managed the service for over ten years. He had ensured there was an open and positive culture in the service. People and their relatives felt supported by him. Relatives in particular, felt that his management had led to positive improvements in their family members’ wellbeing. For instance, one relative told us, "I speak to Mike Winters [registered manager] and (a senior member of staff); they are very open. It's very nicely run. Every time I go, the staff are happy. My relative's behaviour has changed to become much more positive."

The provider undertook a range of audits to check on the quality of care provided and identify where any improvements were needed.