Five Penny House provides residential care services for up to six people with learning or physical disabilities. There were five people using the service during our inspection.

At the last inspection in May 2015 the service was rated Good. At this inspection we found the service remained Good.

There was a registered manager 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.

Medicines were administered safely and stored securely. Accidents, incidents and safeguarding concerns were recorded and dealt with appropriately. Staffing levels were appropriate for the needs of people who used the service. Risk assessments relating to people's individual care needs and the environment were reviewed regularly.

Staff received appropriate training and support. 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 have enough to eat and drink and attend appointments with healthcare professionals.

There was a welcoming and homely atmosphere at the service. People were at ease with staff. Staff knew how to communicate with people. Staff treated people with kindness and compassion.

Staff had a clear understanding of people's needs and how they liked to be supported. People's independence was encouraged without unnecessary risks to their safety. Support plans were well written and specific to people's individual needs.

Staff felt the service was well managed. Staff described the manager as approachable. There was an effective quality assurance system in place.

Further information is in the detailed findings below.

The inspection visit took place on 5 May 2015. This was an unannounced inspection which meant that the staff and provider did not know we would be visiting.

We last inspected the service on 4 November 2013 and found the service was not in breach of any regulations at that time.

Five Penny House is a purpose built detached property which provides accommodation, personal care and support for up to six people with complex needs such as learning and / or physical disability. There were lounges, a dining room and a large accessible kitchen and six bedrooms. Each of the bedrooms were individually decorated.

There was a registered manager in post. 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 currently four people living at Five Penny House with plans for two other people to move into the service in the near future.

We observed the care and support the four people received as due to the nature of people’s disability, people could not communicate directly with us. We discussed safeguarding with staff and all were knowledgeable about the procedures to follow if they suspected abuse. Staff were clear that their role was to protect people and knew how to report abuse including the actions to take to raise this with external agencies.

The staff we spoke with told us that there were enough staff on duty to meet people’s needs. We saw that three staff routinely provided support to four people during the day with two staff being available throughout the night.

There were policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS). The registered manager had the appropriate knowledge to know how to apply the MCA and when an application for a DoLS authorisation should be made and how to submit one.

We saw that staff were recruited safely and were given appropriate training before they commenced employment. Staff had also received more specific training in managing the needs of people who used the service such as person centred support and allergen awareness.

We saw people’s care plans were person centred and people had been assessed. The home had developed person centred plans to help people be involved in how they wanted their care and support to be delivered. We saw people were given choices and encouraged to take part in all aspects of day to day life at the home from watching a film together to helping to make the evening meal. Everyone had undergone a person centred review recently where themselves, staff, family and social workers were involved in reviewing their support and planning actions and outcomes for the future.

The service encouraged people to be as independent as possible. People were supported to be involved in the local community as much as possible and were supported to access facilities such as the local G.P, shops and leisure facilities if they so wished.

We also saw a regular programme of staff meetings where issues where shared and raised. The service had an easy read complaints procedure and staff told us how they could recognise if someone was unhappy and what measures they would take to address any concerns. This showed the service listened to the views of people.

There was a regular programme of staff supervision in place and records of these were detailed and showed the service worked with staff to identify their personal and professional development.

People who wanted to were encouraged to help prepare food with staff support and on the day of our visit one person helped prepare some flapjacks. We saw people had nutritional assessments in place and people with specific dietary needs were supported. We saw from support records and talking with staff that specialist advice was sought quickly where necessary not only for nutritional support but any healthcare related concerns.

We saw staff supporting people with dignity and respect. We saw staff were caring and helped people in all aspects of their daily living with kindness. There was lots of laughter and caring physical interaction that was appropriate between staff and people using the service.

We reviewed the systems for the management of medicines and found that people received their medicines safely and there were clear guidelines in place for staff to follow.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure the service and equipment was safe for people and staff. We found that all relevant infection control procedures were followed by the staff at the home and there was plenty of personal protective equipment to reduce the risk of cross infection. We saw that audits of infection control practices were completed.

We saw that the registered manager utilised a range of quality audits and used them to critically review the service. They also sought the views of people using the service and their families on a regular basis and used any information to improve the service provided. This had led to the systems being effective and the service being well-led.

Accidents and incidents were also reviewed by the registered manager and appropriate measures taken to reduce the risk of any further re-occurrence.

During the visit, we met all five people who used the service. People had limited verbal skills and found it difficult to make direct comments about many aspects of the service. Therefore we spent time observing staff practice when they worked with people.

We spoke to staff and found that they were very knowledgeable about people's likes and dislikes and how they wished to be supported. We were able to see how people's skills and independence were promoted.

We saw examples of decisions that people had been involved in making and we could see the procedures which staff followed where people did not have the capacity to make decisions for themselves. We found that the care records contained evidence to confirm that the person and their relative or advocate had been involved in drawing up the plan of care and keeping it up to date.

Where people were highlighted as being at risk, for example, with diabetes, care plans had been developed. We found that care records contained up to date assessments, care plans and risk assessments. We found that care plans were reviewed monthly.

We saw that people who used the service had a choice of food and drink and were involved in menu planning and shopping for food.

During our inspection we were able to see that there was enough staff on duty to meet the needs of people.

We saw that records were stored safely, however still accessible to staff when needed.

We only spoke with one person who used the service as most people living at Fivepenny House had complex needs and were unable to communicate their views and experience to us. The person we spoke to agreed that they were treated well, they liked living at the home and staff were good.

We found that people were treated with dignity and respect. We saw there was a friendly and relaxed atmosphere between people living and working at the home. We observed staff interacting well with people and supporting them which had a positive impact on their wellbeing.

We found the premises that people, staff and visitors used were safe and suitable and that people were cared for and supported by suitably qualified, skilled and experienced staff. We also found that staff were appropriately supported in relation to their responsibilities which enabled them to deliver care and treatment safely and to appropriate standards.

We found there was an effective complaints system in place at the home.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time of the inspection.

People living at the home had complex needs and were not able to communicate verbally their views and experiences to us. We were able to observe people’s experiences of living in the home and their interactions with each other and the staff.

Throughout our visit, we observed the positive way that staff interacted with people using the service. We saw all staff treat people with respect and courtesy.

We observed staff encourage people to make their own decisions, from what activities to get involved with, to what drink or condiments people wanted to have with their lunch. Staff used their knowledge of the person to interpret body language and limited verbal communication, to take note of people's opinions, choices and preferences. During our visit, we saw that staff actively engaged everyone in conversations and activities, tailored to the needs of the person.