About the service:

• 3 Edith Road (Tregona) is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided. Both were looked at during this inspection. At the time of our inspection there were three people living in the service.

• The service supported people with learning disabilities who displayed behaviours which may challenge others. Staff did not wear anything that suggested they were care staff when coming and going with people.

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

People's experience of using this service:

We received positive feedback about the service and the care people received. The service met the characteristics of Good in all areas.

• The service effectively applied the principles and values of Registering the Right Support and other best practice guidance. These ensured that people who used the service lived as full a life as possible and achieved the best possible outcomes, that include control, choice and independence.

• People experienced high quality care that was safe, effective, caring, responsive and well led.

• People’s relatives, care managers and supporting health and social care professionals consistently provided positive feedback about all aspects of the care people received.

• People were supported by a small, consistent staff team who were kind, caring and inspired by their manager to deliver high quality, personalised care.

• People were protected from discrimination, neglect, avoidable harm, and abuse by staff.

• Staff ensured the human rights of people who lacked a voice, due to complex communication needs, were upheld and respected.

• Risks to people's safety had been identified and assessed. Staff followed people’s risk management plans to keep them safe.

• Staff felt valued and respected by the management team and consistently demonstrated high levels of morale.

• Staff had the required skills to meet people’s needs effectively, which led to good outcomes for people and promoted their quality of life.

• People’s care plans were comprehensive, providing staff with the required information about their needs and how to meet them.

• The registered manager had worked effectively with local organisations, health and social care professionals and multi-disciplinary teams and was often the driving force to improve outcomes for people, through joined up care provision.

Rating at last inspection:

• At the last inspection on 29 November 2019 the service was rated good.

Why we inspected:

• This was a planned inspection o the service.

Follow up:

• We did not identify any concerns at this inspection. We will therefore continue our on-going monitoring of the service and all information we receive. We will use this information to determine when we next inspect the service.

Edith Road (Tregona) is a care home without nursing, operated by a corporate adult social care provider. The provider operates an additional three registered limited companies. Edith Road (Tregona) is one of 300 locations under Voyage 1 Limited. The care home provides accommodation and personal care to people with learning disabilities and/or autism spectrum disorder. The house is a detached bungalow with three bedrooms, situated in a quiet residential street of Maidenhead.

The location is registered to accommodate up to three people. At the time of the inspection, two people lives at the care home.

At the time of the inspection, there was no registered manager. 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. Our registration team was in the process of registering the home manager with us.

Since transitional registration under the Health and Social Care Act 2008 on 20 October 2010, Edith Road (Tregona) has not always maintained compliance with the relevant regulations at each inspection by us. However, at the most recent inspection was a routine planned visit on 8 September 2014 we checked five outcomes, all of which were compliant. This inspection is the first visit under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the first comprehensive rating under the Care Act 2014.

People were safeguard from abuse and neglect. There was a robust system in place to ensure that people’s safety was maintained.

Risks for people were assessed, mitigated, documented and reviewed. Appropriate records were kept and readily available to demonstrate this to us at the inspection.

The building and premises risks were assessed and managed to ensure people, staff and visitor safety at all times.

Enough staff were deployed to support people. Care workers we spoke with were satisfied that there was sufficient staff and that they did not place people at risk when they were busy. Our observations showed that the service was busy at times, but overall calm and relaxed and staff were dedicated to the people they supported.

Medicines were safely managed. We examined the handling of people’s medicines during our inspection and found that people were safe from harm. Storage of medicines was correct. The community pharmacist audited the safety of medicines management at Edith Road (Tregona) and found only a small number of improvements were needed.

Staff were knowledgeable and competent. They received appropriate levels of training, supervision and performance appraisal. Relevant subjects were used to teach staff about caring for people with learning disabilities. This included the management of challenging behaviour and dealing with people’s epilepsy.

The service followed the requirements of the Mental Capacity Act 2005 (MCA). The recording of consent and best interest decision meant the service complied with the MCA Codes of Practice. There was clear information at the service regarding people’s applications, reviews and expiry dates for standard DoLS authorisations.

People received nutritious food which they enjoyed. Hydration was offered to people to ensure they did not become dehydrated. Snacks and treats were available if people wanted or chose to have them.

We found the service was caring. We observed staff were warm and friendly. As staff had worked with most people over an extended period of time, they had come to know each person well. The two people who used the service had lived there for a long period of time. This reflected in the care that people received from staff.

Responsive care was provided to people. Their wishes, preferences, likes and dislikes were considered and accommodated. Staff knew about the compla

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

At the time of this inspection there were two people living at the home. We used observations of the interactions between them and the staff to assess their views on how they were cared for as they were not able to communicate verbally with us. As part of this inspection we spoke with the registered manager, three care staff, the relative of one of the people living at the home and one care manager from the local authority. We also reviewed records which included, two care plans, daily care records, and other records relating to the management of the home.

Is the service safe?

People experienced care and support that was planned and delivered in a way that was intended to ensure people’s safety and welfare. The provider had effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager was aware of a recent Supreme Court judgement changing the way a 'deprivation of liberty' is determined. The manager had reviewed all people at the home that the ruling may apply to and had applied for and obtained authorisation as required under DoLS legislation.

Is the service effective?

The care plans showed people's needs and any risks to their welfare and safety were assessed. The daily notes and health professional notes showed care and treatment was planned and delivered in line with people's care plans. The relative we spoke with told us they felt their family member's needs were being met and their care was delivered in the way they preferred.

CQC monitors the operation of the Mental Capacity Act 2005 which applies to all services providing care and support for people. Before people received any care or treatment they were asked for their consent and the staff acted in accordance with their wishes. Staff we spoke with demonstrated a good understanding of people's rights to make their own decisions and their individual responsibilities under the requirements of the Mental Capacity Act 2005.

Is the service caring?

Our observations of interactions between staff and the people living at the home demonstrated staff had a sound knowledge and understanding of the people's individual ways of communicating.

All interactions observed were calm, caring and professional. Staff showed that they knew the needs of the people they were supporting and we saw they were doing things the way people liked them done.

Is the service responsive?

Care plans and risk assessments were routinely reviewed and any identified changes were documented. Changes or newly identified needs had been added to care plans and any actions taken in response were clearly recorded. Where changes were identified, appropriate actions were taken, for example, consultation with, or referral to, an external health professional.

There was evidence that learning from incidents or investigations took place and appropriate changes were implemented. For example, following an incident, the home had obtained a specialised piece of equipment that would enable staff to assist someone up from the floor if needed.

Is the service well-led

The provider had an effective system to regularly assess and monitor the quality of service that people received. People who use the service, their representatives and staff were asked for their views about their care and support and they were acted on.

The home had an effective system to regularly assess and monitor the quality of service that people received against the requirements of the essential standards. The relative we spoke with was aware of how to complain although they commented they felt there was nothing to complain about.

Staff we spoke with felt they were provided with training that enabled them to do their job safely and efficiently. We found there were enough qualified, skilled and experienced staff to meet people’s needs. We looked at the staff training records and saw that all staff were up to date with the training the provider considered mandatory.

We spoke with staff and a family member as the people who lived at the home were unable to communicate verbally with us. The staff told us they felt well supported to perform their role and that they felt they knew people well which meant they ensured they were meeting their needs. They told us they used the care plans to help them support people and to understand their preferences which meant they ensured people were cared for as they wanted to be.

We spoke with a family member who told us they felt their family member was looked after "very well" and that the staff seemed "very happy here". They told us they felt the staff were very supportive and were good at adapting to the needs of their family member as their health and abilities changed over the time they had lived there.

We observed people at the home and saw that they seemed content whilst in their rooms or the communal areas. We saw the care plans stated different types of behaviours that people displayed when they were happy or when they were frustrated or hungry, we observed that people displayed the behaviours of being happy for the majority of our visit and those of being hungry at lunch time. This meant that the staff ensured they met the needs of people and were minimising frustration and anxiety.

We used a number of different methods to help us understand the experiences of people who use the service because people had complex needs and they were unable to tell us their experiences.

The registered manager was not present during the inspection. We spoke with care workers during the visit and the operations manager by telephone.

At a previous inspection on 20 August 2012, we found the provider was non-compliant with three outcomes, and we issued compliance actions about these regulations.

We viewed the building and premises and observed that improvements had been implemented. We looked at records about staffing and management of the home. We saw the provider had made changes to ensure they were compliant with this outcome. The registered manager had decided to transfer to the position of deputy manager, which meant the provider was now compliant with the training requirements for this position.

People who used the service were unable to communicate verbally. We used observation wherever we could, to help us understand their experiences and views of the service provided.

We observed members of staff interacting with people who live at the home. We saw people were offered choices about aspects of the way they were cared for and people were well groomed and seemed content either in their bedrooms or in the communal living spaces.

We observed the kitchen had been renovated since our last inspection. However, other parts of the premises such as paving stones in the garden, needed repairs. We looked at a copy of the home's annual service review from November 2011. Relatives had commented about single glazed windows at the front of the property but the manager was unable to tell us if these were to be replaced.

Care plans were person centred and contained detailed information about how to care for each person. We saw staff records and other records relevant to the management of the service were available but not always detailed or in a format that enabled the provider to access the information promptly.

We spoke to one person during our visit. Other people who use the service were unable to communicate verbally, so we used observation wherever we could, to help us understand their experiences.

One person told us they have access to medical care when they need it and are supported to attend appointments.

We observed staff respecting people’s wishes, for example, a request not to go to the day centre but to stay at home instead.

We observed people having freedom to move around the building and sit where they wanted, whether in company or in their rooms. We saw a member of staff encouraging a person to put some warmer clothes on when she realised her hands were cold.

We saw that personal care was carried out in private areas of the building (bathrooms or bedrooms) and staff were heard knocking on the bathroom door before entering. We heard a member of staff asking a person using the service if she could go into to her room to collect something on her behalf.