The inspection took place on 19 June 2017 and was unannounced, which meant that the provider did not know that we were coming.

Headonhey is registered to provide accommodation for up to seven adults. At the time of our visit there were seven people who lived in the home. Care is provided for people with complex learning disabilities and associated physical disability needs. It is managed and owned by Stockdales of Sale, Altrincham and District Limited (Stockdales), which is a charitable organisation.

At the last Care Quality commission (CQC) inspection on 3 February 2015, the service was rated Good in all domains and overall.

At this inspection we found the service remained Good in all key areas and overall.

The service had a registered manager. 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 ethos of the home was to provide person centred care and support to each person who used the service by recognising and celebrating their individuality.

Due to the complex needs of people living at Headonhey it was difficult for us to ascertain their opinions on the service they received, as they were unable to tell us verbally what they thought or felt. However, we found we could use the information contained within the care plans to help us understand their unique communication styles, which we were then able to use to capture feedback about their experiences. We saw people looked happy and comfortable in their surroundings.

The staff had risk assessments in place to identify risks when meeting people's needs. The risk assessments showed ways these risks could be reduced.

The provider continued to have systems in place to safeguard people from harm and abuse and make sure that safeguarding alerts were raised with other agencies, such as the local authority safeguarding team, in a timely manner. Staff knew how to report any concerns related to abuse.

Medicines were stored and administered safely. Clear and accurate medicines records were maintained.

People continued to take part in a variety of social activities. Each person has a weekly plan that contained information about the activities they were taking part in. Relationships and friendships were maintained.

People had the opportunity to remain in contact with people that mattered to them. People and their relatives continued to remain involved in an assessment of need. Following an assessment, a care plan is developed to ensure staff supported people to meet their needs. The care plans continued to be reviewed with people on a regular basis to ensure they remained relevant.

Staff knew each person well and had a good knowledge of the needs of people. Training records showed that staff had completed training in a range of areas that reflected their job role and enabled them to deliver care and support as appropriate.

The complaint process was made available to people and their relatives. One complaint had been raised, investigated and a response provided to the complainant.

The registered manager maintained effective leadership to staff at the service. The manager was at the service each day and provided management support at the service.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits and relative surveys to seek their views about the service provided.

The service was constantly striving to improve and learn and demonstrated areas of recognised best practice.

The inspection took place on 3 February 2015 and was unannounced. The last inspection of Headonhey was carried out on 5 November 2013 where no breaches of legal requirements were found.

Headonhey is registered to provide accommodation for up to seven adults. Care is provided for people with complex learning disabilities and associated physical disability needs. It is managed and owned by Stockdales of Sale, Altrincham and District Limited (Stockdales), which is a charitable organisation.

The service had a registered manager. 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.

We found the service to be a good service. The ethos of the home was to provide person centred care and support to each person who used the service by recognising and celebrating their individuality.

There was a strong person centred culture apparent within the service. (Person centred means care is tailored to meet the needs and aspirations of each individual). Personalised programmes and flexible staffing enabled people to live as independently as possible with the amount of support they needed to keep them safe. People were included in decisions and discussions about their care and treatment. Staff described working together as a team, how they were dedicated in providing person centred care and helping people to achieve their potential. Staff told us the registered manager led by their example and was supportive of them.

Due to the complex needs of people living at Headonhey it was difficult for us to ascertain their opinions on the service they received as they were unable to tell us verbally what they thought or felt. However, we found we could use the information contained within the care plans to help us understand their unique communication styles which we were then able to use to capture feedback about their experiences. We saw people looked happy and comfortable in their surroundings.

People who used the service were encouraged and empowered to make choices about different aspects of their lives. It was clear from speaking with people and our observations that the staff had developed good relationships with people and understood each person well. We saw people had their dignity and privacy respected.

The care plans were detailed and contained a good amount of information to help staff support people well. There were capacity assessments in place and the correct procedures had been followed to ensure people were not unlawfully deprived of their liberty and did not have any restrictions put upon them which had not been agreed.

We found the service to be well led, relaxed and friendly and people were supported by appropriately trained staff who were caring and knowledgeable about them. We found the skill mix and staffing levels were sufficient to support people safely and effectively. There were sufficient staff on duty to meet people’s needs. Staff received training and support to enable them to carry out their tasks in a skilled and confident way.

People had the opportunity to be involved in a range of activities and were encouraged to maintain relationships with their friends and family and to participate in their local community.

The service was constantly striving to improve and learn and demonstrated areas of recognised best practice.

Due to the complex needs of people living at Headonhey it was difficult for us to ascertain people’s opinions on the service they received as they were unable to tell us verbally what they thought or felt. Although the people we spoke with found it difficult to fully express what they were trying to say, they looked happy and comfortable in their surroundings.

We could see that the newly refurbished kitchen, when finished, would make mealtimes more inclusive.

People's care records contained detailed information to show how people were to be supported and cared for and how their dignity and privacy were to be respected.

We saw people were given lots of support and encouragement to take part in the many varied activities that took place. Staff told us how important they felt it was for the people using the service to feel part of the community.

We were also told by staff that great importance was attached to ensuring that people using the service were involved in decision making about their daily routines.

Capacity was considered and consent sought for all interventions. Efforts were made to ensure that the people could communicate their wishes to the best of their abilities.

We saw care was delivered competently and respectfully. We looked at the care plans, which contained a range of health and personal information. Support plans were individualised and personal preferences taken into consideration.

The service had robust recruitment and induction procedures and training and staff development were on-going.

There were quality assurance systems in place to facilitate continual monitoring and improvement of the service. Efforts were made to ensure that the people who used the service and their representatives were able to raise any concerns.

Seven adults with complex physical needs and varying levels of learning disabilities lived at Headonhey. We used a number of different methods to help us understand the experiences of people using the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed the adults being treated compassionately with their individual needs considered. It was clear that staff knew each person well and was able to support them effectively. We observed staff sitting down with individuals having conversations, sharing humour and offering assistance when needed.

Care files were maintained in a neat and chronological order. A key worker was assigned to each adult. Each file contained a "Listen to me" workbook which detailed the likes, dislikes and personal needs of each individual. It was clear that each person had regular attendance at the dentist, chiropodists and optician. All visits from health professionals had been recorded.

Next to the home was a life skills centre, which provided a range of organised activities which included Christmas events. One adult also undertook regular work as a volunteer with an external agency. Regular trips out were organised, with the home having access to a number of vehicles, one adapted with changing facilities when required.

Due to the complex needs of people living at Headonhey it was difficult for people to reliably give their verbal opinions on the service they received. We looked at people's records, how people interacted with the staff, general observations throughout the visit and discussions with staff.

We saw that people were comfortable in their surroundings and in their interactions with the staff.

Staff told us that people were encouraged to make choices around their day to day lives and individual personal preferences were always respected.

Staff said that people’s privacy and dignity was always respected and that all care needs were met on an individual basis.

Staff told us that the home had a relaxed, homely atmosphere. One person told us “This is a happy home.” Another staff comment was “I love working here, it’s a lovely home.”

As part of this review process we contacted Trafford Commissioners who had recently undertaken a monitoring review of the service. No major concerns were raised.