The service provides support to nine people with a learning disability and people also received personal care support in their own shared home. Care Worldwide also provides a service to nine people in a registered home next door to this service; Hill Lodge 2. The management arrangements and staffing provided are shared across the two services. People are able to spend time in either service and there are interconnecting doors between the two properties. At the last inspection, on 19 October 2015, the service was rated Good. At this inspection we found that the service remained Good.

People continued to be supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in people’s daily life were assessed and planned to protect them from harm. People were supported by enough staff to ensure they received care and support when they needed it. Staff had been suitably recruited to ensure they were able to work with people who used the service. Medicines were managed safely and people received their medicines as prescribed.

The care that people received continued to be effective. People were supported by staff who had the knowledge and skills to provide their care and support. People chose what they wanted to do and staff knew how to act if people did not have the capacity to make decisions.

The care people received remained good. People’s independence was promoted and they could choose how to spend their time and what activities to be involved with. People could develop close personal relationships and kept in touch with family and friends who were important to them.

The service continued to be responsive to people. People completed voluntary work, went to college and time with friends doing what interested them. People were involved in the planning and review of their care and family members continued to play an important role. Where people had any concerns they were able to make a complaint and this was responded to.

The service continued to be well-led. Systems were in place to assess and monitor the quality of the service. People felt the staff listened to them and were able to comment on the quality of the service. The registered manager promoted an open culture which put people at the heart of the service.

We inspected this service on 19 October 2015. This was an unannounced inspection. Our last inspection took place in August 2013 and at that time we found the home was meeting the regulations we looked at.

The service provides support to nine people with a learning disability and five people who receive personal care support in their own shared home. Care Worldwide also provides a service to nine people in a registered home next door to this service; Hill Lodge 2. The management arrangements and staffing provided are shared across the two services. People are able to spend time in either service and there are interconnecting doors between the two properties.

There was a registered manager in the service. 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 were supported with their independence and knew how to keep safe. Staff supported people to understand any risks to prevent avoidable harm. Where people were concerned about their safety they knew who to speak with. Staff supported people to raise any concerns and assisted with any investigation to ensure people were protected from harm.

People kept their medicines in the bedroom and were helped to understand what their medicines were for and to take responsibility for keeping their medicines. Staff knew why people needed medicines and when these should be taken.

People were confident that there were sufficient numbers of staff to meet their needs and keep them safe. Staff received regular training that provided them with the knowledge and skills to meet people’s needs.

People had access to food and drink that they liked and specialist diets were catered for. People’s health and wellbeing needs were monitored and they were supported to organise and attend health appointments as required.

People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. Staff sought people’s consent before they provided care and support and where people were not able to make decisions for themselves, they were supported to make decisions that were in their best interests with the help of people who were important to them.

People were treated with kindness, compassion and respect and staff promoted people’s independence. People liked the staff who supported them and had developed good relationships with them.

People maintained relationships with their families and friends who were invited to join in activities with them. People chose how to spend their time and participated in community activities alone, with friends or with staff support. People felt they could do the activities they wanted to at a time that suited them.

Staff listened to people’s views about their care and people were able to influence the development of the service. People knew how to complain about their care and concerns were responded to. People were involved with any investigation and knew about any changes that were made.

The provider assessed and monitored the quality of care to ensure standards were met and maintained. The provider and registered manager understood the requirements of their registration with us and informed us of information that we needed to know.

During our inspection we saw that people were encouraged to be as independent as possible. People told us about their weekly activities, which included activities in the local community, working and attending a community centre. People told us they could choose how to spend their time and who to spend time with. One person told us, “I meet up with friends and we go out for a meal or to the pub.” Another person told us, “I love going to concerts and watching wrestling. We choose where we want to go.”

We saw that people received their care in a positive and caring manner. We observed care being provided by staff who had the knowledge and skills to deliver the support that each person needed.

We saw that the provider had an effective system in place to assess and monitor the service, which focussed on improvement. People told us they were happy with their care and the staff were responsive to their needs. We were told they were consulted about the service being provided and felt their views were listened to.

Medication systems were in place and monitored to ensure people received their medicines as prescribed.

We inspected this service in September 2012, and we found the service was not compliant with how medicines were managed. We carried out this inspection to check improvements in this area. The inspection was unannounced, which meant the provider and the staff did not know we were coming. We spoke with two people using the service, and one staff member on duty.

Some people using the service were visiting London with staff and there were two people in the home for us to talk to. People told us they knew what medicines they took and when they should have them. This meant people were informed about their medicines to maintain their well being.

Medication storage systems had improved although medication administration practices were observed as being unsafe, because medicines had been recorded as being given before they had been administered.

There were duplicate keys for the medication cabinet held by each member of staff which meant the security of the medication could be compromised.

People received care and support that met their individual needs. People had care records which had been written in a style that people understood, that included pictures and symbols to support understanding. People told us they had decided how they wanted to be supported.

Staff supported people to go out and do the things they enjoyed, including social activities, voluntary work and day care provision. People said they enjoyed playing crown bowls, going shopping, going out for a drink and to concerts and were looking forward to going on holiday. People told us, “If we need help the staff are always there. I like to go out with my friends and they always know where I am. I know how to keep safe.”

People were encouraged to be independent and they told us they were responsible for looking after and tidying their rooms and they shared domestic duties including cooking. We saw people being supported to make two different types of curry for the evening meal. One person told us, “We’ve made two curries, as some people don’t eat meat, but we all like curry.”

The medicines that were to be kept at a low temperature, where not kept securely. The systems in place for monitoring and acting upon concerns with medication storage and temperature was not robust. This meant we saw medicines stored incorrectly, which could place people at risk, as the integrity of some medicines may have been compromised.

Before moving into the home people were able to spend time with people and have over night stays and weekend visits. People told us “we are able to meet with people before we move in” and “We could say if we didn’t like someone”. People were confident staff took their views into account as it was important that they were happy in their home.

Each person had a plan of care which were reviewed with them and any changes were recorded. Where people needed health support, this was discussed with them and the care people needed was recorded. People told us they could decide if they wanted to be seen in private when receiving health care.

The routines and daily activities were flexible and staff responded to people’s needs and the staffing was provided to ensure people were able to carry out planned activities. People told us they were able to have a job, attend college courses, go out with friends and were involved in many activities. People told us that during the last month they had been going to weekly football training sessions and watched Burton Albion play and some people had been to see a rock band and the Abba experience. Other people told us they enjoyed going shopping with friends and family and liked to have a drink and meal out.

People told us they were involved in making decisions about their care and their views were taken into account. People knew about their rights and if they needed help making decision they would involve others including an advocate. One person commented, “It’s up to us to sort out our life, we have to make our own decisions.”

The home supported people to develop skills needed to live independently and people took responsibility for looking after their home and their bedroom. People told us, “We look after the house ourselves, we do the carpets, chairs and look after our own rooms, and I love it” and “I like to help out in the kitchen.”

People knew how to keep safe in the home and the community and told us they would talk to the staff if they were worried. People knew how to make a complaint, and told us they would be comfortable talking to staff about any concern. People said they could talk openly with staff and be honest about what they wanted to do and how they felt and said “I’d talk to my key worker” and “I’d speak to the staff here, they’d sort it out.”