This unannounced inspection took place on 12 October 2017. We last inspected this service on 4 August 2015 and rated the service as Good.

Esther Care Home is a privately operated residential and respite service that provides personal care and accommodation for up to 11 adults with learning disabilities. At the time of the inspection there were 11 people using the service.

The service had a registered manager in place. 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.

Although staff confirmed they received a comprehensive induction programme upon commencement of employment; and they were given competencies to complete and have signed off by senior staff, the service did not have clear records of this that were easily accessible. We shared our concerns with the administration manager who confirmed this was being addressed.

Care plans were not always easy to navigate as records were not always kept in one format. The service had an electronic care planning system in place since November 2016, however had not ensured all information was transferred. This meant it was difficult for staff to navigate and ensure they were delivering up to date care.

People were safe, staff had sufficient knowledge of the providers safeguarding policy and procedures to identify and report suspected abuse. Staff received on-going training in safeguarding and whistleblowing to keep people safe.

People were protected against identified risks. The service had robust risk management plans in place that gave staff clear guidance on how to keep people safe.

The service deployed sufficient numbers of staff to keep people safe. The service had systems and processes in place to ensure suitable staff were employed. Staff reflected on their working practices through supervisions and appraisals.

People’s medicines were managed in line with good practice. Staff were aware of the correct action to take in response to any errors and how to seek guidance on minimising the impact on people. The service carried out daily medicine audits to identify any errors.

Staff reflected on their working practices through supervisions and appraisals. Staff were supported to undergo regular training to effectively meet people’s needs. Staff told us they received sufficient training and could request additional training if required.

People are 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.

People confirmed their consent was sought prior to care being delivered.

People were encouraged to make healthy choices and had access to sufficient amounts of food and drink that met their dietary needs and requirements. The service supported people to access a wide range of healthcare services to ensure their health and well-being was maintained and monitored.

The service encouraged people to maintain relationships with people that were important to them. People were supported to make decisions about their care and had their decisions respected by staff.

Staff treated people with respect and encouraged their dignity. People confirmed staff respected their privacy. Staff understood the importance of maintaining people’s confidentiality and embracing people’s diversity and promoting their equality.

The service had developed comprehensive care plans in place that were person centred, reviewed regularly and where possible people were supported to develop their care plans.

People were supported and encouraged to participate in a wide range of in-house and community based activities. People told us they knew how to raise concerns and complaints.

The se

This was an unannounced inspection that took place on 4 August 2015.

Esther Care Home is a privately operated residential and respite service that provides personal care and accommodation for up to 11 adults with learning disabilities.

The home 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.

In May 2013, our inspection found that the service met the regulations we inspected against. At this inspection the home met the regulations.

During our visit we saw that the home provided a safe environment for people to live and staff to work in. There was a warm atmosphere that was enabling and inclusive for people using the service. They came and went as they pleased and told us they had been out enjoying themselves. The home was well maintained, clean and furnished.

People said they liked living at the home and thought staff provided a good service. They said staff provided the care that was needed in a way that people liked. There were also opportunities for people to choose individual and group activities and decide if they wished to participate in them.

The records we sampled were comprehensive and kept up to date. The care plans contained clearly recorded, fully completed, and regularly reviewed information. This enabled staff to perform their duties appropriately.

The staff were very knowledgeable about the people they worked with as individuals. They had appropriate skills, qualifications and were focussed on providing individualised care and support in a professional, friendly and supportive way. Whilst professional, they were also friendly, caring and accessible to people using the service. Staff said they had access to good training, support and career advancement.

People were protected from nutrition and hydration associated risks with balanced diets that also met their likes, dislikes and preferences. They were positive about the choice and quality of food available. People were encouraged to discuss health needs with staff and had access to community based health professionals, as required.

The management team at the home, were approachable, responsive, encouraged feedback from people and monitored the quality of the service provided from day to day, although the monitoring systems required more clarity in their recording to make them easier to use.

On the day of our inspection there were nine people living at Esther Care Home on a permanent basis and one person regularly using the homes respite service.

We used a number of different methods to help us understand the experiences of people using the service because most of the people who lived at this care home had complex needs, which meant they were not always able to communicate with us. The people who did speak with us all said that they were happy living at the home. We received positive responses from people about the staff who cared for them; one person told us "the staff are nice I can do what I want".

Through the use of Short Observational Framework for Inspections (SOFI) we were able to observe that people's experience of the service was a positive one. During our inspection we saw staff always treated people with respect and dignity and people were supported to make informed decisions about how they lived their lives. We also gathered evidence of people's experiences of the service by speaking to the registered manager and other staff who worked in the home and reviewing various records the provider is required to keep.

We saw staff were supported and supervision was undertaken by senior support workers. However we found there was no formal appraisal system in place for the provider/ registered manager to support staff, promote professional development and progress learning and development plans.

The house is well maintained, spacious and attractive. People have their own rooms, six of which are en-suite; one is on the ground floor. There is a well maintained garden. Many of the people living there attend a day centre each weekday. Others go to college once or twice each week and have other outings and activities. When at home people have access to a large sitting room, a dining area and a games room which also accommodates the office.

The people we spoke to said that they liked living there. We spoke to two relatives who praised the care provided by Esther Care Home. They felt people were safe, well cared for and their health and wellbeing had improved since they moved in. We saw that people were respected and their dignity was protected and the care and support provided seemed to be appropriate to their needs. The provider had good mechanisms for monitoring the quality of the environment and has recently introduced systems inviting feedback from people’s representatives.

We noted that a lot of people required fairly high levels of staff attention and we had concerns about whether the staffing level was adequate to ensure people were safe and that their choices were respected. We also had concerns about the degree to which staff understood safeguarding policies and procedures. We have asked the provider to provide an action plan stating how they will address these two concerns.