This was an unannounced inspection which we carried out on 24 August 2016.

We last inspected Hawkstone House in July 2014. At that inspection we found the service was meeting all of the legal requirements in force at the time.

Hawkstone House is a care home that provides accommodation and personal care for up to 10 people with learning disabilities. Nursing care is not provided. Ten people were using the service at the time of inspection.

A registered manager was 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.

People and staff told us they felt safe and there were enough staff on duty at all times to provide safe and individual care to people. There was an emphasis on providing person centred care to ensure people received safe care and support in the way they wanted and at times they chose. Risk assessments were in place and they accurately identified current risks to the person.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the treatment they needed. Menus were varied and staff were aware of people’s likes and dislikes and special diets that were required.

Staff had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. We have made a recommendation about medicines management where medicines were given in a person's best interest. People received their medicines in a safe and timely way.

People were supported to go on holiday and to be part of the local community. They were provided with opportunities to follow their interests and hobbies and were introduced to new activities. They were supported to maintain some control in their lives. They were given information in a format that helped them to understand and encourage their involvement in every day decision making. A complaints procedure was available and written in a way to help people understand if they did not read.

People had the opportunity to give their views about the service. There was regular consultation with people and/ or family members and their views were used to improve the service. The home had a quality assurance programme to check the quality of care provided.

Staff and relatives said the management team were approachable. Communication was effective to ensure staff and relatives were kept up to date about any changes in people’s care and support needs and the running of the service.

We have considered all the evidence gathered during the inspection and used it to answer the five key questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found. The summary describes the records we looked at and what people who used the service, relatives and the staff told us.

Is the service safe?

At the time of our visit there were 10 people who lived at the home. We spoke with two people who both told us they felt safe. We also spoke with two relatives, they told us they were pleased with the standard of care and felt people living at the home were safe.

Each person's care file had risk assessments which covered areas of potential risk. When people were identified as being at risk, their plans showed the actions required to manage these risks.

Safeguarding procedures were in place to protect people from the risk of abuse and we found staff understood their roles and responsibilities in safeguarding the people they supported.

Overall, we found there were enough skilled and experienced staff to ensure people received a consistent and safe level of support. The staff we spoke with told us there was always enough staff on duty to ensure people were kept safe. However, they said there were occasions when they felt there were not sufficient levels of staff on duty, such as when an incident occurred which required a number of staff to support with physical interventions. One staff member said “90% of the time staffing levels are fine, but there are occasions where I have thought we could have done with an extra staff member for that shift”.

The care records reviewed were accurate, relevant, complete and up to date. They were also stored securely to ensure confidentiality. We saw appropriate records were maintained in relation to the management of the service. All records were located promptly when requested.

Is the service effective?

The home had a good working relationship with other healthcare professionals and followed their guidance and advice. The input of other healthcare professionals involved in people's care and treatment was clearly recorded in their care plan.

Is the service caring?

Overall people said they were pleased with the standard of care provided. One person told us they had looked at several homes when deciding where their relative should live and Hawkstone House “Stood head and shoulders above everywhere else; due to the genuinely caring and calm environment”.

We found the care staff we spoke with demonstrated a good knowledge of people’s needs and were able to explain how individuals preferred their care and support to be delivered.

Is the service responsive?

Care records were reviewed and any changes made either when people’s needs changed or as part of the six monthly review process. We saw evidence of this within the care records we reviewed.

Where people’s needs changed and additional staff support was required we saw evidence the service put additional staff on duty to ensure people were kept safe.

Is the service well-led?

We saw there was a quality assurance monitoring system in place that was designed to continually monitor and identify shortfalls in the service and any non-compliance with the essential standards of quality and safety.

People told us they liked living in the home. We saw how staff asked people for consent. For example, when discussing their cooking for the week, staff asked, “Would you like any help to work out your menus for the week.” We spoke with three people who used the service and asked if they were asked for their consent to care and treatment. Comments included, “They always ask me if I want anything first before we do it”, “If I need any medication they always ask me first” and “I like it when we go swimming it’s fun and enjoyable.” We saw consent to care and treatment was recorded in people's care plans.

People told us they liked the people caring for and supporting them. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Each person was allocated a key worker following admission. The key worker made sure people were provided with the information they needed, helped people to feel comfortable in their new surroundings, and enabled them to ask any questions about life in the home. Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare.

Care was individually planned according to risk, for example one person enjoyed swimming and a safeguarding protocol was in place that allowed him to go swimming weekly. Risk assessments were evaluated every six months unless there was a change in a person’s behaviour and then a new risk assessment was carried out.

People told us it was always clean and tidy and everyone helped to do the cleaning. We saw evidence of cleaning on a daily basis. There were effective systems in place to reduce the risk and spread of infection. We saw bedrooms were clean and well maintained and staff told us specific cleaning routines were in place to maintain hygiene standards and people were encouraged to keep their own rooms clean with help from staff.

We saw evidence staff received regular supervision and were supported in their role. One member of staff said, "I like working here, I get a lot of job satisfaction and I have become more confident in my job." Another member of staff said, "I like it here as I feel I make a difference to somebody's life."

People had their comments listened to and acted on. People who used the service said they felt staff listened to them. People said they felt confident to speak to the staff about any concerns they may have.

We spoke with four people who lived at Hawkstone House. They told us they made decisions about what they did, such as what time they wanted to get up or go to bed. They said staff listened to them when they made their wishes known. One person said ‘’It’s my house, I like it here’’. Another person said ‘’staff always let me choose what I want to eat’’.

People told us they were happy living at Hawkstone House and that staff provided them with care and support when they needed it. One person said ‘’when I feel poorly, staff always look after me and help me feel better’’. Another person said ‘’I like living here, it’s ace’’.

The four people we spoke with told us they felt safe living at Hawkstone House. One person said ‘’staff are nice and kind to me’’. Another person said ‘’when I get upset staff make me feel ok again’’.

The four people we spoke with told us they found the staff, friendly, respectful and polite. They said they would approach staff if they had a problem and felt they would be listened to.

We spoke to two visiting professionals who told us that Hawkstone House is very homely, staff are helpful and provide good care and support to the people living there.

People told us they like their rooms, the home is kept clean and that they like the meals.

People told us that they like living at Hawstone House and that they like the staff.

People said that they enjoy the activities they do.

Two people told us that meals at the home are good.

One person told us they would be able to speak to staff if they were unhappy about anything in the home.

One person told us that she gets her medication when she needs it and that she understands what her medication is for.