We inspected Estoril on the 26 November 2018.

Estoril is a residential care home for up to five people with learning disabilities. At the time of our inspection five people were using the service. The service was provided in a converted house in a residential area with easy access to the local community and had a large garden. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

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.

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.

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.

The service was safe. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were systems in place to minimise the risk of infection and to learn lessons from accidents and incidents. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

The service was effective. People were cared for and supported by staff who had received training to support people to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. 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. People were supported to eat and drink enough to ensure they maintained a balanced diet and referrals to other health professionals were made when required. The environment was well maintained and suitable for the needs of people.

The service was caring. Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences for care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed choices.

The service was responsive. People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis. People were supported to follow their interests and participate in social activities. The registered manager responded to complaints received in a timely manner.

The service was well-led. The service had systems in place to monitor and provide good care and these were reviewed on a regular basis.

Further information is in the detailed findings below.

The inspection took place on 2 February 2016 and was unannounced.

Estoril is a small care home providing intensive support for up to five people who have a learning disability or who are autistic and have complex support needs. The service does not provide nursing care. At the time of our inspection there were five people using the service.

A registered manager was in post at the service. 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.

Detailed assessments had been carried out and personalised care plans were in place which reflected individual needs and preferences. However, there was a focus on supporting people with their behaviour needs and as a result; people’s individual cultural and spiritual preferences were not always considered. Staff used on-going observation to establish people’s views but had not considered alternate ways of finding out what people thought of the service they received. People enjoyed going out with staff but were not always supported to engage in meaningful activity when at home.

Staff had a good understanding in how to keep people safe. Risks were well assessed and steps were taken to minimise potential risks. There were sufficient numbers of staff to meet people’s care needs and keep them safe. There were systems in place to manage medicines and people were supported to take their prescribed medicines safely. The provider had a robust recruitment process in place to protect people from the risk of avoidable harm.

Staff were focussed on ensuring all decisions were made in people’s best interest, involving family and outside professionals as appropriate.

Staff supported people to have sufficient food and drink that met their individual needs and preferences. People’s health needs were managed by staff with input from relevant health care professionals.

People were treated with kindness, dignity and respect by staff who knew them well. Staff had the skills to support people to communicate their preferences. The provider had an effective complaints procedure and people had confidence that concerns would be investigated and addressed.

There was an open culture and the manager demonstrated good leadership skills. Staff were enthusiastic about their work and felt able to express their views. The provider had systems in place to check the quality of the service and to make improvements where necessary.

People who use the service have learning difficulties and many were not able to verbally comment on the care or services provided.

We toured the building and were invited into people’s bedrooms. We saw people kept their rooms in the way they preferred. One person told us their room was untidy because that was how they liked it.

Care records indicated that the needs of people had been carefully monitored and attended to. The care records contained appropriate assessments, care plans and reviews. Details of appointments with healthcare professionals were recorded.

We saw a range of other records were in place to protect people against the risk of unsafe or inappropriate care. This ensured staff had the necessary experience and qualifications to support people with their care appropriately and safely.

There were suitable arrangements in place to manage medicines. This ensured that people were protected against the risks associated with medicines.

The premises were clean and tidy. Safety inspections of the portable appliances, gas and electrical installations had been carried out. Fire safety arrangements were in place.

The home had a development plan and suitable arrangements for monitoring the quality of care provided.

Some people were not able to verbally tell us their experiences. We therefore used a number of different methods to help us understand the experiences of people who used the service, including talking to people, looking at records and observing the care being delivered.

We could communicate verbally with some people who used the service to find out their views and experiences. One person we spoke with told us that they felt well cared for and that they were happy living at the home.

We saw evidence of choices and decisions made by people who used the service recorded in their care plans.

We saw that people who used the service were comfortable with staff and had good interaction with them. It was clear that staff knew the people they were supporting very well. Staff showed a good understanding of people’s communication needs.