About the service: Firs and Hewlitt provides accommodation and personal care for up to 13 people with a learning and/or physical disability. At the time of our inspection 11 people lived at the service.

People’s experience of using this service:

We found the service continued to meet the rating of a good service. For more details and a copy of the full report, please see the full report which is on CQC website at www.cqc.org.uk

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.

People told us they liked living at Firs and Hewlitt and that staff were kind and caring. People said they did not have to wait to be supported by staff. However, we found deployment of staff was such that people may miss out on important interaction from staff. We also found that the communal environment in which people used required improvement, redecoration and new furnishings. We have issued a recommendation to the registered provider in this respect.

People said they could take part in the activities of their choice and there was evidence in people’s care records they had been fully involved in their care planning.

People were provided with the food of their choice and they were supported to be involved in the running of the service through regular meetings, as well as being able to do things independently.

People were kept safe by the robust processes and procedures in place that related to medicines, recognising safeguarding incidents, identifying risks to people and acting on concerns or worries.

People were cared for by staff who received appropriate training and staff who felt supported by management and enjoyed their role.

People lived in an environment that suited their needs and they were assisted with accessing health care professional involvement when needed. People were supported by other professionals to help ensure their quality of life was improved as staff at Firs and Hewlitt worked in conjunction with other agencies.

Rating at last inspection: We last inspected Firs and Hewlitt on 31 March 2016 when we rated the service as Good. The report was published on 20 May 2016.

Why we inspected: This fully comprehensive inspection was carried out in line with our inspection methodology in that we scheduled the inspection based on our previous rating.

We carried out an unannounced inspection on 31 March 2016.

Firs and Hewlitt provides accommodation and personal care for up to 13 people with learning and physical disabilities. At the time of our inspection there were seven people living in The Firs and five people living in Hewlitt and both were located next door to each other.

The service had two managers in post; one was the registered manager, while the other manager was in the process of registering with the commission. Each bungalow was managed independently from the other and the provider was in the process of registering the bungalows as independent homes. 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm. People’s medicines had been managed safely.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff who knew them well. Staff also felt that they knew the people they supported well.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices. The service supported people with health care visits such as GP appointments, optician appointment, chiropodists and hospital visits.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to continually improve the quality of the service. The provider also had effective quality monitoring processes in place to ensure that they were meeting the required standards of care.

During our inspection we spoke with eight people who used the service, six support staff, three managers, three relatives and one external health professional. We considered all the evidence we had gathered under the outcomes we inspected.

This is a summary of what we found:

Is the service safe?

People told us they felt safe. Safeguarding vulnerable adults from abuse procedures were robust and staff understood how to safeguard people they cared for. Systems were in place to make sure that managers and staff learnt from events such as accidents, incidents, complaints and whistleblowing investigations. This reduced the risks to people and helped the service to continually improve.

The service had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put into place to ensure that people's human rights are protected should their liberty be restricted in any way. Staff had been trained to understand when an application should be made and knew how to submit one.

Staff knew about risk management plans and showed us examples where they had followed them. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

Staff were sufficiently qualified, skilled and experienced to meet the needs of the people who used the service. We looked at staff rotas which showed us that there was an appropriate level of staffing in place. Policies and procedures were in place to make sure that unsafe working practice was identified and people were protected.

Is the service effective?

People’s health and care needs were assessed with them. Specialist dietary, personal care and psychological needs had been identified in care plans where required. People told us that they had been involved in writing their care m and that they reflected their current needs.

Is the service caring?

People were treated with respect and dignity by the staff. People were supported by kind and attentive staff. We saw that support workers showed patience and gave encouragement when supporting people. People we spoke with told us, “The staff look after me very well here."

People who used the service, their relatives, friends and other professionals involved with the service completed a yearly satisfaction survey. 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 knew how to raise a concern or complain if they were unhappy.

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

People completed a range of activities in and outside of the service regularly.

Is the service well-led?

The service had a quality assurance system in place. Records seen by us showed that identified shortfalls were addressed promptly. We were therefore assured that the provider had taken steps to continually improve the service.

Staff told us they were clear about their roles and responsibilities and staff demonstrated a good understanding of the ethos of the service.

Firs and Hewlitt is a home separated into two separate units, Firs unit and Hewlitt unit, each accommodated up to seven people with physical and learning difficulties, some of whom had more challenging behaviour. Building work was being carried out at Hewlitt to increase the capacity. Not all people were able to communicate verbally with us about their time at the home.

People who were able to communicate told us that they were generally happy living at the home. One person said, "The staff are all friendly and the food is nice; we get to choose what we want to eat." and, “I watch the television and my videos and listen to music. It has been a while since I went out shopping or to the pub. We probably go out about once a month. There’s not much else to do here, but I’m quite happy with how much I get to do.”

We also reviewed the relatives' survey comments. One of the relatives stated, “The staff here are really lovely. They always make me feel very welcome, and there is a lovely atmosphere.”

We observed that people were treated with respect, and that staff supported them during the day. However, we observed that activities provided on the day of our visit were limited to watching television.

Staff told us Firs and Hewlitt was a nice place to work, and that they thought they had enough staff to meet the needs of people. They also told us they felt supported by management. We observed that the home was visibly clean and tidy on the day.

The home has three separate units, two with six people living in and one unit with one person living in it. We inspected one of the six bedded units. We found that the unit was airy and clean; people appeared to have their personal care needs met and were frequently offered food and drinks. We observed that staff were kind and people appeared relaxed in their presence. There was also a lot of input from external health professionals evident in people’s health files.

However, we found that there were very few activities for people unless they attended a day centre. Staff interactions were kind, but concentrated on meal times; there was minimal interaction between staff and people who used the service outside of mealtimes.

People’s care plans were not sufficiently detailed, which meant that staff may not be clear on how support people appropriately which may result in differences between how staff care for people.