Heronsmede is a 'care home'. It is a detached property, providing accommodation over two floors and has a secure rear garden. People in care homes receive accommodation and nursing or personal care as a 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 is registered to provide accommodation and support to eight people with a learning disability or autistic spectrum disorder. At the time of the inspection, there were eight people using the service.

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.

The care service has 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.

The service was last inspected in January 2016. At that inspection, the service was rated good overall but requires improvement in the safe domain. At this inspection we found improvements had been made and sustained, therefore the safe domain is now rated good. We also found examples of outstanding care and support in both the effective and responsive domains which have been rated accordingly.

The provider kept staffing levels under review and people benefitted from being cared for by an established and experienced team of staff. There were sufficient numbers of skilled staff deployed appropriately to provide safe support for people. Robust recruitment practices helped to ensure suitable people were employed to work at the service.

People were protected from the risk of abuse by staff who were trained and had the knowledge and skills to identify safeguarding concerns and act on them. Risks to people's health and well-being were assessed and appropriate plans were in place to minimise risks. Regular checks were made regarding the safety of the premises and the provider had plans in place to manage foreseeable emergencies. Medicines were managed and administered safely.

People received extremely effective support from a staff team who were regularly supervised and had their personal performance evaluated at an annual appraisal. Staff were trained in the skills necessary to fulfil their role and had received extensive training in areas relating to the specific needs of people.

The strong person-centred approach focussed on individuals. The consistency of approach used by the staff team enabled people to make changes to affect positive outcomes in their lives. Staff worked with health and social care professionals to meet people’s complex health needs. They adopted a 'can do' attitude to supporting people to live life to the full in spite of those 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 support this practice.

People’s nutrition and hydration was monitored and staff supported them to have a varied diet.

The interactions between people and the staff were positive. Staff showed a genuine interest in the wellbeing of those they supported and demonstrated kindness and understanding toward people. Staff involved people in choices around their daily living and people's independence was encouraged.

People were relaxed and comfortable in the company of staff, they did not hesitate to seek support and assistance when required. People were spoken to and about in a respectful manner; their privacy and dignity were maintained.

Staff

This inspection took place on 6 and 7 January 2016 and was unannounced on the first day.

We previously inspected the service on 24 October 2013. The service was meeting the requirements of the regulations at that time.

Heronsmede provides a service for up to eight people with learning disabilities or autistic spectrum disorder.

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.

People who were most closely involved with those who lived in Heronsmede were overall positive about the quality of care they received. Some had more negative views and experiences than others however they all thought the staff were caring and capable.

We found staffing levels met those which had been assessed as appropriate by the provider. On most occasions set staffing levels had been maintained and where not this was due to short-term unforeseen staff absence. However, we were told by both staff and relatives that staffing had recently been maintained by individual staff members working long hours. This could pose some risk to people through tiredness of staff who cared for and supported them. We found Community Homes of Intensive Care and Education Limited (CHOICE) had actively tried to recruit staff in a very difficult and competitive market. We also found people were protected by effective recruitment policies which prevented the recruitment of people who were not suitable to work with often vulnerable people.

We have made a recommendation about staffing. Full details can be found under the safe section of this report.

The service had detailed and up to date risk assessments in place which formed part of an effective care planning system. People’s changing needs and the associated risk assessments and care plans were reviewed regularly to ensure they were appropriate and up to date.

We found medicines were administered safely and the overall standard of record keeping we found was good.

Staff told us they felt supported and were offered significant amounts of training. This equipped them with the skills and knowledge they required to provide a high standard of appropriate care and also training to assist in their personal and professional development.

Although people had some differing views of the overall service they all agreed they had opportunities to raise any concerns. They told us they had been asked for their views regularly and that they could contact the service without any unreasonable restrictions.

The newly appointed and registered manager was said to be providing effective support to staff and to people who lived at Heronsmede. There was a significant level of good will expressed towards the registered manager, recognising the challenges they faced.

The people who use the service have limited verbal communication. We spoke with two people and three relatives of other people who use the service. We observed people appeared contented in the home. On the day of our inspection people attended college courses, a day centre, and a health appointment. All the people who use the service went to a social club in the afternoon. They chose additional activities in the home. One person told us “I like living here.”

We saw staff talked respectfully with people. Staff told us care plans helped them identify activities people wished to attend. We saw care plans noted tasks people aspired to manage independently, and guided staff to progress this safely.

We saw people’s care plans reflected their individual needs and wishes and were reviewed annually. Known risks were identified and assessed. Guidelines noted methods to reduce the risk of harm. We spoke with five support workers. They told us communication between staff worked well and ensured they were aware of any changes to people’s support needs.

One care worker told us the home was “a nice environment for people.” The home was spacious and clutter free. Regular checks and services ensured the home was maintained appropriately.

Staff told us they felt supported by the manager. Staff attended supervision meetings and annual appraisals. This allowed staff to discuss issues and plan their development. Mandatory and additional training was provided, and training checks and audits identified when refresher training was required.

The provider conducted annual surveys with people who use the service and their relatives to gauge how well they met people’s needs and expectations. They carried out monthly and quarterly audits to ensure the service met compliance with the regulations of the Health and Social Care Act 2008. Where improvements required were identified, an action plan for improvements was agreed and progressed. One relative told us “Everything is good, I’m very happy with how X is looked after. They keep me informed. All is going really well.”

We spoke with one person who used the service. They told us they felt safe there, and the staff were friendly.

Relatives of people living in the home told us they felt their relatives were safe and happy there. One relative said “from what I see the home is well run. The staff are great: the home is well organised and works really well.” Another told us “this home is a nice place to be.”

We saw care plans were person focused and appropriate to the person’s care needs. We saw people requiring support and their families were involved in updating care plans, as were other health workers where appropriate. We saw staff asked for consent before providing care.

Relatives told us they felt their loved ones were safe in the home. We saw staff were trained in safeguarding, and the provider had planned refresher training.

Staff told us they were supported to develop their skills and knowledge through training. The provider told us they encouraged promotion from within the company to retain staff.

We saw an easy to read complaints procedure for people living in the home, explaining how to make a complaint. Relatives and staff told us they had confidence to make complaints, and in the ability of the manager to deal with these.

During our previous visit on 21 October 2011 we spoke to people who lived at this home and they told us they liked living at Heronsmede and enjoyed the facilities it provided. During this current visit, on 17 April 2012, we did not need to speak with people again, as we had returned to check if improvements had been made to the quality assurance processes where we had found some minor shortfalls last time.

People at this home have very individual communication needs and therefore we were not able to carry out detailed interviews with them. We did however speak with three residents, assisted by staff, and made observations throughout the day when we met most of the eight residents who live at Heronsmede.

People told us they were happy living at this home and agreed they were given choices about how they wished to spend their time. We noted positive interactions between staff and residents, with residents approaching staff for assistance when they needed support.