This inspection was carried out on the 8 January 2019 and was unannounced. 10 The Crescent is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The accommodation is a semi-detached house with a garden in Pewsey. 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.

There were two registered managers 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.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated as Good:

People were supported to live their own lives by staff who enjoyed working at the service. People had personalised care plans, which gave staff the guidance needed to provide person-centred care 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.

Risks had been identified and assessed. Systems were in place to make sure the environment was safe and regularly checked. Medicines were managed safely, people had their medicines as prescribed.

People were supported by staff that had been recruited safely. Staff were trained and had the skills needed to support people. Staff were aware of the different types of abuse and how to report any concerns.

Systems were in place to monitor the quality and safety of the service and the provider was continuously improving how the service operated. Staff worked with healthcare professionals to provide effective care that met people’s needs.

Further information is in the detailed findings below.

10 The Crescent is registered to provide accommodation with personal care for up to five people with learning disabilities. At time of the inspection four people were living at the home. The accommodation is provided in a semi-detached house, located in the village of Pewsey.

The inspection took place over two days on the 7 and 8 April 2016 and was unannounced.

The service had a registered manager who was supported by a home manager in the day to day running of 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. The provider told us the home had been managed by a home manager and was in the process of submitting an application to be the registered manager. The registered manager had a strong presence in the home on a daily basis.

Staff knew people’s individual communication skills abilities and preferences. There was a range of ways used to support people to communicate their wants and wishes. People were supported to follow their interests and take part in social activities. People were encouraged and supported to develop and maintain relationships with people that mattered to them and avoid social isolation.

Care plans were personalised and each file contained information about the person’s likes, dislikes and preferences. People’s needs were reviewed regularly and as required. Handover between staff at the start of each shift ensured important information was shared and acted upon where necessary.

People were protected against the risk of potential harm and abuse. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe.

People were supported by sufficient staff with the right skills and knowledge to meet their needs. Safe recruitment practices were followed before new staff were employed to work with people. People’s needs were met by staff who had access to the training they needed. Training records for staff confirmed they received training on a range of subjects.

There were safe medicine administration systems in place and people received their medicines when required. Records confirmed people had access to health care professionals as required such as a GP, dentist and an optician.

People’s dietary needs and preferences were clearly recorded in their care plans. One person told us they liked the food and were able to make choices about what they had to eat.

The home manager, deputy manager and staff acted in accordance with the requirements of the Mental Capacity Act 2005. Where people did not have the capacity to make decisions themselves, mental capacity assessments were in place and records showed that decisions had been made in line with best interests. Where required Depravation of Liberty Safeguarding applications had been submitted by the provider.

The home manager investigated complaints and concerns. People and staff had confidence the home manager would listen to their concerns and would be dealt with appropriately. Relatives felt communication could be improved as they were not always kept up to date. People and their relatives were able to share their views on the service and knew how they could make a complaint. The provider had quality monitoring systems in place. Accidents and incidents were investigated and discussed with staff to minimise the risks of reoccurrence.

When we inspected there were three people living in the home. We spoke with the three people who used the service, one relative and five staff. We also made our own observations during the visit.

People who used the service told us they were satisfied with the service they received. We observed people were relaxed and got on with their daily life. One person who used the service told us "I like it here."

People told us that staff treated them with respect. One relative said “I find staff are respectful and accommodating.” We saw staff speaking and responding to people in a kind and respectful manner.

The care records showed us that as people's health needs changed the care and support they needed was also changed. These records included information from health and social care professionals which helped ensure people got the care and treatment they needed.

Staff confirmed they had regular supervision but this was not always recorded in the staff's employment file. The home trained their staff and had procedures which protected people from any form of abuse. One person told us they did not have any concerns about the service and a relative said “the manager said if there was ever anything wrong I just had to tell him.”

The people using the service ate planned meals, there was a range of drinks available and they could choose when to have snacks and drinks.

The evidence we collected showed us the service kept people safe and met their care needs.

There were four people living at 10 The Crescent when we visited. Each person had a learning disability. We were able to talk with two people and ask a range of direct questions about their care. We observed staff interacting with all four people at the home. After our visit we talked by telephone with a family member of one of the people who lived at the home. They told us they were happy with the care and support given to their relative. They said: "they are settling in well."

The people who we talked with told us they were happy living at the home. One said: "it's good living here" and another said "staff ask me nicely" and "they are nice." People said they liked the staff and they were looked after well. Both people we said told us they had got to know the staff well. They said they were not expected to do anything they did not want to do. People were able to make their own minds up. If a person did not have the capacity to make a decision for themselves, staff would act in the person's best interests. Staff involved people who spoke for the person in any major decisions.

We observed care delivered with kindness and good humour. People appeared happy and settled in the home and staff supported them to be as independent as possible. We judged people were given their medicines safely. The service had enough staff with the right skills and experience to support people. People's records and those to run the home were kept confidential and held securely.

Due to their learning disability and their complex communication needs, not all people living at 10 The Crescent were able to tell us about the service they received.

One person told us they liked living at the home. They said they could choose what time they got up and what time they went to bed. They said they could choose what they ate and when they went out. They liked going to a local social club to meet their friends. They said they also liked their bedroom. They had a large flat screen television which they enjoyed watching. They had a range of personal possessions which reflected their interests. This person told us they liked gardening and enjoyed growing flowers and vegetables. They said they planted hanging baskets in the summer.

People were very comfortable and relaxed in the presence of staff. They were well groomed with clean coordinated clothing, which reflected their personality. One person communicated with staff by pointing to what they wanted. Staff responded positively and were attentive to the person’s needs. Another person made a hot drink independently and joined us at the dining room table. They told us they helped with housekeeping tasks on certain days of the week. They said they cleaned their bedroom and changed their bed linen before we arrived.

One person told us they liked the staff and knew them well. They said they would tell staff if they were not happy about any aspect of their care.

People required varying levels of staff support to maintain their personal care routines. Local services such as the dentist, optician, GP and Community Team for People with Learning Disabilities were used to meet people’s individual health care needs. People were regularly able to access the local community and take part in social activities they enjoyed.