The inspection took place on 24 August 2018. The inspection was announced. This was because the service is a small care home for people with learning disabilities and/or autism who are often out during the day. We needed to be sure that they would be in. Telephone calls were made to relatives on 6 September 2018 in order to capture their views and experiences of the care provided to their loved ones.

8-8a The Cedars is a residential care home for 10 people with learning disabilities and / or autism. There were seven people receiving care at the time of this inspection aged from early 20’s to 60 years of age. There are two buildings making up the premises, people with a range of needs live in the main building and people with more complex needs live in ‘The Coach House’. Bedrooms in the main building are decorated and furnished as flats, with two self-contained flats within The Coach House.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The care service had adopted the principles and values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. Some people with learning disabilities and autism using the service can live as ordinary a life as any citizen. For others there were some limitations to this due to their complex care and support needs.

Staff had received relevant training and the provider employed robust recruitment procedures to keep people using the service safe. Staffing levels were appropriate and reflected people’s needs with risks appropriately assessed, monitored and mitigated. Medication was safely managed in line with relevant guidelines and were being consistently reviewed to improve administration practices. Premises were safe, clean and tidy and infection control procedures were in place to minimise risk.

Care and support needs were appropriately assessed to ensure that people’s ongoing needs and required outcomes were captured. Staff had received appropriate training to deliver effective care and support and this was monitored and managed by the registered manager and the provider central function. People had access to various healthcare professionals and this was well managed with information routinely shared across organisations. The service supported people to maintain healthy lifestyles and this included specific exercise plans and good nutrition and hydration. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Premises were adequately adapted and designed to meet the specific needs of people who lived at the home.

There was a strong staff group who understood people’s needs. Staff had developed positive relationships with people and there was a relaxed and happy environment throughout the home. Staff used a variety of resources to ensure that people were involved in decisions about their care and support which included signing and visual aids. Staff protected people’s privacy, dignity and respect by affording people their own space, holding confidential discussions in private areas of the home and being unobtrusive in their presence.

The staff team adopted a person centred care approach when setting goals and outcomes with people who lived at the home. Goals were focused on what the individual wanted to achieve as opposed to what others wanted the individual to achieve. This included proactive planning in respect of end of life care which focuse

We carried out this inspection of 8-8A The Cedars on 19 and 26 April 2016.

The last inspection of this service was carried out on 3 December 2013. The service met the regulations we inspected against at that time.

8 The Cedars is registered to provide care and support for up to 10 people with autism spectrum condition and associated complex needs. There were eight people living at the service at the time of this inspection, six in the main house and two people in adjacent coach house. This home does not provide nursing care.

The service had a registered manager who had been in post at this home for five years. 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.

The people who lived at this home were subject to deprivation of liberty safeguards (DoLS) which meant they needed supervision both inside and outside the home for their safety. It is a legal requirement that services tell us about the outcome of DoLS. During this inspection we found that the service had not told us the outcomes of applications that had been made during 2015-2016 about the DoLS. This had been an oversight, as DoLS notifications from the previous year had been submitted to the Care Quality Commission (CQC). We have written to the provider about this outside of the inspection process.

The people who lived at the home had complex needs that meant they were unable to fully express their views. Relatives said people were “safe and well looked after”. One relative told us, “I have always found [my family member’s] needs to be safely managed to a high level.”

Staff were clear about how to recognise and report any suspicions of abuse. There were good systems for staff to be able to raise concerns with senior managers at any time of day or night. Relatives and staff felt there were enough staff on duty at all times to make sure people were safe.

Staff were vetted before they started work at the service to make sure they were suitable to work with vulnerable adults. Staff managed people’s medicines in a safe way for them.

Relatives felt staff were competent and experienced at caring for people with the complex needs associated with autism. Staff said they felt well trained and supported in their roles. Staff understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision and Deprivation of Liberty Safeguards to make sure they were not restricted unnecessarily.

People were supported to have as independent a lifestyle as possible. They were encouraged to enjoy a healthy lifestyle and balanced diet. A relative commented, “Nutrition is always high on the agenda and a good variety of meals are provided.”

People who were able to express a view said they “liked” the home. Relatives made positive comments about how people reacted to the home and the support they received from staff. One relative told us, “I know [my family member] is very happy there and is always ready to go back after home visits.”

A relative commented, “I believe my family member is well looked after by some genuinely caring, enthusiastic staff.” Staff felt there was a “caring culture” at the home and they promoted this with new staff coming to work there.

The records about how to support people were personalised, individual and detailed. People had a range of social and vocational activities that were tailored to their preferences and choices.

People and their relatives were asked for their views about the home and their suggestions were used to improve the service. People and relatives had clear information about how to make a complaint or comment.

The provider involved people and their relatives in reviews about the individual care service people received. Staff felt there w

We spoke to four members of staff who spoke positively and without prompt regarding local management, training and working conditions. We also spoke to two people who lived there who told us that they were happy in the home.

We spent time in the home observing people and staff and found evidence that people were treated as individuals and with respect. We also found evidence of this by reviewing procedures such as the service user consultation policy, activity plans and behaviour profiles.

We viewed four private rooms and the communal areas in the home and found a safe, inviting and friendly atmosphere throughout. There were two large, bright and airy communal lounges, two dining rooms and a well-kept garden that was available for people to use for activities.

We reviewed the complaints procedure with the registered manager and found that there had been no formal complaints since the home had opened.

We haven’t been able to speak to all of the people using the service because some of the people had complex needs, which meant they were not able to tell us their experiences. However, we spoke with one person who told us that “I am fine today” and another told us” I am going out”. We also gathered some evidence of people's experiences of the service by observing care practice. Staff were seen to be attentive and gave people the information about their activities and meal options in a way that was appropriate to their needs. We observed staff discreetly speaking to one person when they were showing signs of becoming anxious.

Throughout the inspection, the staff members on duty were observed speaking to people in a kind and respectful way. We also observed that the people were clean and well groomed.

We asked some of the people for their views of the service. One person commented, "I like

living here it is alright". Another person was about to go out and they commented, "I am

going out Christmas shopping" and another person told us, "I have been to see Duran

Duran in Newcastle". One person commented, "Yes, I like living at this place", and another

person commented "I go out to college". However, due to the complex needs and different

communication styles of people who were using the service the information we received

verbally from some was limited.