This inspection took place on 9 and 11 October 2018 and was unannounced. The previous inspection was carried out in May 2016 and there had been no breaches of legal requirements at that time. We had no previous concerns prior to this inspection.

Flaxpits House provides accommodation for up to ten adults with a learning disability. At the time of our visit there were nine people living at the service. There was a self-contained flat occupied by one person on the first floor, a self-contained annexe (this person had their own staff team) and the main house which provided a home for eight people. The registered manager told us the philosophy of the service was to help young adults with learning disabilities to move onto more independent living.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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.

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. This had been fully embedded into the service provision.

People remained safe at the home. There were sufficient numbers of staff to meet people’s needs and to spend time socialising with them. Risk assessments were carried out to enable people to receive care with minimum risk to themselves or others. People received their medicines safely. There was an ongoing recruitment initiative to fill the five staff vacancies. In the interim a core group of bank and agency staff were being used to offer consistency.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse. Staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management, checks on the equipment and fire systems.

People continued to receive effective care because staff had the skills and knowledge required to effectively support them. People's healthcare needs were monitored by the staff. Other health and social care professionals were involved in the care and support of the people.

People were treated in a dignified, caring manner, which demonstrated that their rights were protected. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected.

Staff recognised the importance of effective communication enabling them to respond to people in a person centred way. People were very much involved, they were consulted about activities and involved in the recruitment of staff.

The home continued to provide a caring service to people. People, or their representatives, were involved in decisions about the care and support they received. Staff were knowledgeable about the people they supported and very committed to providing care that was tailored to the person. People were treated with kindness and compassion.

People received an exceptionally responsive service. Care and support was personalised and person led. People were supported to take part in a variety of activities and trips out based on their interests and aspirations. This included looking at long term goals such as living more independently. Creative and positive steps had been taken to promote positive relationships with each other and supporting people with a positive b

Flaxpits House is registered to provide accommodation for ten people who require personal care. Accommodation for up to nine people is on ground floor level, with an upstairs self-contained flat for one person. At the time of our inspection eight people with learning disabilities were using the service.

This inspection was unannounced and took place on 26 and 27 May 2016.

There was no registered manager in post. The previously registered manager had recently moved to another position in the Trust. The provider had put in place a suitably experienced acting manager and had recruited a permanent manager who was due to take up their post in early June. We were assured the provider would support the successful applicant to apply for registration with CQC as soon as possible. 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 were safe. Staff understood their role and responsibilities to keep people safe from harm. Risks were assessed and plans put in place to keep people safe. There was enough staff to safely provide care and support to people. Medicines were well managed and people received their medicines as prescribed.

The service was effective. Staff received regular supervision and the training needed to meet people’s needs. Arrangements were made for people to see their GP and other healthcare professionals when required. People’s healthcare needs were met and staff worked with health and social care professionals to access relevant services. The service complied with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People received a service that was caring. They were cared for and supported by staff who knew them well. Staff treated people with dignity and respect. People’s views were actively sought and they were involved in making decisions about their care and support. Information was provided in ways that were easy to understand. People were supported to maintain relationships with family and friends.

The service was responsive to people’s needs. People received person centred care and support. They were offered a range of activities both at the service and in the local community. People were encouraged to make their views known and the service responded by making changes.

People benefitted from a service that was well led. The acting manager and senior staff demonstrated good leadership and management. The acting manager and senior staff had an open, honest and transparent management style. The quality of service people received was monitored on a regular basis and where shortfalls were identified they were acted upon.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. There were enough staff on duty to meet the needs of the people living at Flaxpits House. We observed staff that staff took people to college and to the shops. The training records that we saw showed us that all staff had received training in order to perform their roles safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager told us that one application had been submitted but they had not yet been informed of the outcome. This showed us that the manager had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

It was clear from what we saw and from speaking with staff that they understood people’s care and support needs. Some of the people we met had communication difficulties so we were unable to speak with everyone, but one person showed us around their self-contained flat and told us "I like living here".

The care plans that we saw showed that staff worked with people to enable them to be as independent as possible and one staff member told us "I help to keep people safe whilst promoting their independence and helping them to make informed choices".

Is the service caring?

All of the staff that we spoke with and observed were kind and attentive to people's needs. Staff had in-depth knowledge of the people that they were supporting. Support workers and managers that we spoke with were all caring and enthused about the service they offered. One staff member told us "the staff here are caring and take the time to spend with people" and another told us "I love being able to help improve people's self-esteem and confidence and watch them grow and develop skills".

Is the service responsive?

The records that we looked at confirmed that people's individual care needs and preferences had been recorded and that care had been planned and had taken place accordingly. We saw that activities were planned for people in accordance with their personal choices.

Is the service well-led?

Staff understood that the ethos of the service was to provide person centred care. We saw that there were quality assurance processes were in place and that people were asked for their feedback on the service they received on a regular basis.

During the course of our visit, we spent time observing the care provided to people who used the services and the relationships between staff and those living at the home. We spoke with three people being supported at Flaxpits House during our visit. All of the people we spoke with had limited verbal communication but they were able to respond to questions we asked. Whilst talking with people and through our observations, people appeared relaxed and comfortable in the presence of staff.

The manager and staff we spoke with were knowledgeable about the people in their care not just about the practical elements of peoples support but they also knew about them as individuals. This included their likes and dislikes and peoples personality and characteristics. We looked at a range of other information to help us understand people's experiences, which included person centred support plans, peoples preferred method of communication, monthly review recordsand risk assessments. We also viewed minutes from 'resident' and staff meetings and 'residents' questionnaires for their view about the services people received.

We spoke with a relative who was visiting at the time of our visit, they were extremely happy with the care, support and attention their relative received. They told us that their relative was well cared for, that they had confidence in both the manager and staff. They also told that they were consulted and involved fully with their relatives care

People were unable to fully tell us how they had been involved in decisions relating to their care due to the complexity of their learning disability. However, we were able to observe interactions between members of staff and the people they support and we also spoke with staff and looked at care records.

We saw that some of the information in the home was in an accessible format. This included support plans, care plans, health action plans, menus, activity planners, the complaints procedure and the service user guide.

We spoke to two members staff during our visit, they had a good awareness of their role and responsibility to safeguard the people in their care. They knew what constituted abuse and the reporting mechanisms that were in place.

At the time of our visit one person required a high level of both physicals and emotional support from staff with their end of life care. For this person we saw that support care plans had been updated on a daily basis when required. During our visit we were able to speak with two visiting health professionals, they told us that staff had “worked over and beyond” what was expected of them and that staff knew the needs and wishes of the people they supported.

Care records such as care plans, pen profiles, people’s preferred routines and information on how people communicated recorded clear information about how people were supported to make decisions on a day to day basis.

On this occasion we did not speak to people about the outcome areas we reviewed. This was because the people living at the home have communication difficulties. Instead we observed how the staff team interacted with, and provided care to people.

We saw that there was very little interaction with the residents and the communication used by staff was in short burst of sentences directed at people.

We saw some people were engaged in taking part in external activities. One resident was having a massage and we saw that this was positively received.

We found that there had been problems in communication between staff about peoples care.

A new manager had been placed at the home at the beginning of October 2011 in order to resolve concerns which had been raised about the service. The management had begun to make improvements to ensure people’s needs were communicated amongst the staff and with visiting professionals.

We found that people’s needs were not always being met. This was because people’s needs were not regularly reviewed and updated and there were not effective communication arrangements to involve people in their care.