This inspection took place on 28 November and 6 December 2017 and was unannounced.

Hepdene House is a residential care home for up to eight people living with physical and /or learning disabilities. There were eight people living in the home when we inspected.

At the last inspection on 6 November 2015 we rated the service as ‘Good’ and there were no regulatory breaches. At this inspection we found the the overall rating for the service remained ‘Good’.

Staff recruitment procedures ensured staff were suitable to work in the care service. Staffing levels were sufficient and flexible to meet people’s needs.

Staff received the training and support they required to carry out their roles and meet people’s needs.

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.

We saw staff knew people well and understood how to manage risks without limiting people’s freedom unduly. Staff understood safeguarding procedures and how to report any concerns. Medicines were managed safely and people received their medicines when they needed them.

Staff supported people to access healthcare services. People were involved in planning their care and support which was delivered to meet their needs and preferences. Staff supported people to lead active lives of their choosing and to keep in contact with family and friends. There were systems in place to manage complaints.

Staff were exceptional in their commitment to ensuring people could live as full a life as possible by promoting and maintaining their independence. They knew people very well and had developed positive relationships with them. They were compassionate, considerate and respectful in their interactions with people and were extremely skilled in communicating and responding to their needs. Staff continuously looked for ways to improve care, so people had positive experiences and led fulfilling and meaningful lives.

Relatives and staff were complimentary about the management team and leadership of the service. The registered manager led by example and promoted person-centred care. Effective quality audit systems were in place.

This inspection took place on 6 November 2015 and was unannounced.

Our last inspection took place on 16 May 2014 and found the service to be compliant in all of the areas inspected.

Hepdene House provides accommodation and personal care for up to 8 people living with physical or learning disabilities. There were 6 people living at the home at the time of our inspection.

At the time of our 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.

People told us they felt safe at the home and keeping people safe was included within all of the support plans we looked at. Staff knew their responsibilities in maintaining people's safety and had undertaken training in this area.

Staffing was organised in line with the needs and activities of the people living at the home and systems were in place to make sure staff were recruited and worked safely.

People's medicines were managed safely and the home was clean and tidy.

People’s dignity and rights were promoted and they were treated with respect by staff who understood their individual needs. Staff involved people in their care, supported their independence and promoted person-centred care.

Staff were skilled and knowledgeable about people’s needs and training was on-going to support staff in their role.

Staff worked well to maintain the requirements of the Mental Capacity Act in general, and the specific requirements of the Deprivation of Liberty Safeguards.

People were supported to maintain and improve their health and well-being.

There were good relationships between staff and people who lived in the home. Staff were kind and caring with high regard for people’s individual needs.

Delivery of care and support was entirely person centred. People were supported to make their own decisions and to lead their lives as they chose. We found the work of staff in this area to be outstanding.

Systems to monitor and review the quality of the provision were in place and the registered manager responded well to advice from other agencies.

During our inspection we looked for the answers to five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

Is the service safe?

We saw risk assessments linked with care plans to reduce potential risk where possible. We spoke with staff who had a clear understanding of the safeguarding procedure and could describe warning signs of abuse. We observed staff moving items in the home so they were not a trip hazard. The manager told us they completed health and safety audits of the home.

Is the service effective?

Each person had a pre-assessment of needs before entering the home. The care plans showed preferences, likes and dislikes. We spoke with staff who told us specific information in peoples care plans. We spoke with people that used the service and they told us they had their needs met. We looked through professional records and saw regular involvement from outside professionals. For example GP visits, Dentist visits and nurse involvement.

Is the service caring?

We observed staff speaking to people that used the service in a respectful manner, speaking at eye level and offering time for a response. We saw staff offered encouragement to people when supporting them. We found the service user handbook informing people who used the service, they can expect to be treated with respect and dignity in line with their care plan.

Is the service responsive?

People told us they are involved in their care plan reviews. We saw advocacy services were being used where people did not have capacity to make their own decisions. The service did have a complaints book that was easily accessible but there were no recent entries. On an annual basis the home sent out questionnaires to family members. One person said getting out in transport for their family member should be easier. The home responded to this and set up a taxi account which suited the person’s needs.

Is the service well led?

We saw evidence that the home worked well with other agencies to make sure people received their care in a joined up way. The provider had a quality assurance team which included a senior manager making frequent visits to the home. The manager told us they carried out audits on a daily basis which prompted action plans. As a result the quality of the service was continuingly improving. Staff told us they were clear about their roles and responsibilities in the home and were familiar with the quality assurance processes in place.

We spoke with two people who used the service, other people who used the service could not communicate clearly so we observed staff providing support and we spoke with staff about the people who used the service. This gave us assurances that staff knew the needs of people and knew how to deliver the care and support effectively.

Our observations of the service showed that care staff spoke with and interacted with people who used the service in a friendly, patient and pleasant manner. Care staff supported people in a sensitive way using differing methods of communication to ensure that people who used the service understood what was going to happen.

There were appropriate systems and processes, policies and procedures in place. Report writing in the care records reflected the changes in care and treatment that people received. We also found that staff were supported and monitored in their working practice and had training and appraisals programmes in place.

The people who used the service appeared happy and comfortable with their surroundings. They appeared to be relaxed with the staff in their interactions with them. We noted that people had access to a wide range of activities which were personalised to their individual needs and documented clearly in the support plans.

We brought forward the planned unannounced annual inspection because we due to receiving anonymous information which concerned us. The information was in relation to staffing.

At the time of our visit, we were able to speak with two people who use the services and they told us staff looked after them well. They felt comfortable and safe living at the home.

Some people living at Hepdene House have complex needs and could not tell us what they thought about the service. From our observations and from talking to staff we could see that people get on well together and staff have a very good understanding of people's needs. A vising relative confirmed that they were happy with the standard of care provided.