The inspection took place on 05 July 2017 and was unannounced. Gombards provides accommodation and personal care for up to eight younger adults who live with learning and physical disabilities. At the time of our inspection eight people lived at the home.

At the last inspection on 29 July 2015 we rated the service Good. At this inspection we found the service remained Good.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

People who lived at home had very limited verbal communication skills and could not talk to us. However we observed staff communicating effectively with a person and easily interpreting the person`s body language and the sounds they made.

People`s care plans were personalised and described in detail their body language and facial expressions for staff to be able to ascertain if people consented to the care they received and how they expressed sadness, happiness or pain.

Staff had received training in how to safeguard people from abuse and knew how to report concerns both internally and externally. Safe and effective recruitment practices were followed. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

People`s relatives told us they were overall happy with the service people received and they felt people were safe and well supported to live an active life.

People had a busy lifestyle and they were encouraged and supported to access the community, go on holidays and helped do other activities they enjoyed. Potential risks to people’s health and well-being were identified, reviewed and managed effectively.

Relatives and healthcare professionals were positive about the skills, experience and abilities of staff who worked at the home. Staff received training and refresher updates relevant to their roles and had regular supervisions and meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

We saw that staff had developed positive and caring relationships with the people they cared for. Relatives were involved in the planning, delivery and reviews of the care and support provided.

The registered manager and the provider had a regular programme of audits to assess the quality and the safety of the service.

The inspection took place on 29 July 2015 and was unannounced. At our last inspection on 27 August 2014, the service was found to be meeting the required standards in the areas we looked at. Gombards provides accommodation and personal care for up to eight younger adults who live with learning and physical disabilities. At the time of our inspection eight people lived at the home.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

The CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that DoLS authorities had been properly obtained in relation to everybody who lived at the home in order to keep them safe. However, mental capacity assessments and best interest decisions had not always been carried out and formalised in a way that satisfied requirements of the MCA 2005.

People who were present at the home during our inspection were unable to communicate with us. Relatives told us that their family members were kept safe. Staff had received training in how to safeguard people from abuse and knew how to report concerns both internally and externally. Safe and effective recruitment practices were followed. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

There were plans and guidance to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe. Staff who had been properly trained helped people take their medicines safely and at the right time. Potential risks to people’s health and well-being were identified, reviewed and managed effectively.

Relatives and healthcare professionals were positive about the skills, experience and abilities of staff who worked at the home. Staff received training and refresher updates relevant to their roles and had regular supervision meetings, linked to an appraisal system, to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff made considerable efforts to ascertain people’s wishes and obtain their consent before providing personal care and support, which they did in a kind and compassionate way. Information about local advocacy services was available to help people access independent advice or guidance with the support of staff or relatives.

We saw that staff had developed positive and caring relationships with the people they cared for. Relatives were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about people’s medical and personal histories had been securely maintained throughout the home.

We saw that care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences wherever possible. Staff knew the people they looked after very well and were knowledgeable about their background histories, preferences, routines and personal circumstances.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community. Relatives told us that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded and investigated thoroughly with learning outcomes used to make improvements where necessary.

Relatives, staff and professional stakeholders very were complimentary about the manager, deputy manager and how the home was run and operated. Appropriate steps were taken to monitor the quality of services provided, reduce potential risks and drive improvement.

During our inspection we spoke with two people who used the service, five staff, three relatives, two external professionals and the manager. When we visited there were eight people using the service.

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.

The service was safe, clean and hygienic. Environmental audits were carried out regularly therefore not putting people at unnecessary risk.

The provider had safe and effective staffing rotas. 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’s relatives told us that they had been involved in writing care plans and that these reflected their relative’s 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. Relatives we spoke with told us, "The staff are very good here and are always caring."

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 and their relatives 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.

We used a number of different methods to help us understand the experiences of people who used the service, because the people had complex needs which meant they were not able to tell us their experiences. We saw that staff were able to communicate with people in other ways.

We looked at the care plans of two of the eight people who lived at the home. We saw that relatives of the people who lived at the home had been present at, and involved in, the annual review and assessment of their needs. This indicated that they had given consent for the care plan that had been agreed at the review.

We observed care workers interacting with people in a caring and reassuring manner. The care workers talked to people as they were assisting them to make decisions and eat their meals. The manager told us that because of the complex needs of the people who lived at the home food was often prepared on an individual basis.

On the day of our inspection the home looked clean and smelled fresh. We saw that all the bedrooms were thoroughly cleaned on a daily basis. The bedrooms we looked at were clean and dust free.

Records showed that the staff members had started work only after a full and satisfactory criminal records check had been received.

People's records were protected from access by unauthorised people but did not contain all the appropriate information and documentation. Weight and food charts were not always completed in accordance with the care plans.

On our arrival for inspection on 21 August 2012, all people that used the service had already left to attend their planned daily activities. We observed two people returning to the home in the early afternoon. We saw staff supporting them to get to the home from their minibus.

None of people had the verbal abilities to speak with us about their experience of living in this home, but we observed staff interactions with two people and checked documentation related to people’s satisfaction with support and care they received. We also checked involvement of people’s relatives and their comments related to quality of care that people received.