Hutton Avenue provides nursing and residential care services for up to nine people with learning or physical disabilities. There were eight people using the service during our inspection.

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

Staff had completed training in safeguarding vulnerable adults and understood their responsibilities to report any concerns. Thorough recruitment and selection procedures ensured suitable staff were employed. Risk assessments relating to people’s individual care needs and the environment were reviewed regularly.

Staff received appropriate training and support. 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. People were supported to have enough to eat and drink and attend appointments with healthcare professionals.

There was a welcoming and homely atmosphere at the service. People were at ease with staff and relatives said staff were caring. Staff treated people with kindness and compassion.

Staff had a clear understanding of people’s needs and how they liked to be supported. People’s independence was encouraged without unnecessary risks to their safety. Support plans were well written and specific to people’s individual needs.

Relatives and staff felt the service was well managed. Staff described the registered manager as approachable and said there was an open culture. There was an effective quality assurance system in place to ensure the quality of the service and drive improvement.

Further information is in the detailed findings below.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? 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 using the service, their relatives and the staff supporting them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

During our visit to 13 Hutton Avenue, we checked the premises and found it provided a safe and suitable environment.

The assessment, planning and delivery of care and support was centred on the individual and considered all aspects of their individual circumstances.

Staff had been suitably checked and the provider had an effective recruitment procedure in place.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no applications had been submitted, the manager was aware of the recent Supreme Court ruling which redefined the deprivation of liberty in care settings. She had arranged to meet with the provider, the local authority lead and family members to discuss the implications of this ruling for people at 13 Hutton Avenue.

Is the service effective?

Each person had an individual care plan which set out their specific care needs and people had been involved in the assessment and planning of their care. Relatives we spoke with told us they were also involved in the planning of care.

We saw that support plans and risk assessments were up to date and reflected people’s individual needs and we observed staff supporting people in a caring and sensitive way.

One family member commented, “There’s no place out there like it.”

Is the service caring?

We saw that care records were accurate and up to date. The assessment, planning and delivery of care and support was centred on the individual and considered all aspects of their individual circumstances.

Family members told us they were happy with the care provided by 13 Hutton Avenue. Family members told us, “He is happy. We would know if he wasn’t” and “the staff are very helpful to us, I can’t praise them enough.”

We observed that staff were very supportive towards people and their interactions were calm and re-assuring.

Is the service responsive?

People were asked for their views on a regular basis. Family members told us they received surveys and attended meetings at the service. Records showed that people’s needs had been taken into account and care and support had been provided in accordance with people’s wishes.

People had access to a range of specialists and health professionals to ensure they received appropriate care.

We spoke with family members who said they were satisfied with their relative’s care. Family members told us they were involved in reviews of their relative’s care.

Is the service well-led?

The provider gathered information about the safety and quality of their service from a variety of sources and had a system of quality audits in place.

Regular checks of the premises took place to ensure it was safe and suitable for the people who lived there.

People who used the service and their family members were consulted to gather their views about the service provided at 13 Hutton Avenue. We saw that any issues identified had been acted on.

People living at Hutton Avenue had complex needs and most of the people were unable to verbally communicate their views and experiences to us. We were able to observe people's experiences of living in the home and their interactions with each other and the staff. We saw that staff treated people with dignity and respect. Some people were able to talk with us, and share some of their experiences. One person told us, “I like living here."

We found that people had their needs assessed and that care plans were in place.

People were provided with a choice of suitable and nutritious food and drink.

We saw that people lived in safe, accessible surroundings that promoted their wellbeing.

There was a range of equipment available to meet people’s individual care needs. We saw that regular checks and servicing of equipment was undertaken to ensure that it was safe.

There was a complaints procedure in place and this was accessible to people.

People living at the home had complex needs and most of them were unable to

communicate verbally their views and experiences to us. We were able to observe

people's experiences of living in the home and their interactions with each other and the

staff.

From our observation, we found staff effectively supported the people; made sure individuals could follow what had been said; included people in conversations; and approached them in a gentle and caring manner. If people experienced distress staff quickly went to the person and offered comfort and support.

We sat with people over lunch in the dining room. We saw staff assisting two people to eat and drink. We saw that they were not rushed, with staff seated next to the person they were assisting taking note of the person's natural cues, to ensure lunch was a relaxed, pleasant and respectful experience. Lunch was settled and peaceful and people appeared to be enjoying the food provided. We saw staff respecting people's preferences and encouraging them to eat healthily. We saw people being offered more food and choice. People were encouraged to maintain and develop independence and living skills. After lunch, staff asked those who were able to clear away their own plates and utensils, with support offered where needed.

Some people were able to talk with us, and share some of their experiences. They told us "I've been out this morning at life skills. I won the raffle. I've been drinking tea there. I like living here." Another person told us, "I like JLS. I've got their DVD which I like to watch it." We sat with people while they drew pictures after lunch.

The inspection took place on 9 and 15 December 2014 and 12 January 2015. This was an unannounced inspection on day one, and announced on the other two days. We last inspected the service in July 2014. At that inspection we found the home was meeting all of the regulations that we inspected.

13 Hutton Avenue provides residential care for up to nine people with learning and/or physical disabilities. At the time of our inspection there were eight people living at the home.

The home had 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 living at the home. Relatives told us they were confident their family member lived in a safe environment. One relative told us, “My relative is very safe here, there have been no issues.” Another relative told us, “100% confident with this place, much better than where they used to be.”

People lived in a clean, tidy and homely environment, with bedrooms tailored to people’s specific needs, likes and dislikes.

One person told us, “[Name of staff member] gives me my medicine.” Relatives told us their family member received their medicine on time and no issues were reported to us. Staff at the home were trained to administer medicines to people safely and securely.

Staff we spoke with had a good understanding of safeguarding procedures. They also knew how to report any concerns they had and would not be frightened to do that. The provider had procedures in place to monitor and investigate any safeguarding matters.

Staff followed the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). MCA assessments and ‘best interests’ decisions had been made where there were doubts about a person’s capacity to make decisions. The registered manager had also made DoLS applications to the local authority.

Staff had a good understanding of how to manage people’s behaviours that challenged the service and had individualised strategies to help them manage.

Relatives and staff all told us they felt there were enough staff to meet people’s needs, although it was busy at times. The registered manager monitored staffing levels to ensure enough trained staff were available at all times. The provider had systems in place for the recruitment of all staff at the home, including suitability for the post, full history, references and security checks. The registered manager had a programme of staff training in place and monitored this to ensure all staff were kept up to date with any training needs.

The registered manager told us any maintenance work was done by the provider upon request. The provider also had emergency procedures in place for staff to follow and staff knew how to access this information and how to use it.

People told us they enjoyed the food that was prepared at the home. We saw people helping in the preparation. We found people received nutritious meals, snacks and refreshments throughout the day.

People were respected and treated with dignity, compassion, warmth and kindness. People and their relatives that we spoke with highlighted the quality of care provided by staff at the home. One relative told us, “Staff discuss my daughter’s needs with us as a family.” And “If my [name] is unwell they are very quick to let me know and to get the GP.”

People were treated as individuals and monitored so any changes in their needs were identified and procedures put in place to address that change. People’s records were regularly reviewed and discussed with the person where possible and their relatives and best interest decisions made if necessary.

We saw activities taking place within the home and records of outside activities, although these were not always recorded. One relative told us, “My [family member] has a better social life than me, staff ensure that my [family member] goes out on trips.” Another relative said, “The staff organise trips out for everyone, [name] enjoys them.”

There had been no complaints since the last scheduled inspection. Information on how to complain was available to people at the home and to relatives and visitors alike. The registered manager explained what she would do if a complaint was made and said, “We take anything like that [complaints or concerns] very seriously.” One relative told us, “If I had to complain I would see the manager she is very approachable.”

People were regularly asked their views on the home and about their care, both verbally and in pictorial format. The majority of relatives confirmed they were asked their views, during visits, reviews of care or annual service reviews. One person confirmed they had completed a review when showed the form. A relative told us, “Staff are always asking our views though.”

The registered manager and the operational manager monitored the quality of the service through a wide variety of audits and checks within the home. We saw when an issue had been identified the registered manager had put measures in place to deal with the problem and the operational manager monitored these in-house checks for completeness.