This was an unannounced inspection that took place on 11, 12 and 13 December 2018.

21b Upper Brighton Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides care for up to seven young people including people with learning disabilities or autistic spectrum disorder. It is located in the Surbiton area of Surrey.

The service had a 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 and associated Regulations about how the service is run.

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.

At the last inspection in June 2016, the home was rated overall good with safe, effective, caring and well-led being rated as good and responsive as outstanding.

Younger adults with learning disabilities or an autistic spectrum disorder received a service from the home. They had moved from residential schools, other care home placements or parental homes where their support needs could no longer be fully met. The move had massively impacted on their lives in a positive way that was reflected in their progress, personal achievements and opportunities to try new experiences.

There were numerous, varied activities that the young people benefited from, in the community, at home and elsewhere. Staff took great pains to support and help the young people to make their activity choices, based on the interests they had and things they liked to do. Whilst people did not verbally comment about the activities they pursued, their body language showed us they enjoyed them with lots of smiling, laughter and enthusiasm. This had an impact of people thoroughly enjoying their activities and developing bonds and friendships, through them, with staff, each other and others, outside the home.

The home’s positive impact on the young people was further demonstrated by a significant reduction in incidents and situations where people may display behaviour that others could interpret as challenging. Where people displayed anxiety or anger through aggressive behaviour, staff were available and understood how to defuse situations. They understood that this behaviour was a way of expressing people's needs, emotions, feelings and communicating them. Staff were skilled at turning people’s negative behaviour and frustrations into positives by calming situations, finding out what was wrong or what people wanted and addressing their needs. This was achieved by having a thorough knowledge of each person and their likes and dislikes based on trial and error and growing positive relationships and bonds with them.

Due to people’s limited verbal communication, relatives mainly spoke on their behalf. Relatives told us the home had a warm, welcoming and friendly atmosphere. They said staff treated the young people's safety as a priority. This was whilst still acknowledging that people must be enabled and supported to try new experiences and pursue opportunities by taking acceptable risks. Staff weighed up the benefits of activities with the young people in relation to the risks involved. This was demonstrated by the number of new experiences and activities people safely had whilst continuing with those that they previously enjoyed. This meant people received a service that was individual to them. The service and activities were flexible and

We undertook an unannounced inspection on 7 June 2016. At our previous inspection on 3 April 2014 the service was meeting the regulations inspected.

London Care Partnerships Limited – 21b Upper Brighton Road provides accommodation, care and support to up to seven males with a learning disability and/or autism. Some people also had a diagnosis of epilepsy. At the time of our inspection six people were using the service, as one person was on social leave visiting their family.

The service had a 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.

People received the support they required from staff. People’s relatives were grateful for the support provided and felt their family members were well cared for. Staff assessed people’s needs and provided them with the level of support they required. People were supported to develop their independence and learn new skills. A system was in place to encourage people to identify what goals they wished to be achieved and what steps would need to be completed to work towards these goals. We saw that some of the goals set had been achieved. People were being supported to develop their daily living skills and were able to undertake some household tasks. Some people were accessing college courses and staff were currently supporting people to identify employment opportunities, to further develop their skills.

People had made progress since being at the service. Through the support provided by staff and the provider’s behaviour analyst we saw that incidents when people behaved in a way that challenged staff and others had reduced, meaning there was less reliance on the use of ‘when required’ medicines. Relatives also said that people’s communication skills had improved since being at the service. Staff supported people to make individual progress, including managing holidays abroad and supporting people to structure their day.

Staff had built trusting and positive relationships with people. We observed staff adjusting their communication depending on who they were interacting with so that the person could understand what was being communicated. Communication plans and pictorial communication methods were used to further support people to communicate effectively.

Staff supported people with their individual needs. This included in regards to positive sexual health, race, religion and culture. People were supported to maintain contact with those who were important to them. This included supporting people with overnight visits to family, and regaining contact with previously distant family members.

People received the level of support and input from staff they required. This was based on people’s needs and those related to their behaviour. This process was proactive and as people started to show signs which were known to be precursors to incidents where people might behaved in a way that challenged staff and others support was provided by staff to defuse situations. Staff also supported people to receive support with their health through contact with specialist healthcare professionals. Many people had regular contact from dieticians, physiotherapists and speech and language therapists. Care records showed that people were making progress in line with the advice given. Safe medicines management processes were followed and people received their medicines as prescribed.

People were supported to remain safe. Assessments were undertaken to identify any risks to their safety and management plans were in place to minimise these risks. Staff were aware of the potential risks to people at the service and in the community. Some people were deprived of their liberty in order to keep them safe, an

This inspection was carried out by an Inspector who helped answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? 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?

Safeguarding procedures were in place and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such incidents, patterns of challenging behaviour, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

People might not be protected against the risk of poor care because the staff we spoke to did not have a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS), and their responsibilities in relation to them. Staff explained how they would support a person with a behaviour that challenged the service, which could be a deprivation of the person’s liberty. We saw that no applications for DoLS had been submitted, although the provider is considering making an application.

Recruitment practice was safe and thorough to make sure only suitable people were chosen to work with people who use the service. Staff felt well supported and disciplinary action was taken when necessary by management.

Is the service effective?

People were involved when their health and care needs were assessed, and in writing their plans of care. Specialist behavioural management support had been identified in care plans where required.

The premises has been sensitively adapted to meet the needs of people with autism and learning disabilities, with large, open spaces, private bedrooms with en-suite facilities, and two communal lounges.

Is the service caring?

People were supported by attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented that they like living in the home and like the staff. We saw that staff were not rushed and spent time with residents talking to them or in activities.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The home had its own car, which helped to keep people involved with their local community.

The service had responded appropriately to allegations of misconduct by staff, as well as to safeguarding allegations.

Is the service well-led?

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

The manager and area manager monitored and assessed quality within the home in various ways. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes in place. This helped to ensure that people received a good quality service.

We spoke with people who lived in the home who told us about their daily and weekly routines. One person told us;

"I am really happy here. I can go to anyone for help".

People who did not use ordinary speech to communicate were also able to demonstrate how they felt involved and consulted in the home by the manner in which they engaged with care staff and how staff responded to them.

People were able to tell us who their key worker was and let us see the types of activity they enjoyed.

Staff we spoke with showed that they had a sound understanding of people's needs and that they understood the best way to support people. This was reflected in care records and other documentation, such as details on people's likes and dislikes at mealtimes and the areas where people needed most support.

The service was knowledgeable in its responsibilities towards safeguarding people from the risk of abuse. The service was able to demonstrate that it complied with all requirements relating to making notifications and involving appropriate authorities if there was a concern. This included ensuring they liaised with the local authority social services teams, health services and Care Quality Commission.

Staff were able to demonstrate that they received training in areas of their work, such as awareness of disabilities, training in autism, medicine management, safeguarding and working with challenging behaviour.

During the visit to the home service users were engaged in their own activities and routines. Although we did not discuss specific topics or specific standards in themselves with service users, we learned through casual conversation that people felt comfortable in the home, secure with their staff team and enjoyed autonomy and choice in how they spent their day.

We saw positive interactions between staff and people who use the service, with staff being supportive towards the needs of people. We saw that staff treated people with respect and maintained their privacy and dignity. Service users demonstrated a positive and familiar relationship with staff and had free access to staff, both in the office and other areas of the home.