We inspected the service on 29 October 2018. The inspection was announced. We gave the registered manager 24 hours’ notice of our inspection because the service is a small service where people and staff are often out and we wanted to be sure someone would be in.

Hayes Close is a ‘care home’. 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. The service accommodates seven people. On the day of our inspection seven people were using the service.

The care service had not originally 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. However, people were given choices and their independence and participation within the local community encouraged.

At our last inspection on 23 March 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’ overall but there had been a deterioration in well led which was rated as ‘requires improvement’. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks associated with people’s needs had been assessed and planned for. Risk assessments were reviewed monthly to ensure they reflected people’s most up to date circumstances. Staff followed the information in people’s risk assessments which ensured that people consistently experienced care and support that was safe. People did not have any undue restrictions placed upon them and were encouraged to be as independent as possible.

There were sufficient suitably skilled and experienced staff to consistently meet people’s needs. Safe staff recruitment procedures were in place and used to ensure that only staff who met the services high standards worked there. People received their prescribed medicines safely and these were managed in line with best practice guidance. Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence and protect people from harm.

People continued to receive an effective service. Staff received the training and support that was specific and relevant to people’s individual needs. People were supported with their nutritional needs. The staff worked very well with external health care professionals, people were supported with their needs and accessed health services when required. 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. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported. They had a very good understanding of people’s needs, preferences, and what was important to them. Staff used innovative and creative means of communication with people who had communication difficulties. They knew how to comfort people when they were distressed and made sure that emotional support was provided. People’s independence was promoted and they were supported to make informed choices about their care and support.

People continued to receive a responsive service that was strongly focused on their

We inspected the service on 23 March 2016 and the visit was unannounced.

Hayes Close provides accommodation for up to seven people who have a learning disability. At the time of our inspection seven people were living at the home. The service is on two floors accessible by stairs. There is a communal lounge as well as two separate dining areas for people to use. All of the bedrooms are single occupancy. There is also access to a garden area for people to use should they choose to.

It is a requirement that the home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run. The service had a registered manager in place at the time of our inspection.

People did not have concerns about their safety and staff knew how to protect them from abuse and avoidable harm. The registered manager had investigated accidents and incidents to look at ways to prevent them from reoccurring. Risks that people were vulnerable to had been assessed and there were regular checks on the equipment and the premises. There were plans in place that were available to staff to support people to keep safe during emergencies.

People and their relatives were satisfied with the amount of staff available. The provider’s recruitment process was robust and included checking prospective staff before they started to work at the home. This helped the provider to make safer recruitment decisions.

People received their medicines as prescribed. The registered manager had made arrangements for the safe storage and handling of medicines. Only staff that were trained handled medicines. Where people may have needed medicines to help them to reduce their anxieties, this was only offered when other strategies had been tried first.

People received support from staff who had the appropriate skills and knowledge to support people with learning disabilities. Staff had received regular training in areas relevant for the people they supported.

People were being supported by staff that knew about their roles and responsibilities. Staff received an induction when they had started in their role and on-going support from the registered manager.

Staff understood the requirements of the Mental Capacity Act (2005) and understood how to obtain people’s consent before they offered care and support. Staff knew how to support people to make decisions for themselves. Where people may have lacked the capacity to make their own decisions, the provider had followed the requirements of the Act.

People enjoyed the food that was offered to them and were supported to maintain a healthy diet. They could choose what they ate and their preferences and requirements were known by staff.

People had access to healthcare professionals to maintain good health. They were supported to contribute to monitoring their own health and well-being where they could.

People were being supported by staff who cared. They had built relationships with staff that were friendly and warm. Relationships that were important to people had been maintained. People’s dignity and privacy was being upheld by staff and their personal information was being kept secure.

People’s preferences, backgrounds and things that were important to them were known by the staff team. Their care and support was based on these and staff were flexible where people had made specific requests. People enjoyed a full range of activities and interests that they had chosen to be part of.

Where people could, they had been involved in and had contributed to the planning and reviewing of their care and support. Where this had not been possible, relatives had been included. People’s support plans were individual to them and written in detail so

The majority of people that resided at Hayes Close were unable to tell us about their experience of the care and support they received. We observed staff supported people to make decisions about the daily life and ensured that their care needs were met. Records viewed reflected the choices people had made. Several people had been on holiday, which they had enjoyed. One person said: “We went to the seaside and had fish and chips.”

People had a range of assessments and care plans in place to inform staff about how to support people and meet their daily needs. People were supported to take their medicines. Records showed risks identified were managed to ensure people’s care and health needs were met safely by the staff and health care professionals.

People were supported by staff recruited that were suitable and qualified to work with vulnerable people. One person told us they felt safe because staff understood them and said: “I can always talk to ……, she’s my key worker.”

Information about the people who used Hayes Close was kept in their individual care files and stored securely. Staff were aware of their responsibilities to maintain accurate records. Other records relating to the staff and the management of the service were accurate, kept secure and could be easily accessed when required.

People who live at Hayes Close told us they were satisfied with the care and support provided. They had the opportunity to take part in a range of educational and social activities in the community. Special events were celebrated and people went on the annual summer holiday. One person said: “It’s great living here. We always go on holiday every year. It’s the best place ever.”

Information about the service was produced in formats suitable for people using the service. Care plans were written with the person’s involvement and pictures and photographs were used to signify important aspects of their life.

People received a choice of meals to suit their dietary requirements and preferences. Meals were prepared by trained staff taking account of people’s dietary needs. Whilst staff knew people’s preference of food and drink, this was not always evident in the care plans.

People were cared for and supported by trained staff that promoted their safety, independence and wellbeing. Staff maintained their knowledge and skills through regular updates, support and supervision.

Information about how to make a complaint was available in suitable formats for people using the service. People were confident to express concerns verbally or using other modes to communicate their concerns. One person said: “I’ve got no complaints, but if I did I would tell the manager, she will sort it out for me.”

People told us they liked the staff who cared for them. People enjoyed their active and busy lifestyles but were also able to spend time relaxing in a comfortable and homely environment. Because many people living at Hayes Close had communication difficulties we were unable to ask direct questions about many of the essential standards we reviewed. We used observation, looked at records and spoke with staff to gather further evidence.