About the service: 27 Stratton Road is a small service for four people with a learning disability. Accommodation is provided in a small semi-detached property in a residential area. People have their own rooms and share a lounge, dining area and kitchen. There is a small garden which is accessible. At the time of our inspection four people were living at the service.

People’s experience of using this service:

The service was developed and designed in line with the guidance Registering the Right Support. Registering the Right Support and other best practice guidance ensures that people who use services can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include choice, control and independence. We found 27 Stratton Road worked to make sure it was run in line with the values that underpin Registering the Right Support and other best practice guidance. People using the service received person-centred support that was appropriate and inclusive for them.

People’s risks had been identified and there were risk management plans in place to give staff guidance on how to provide support. People had detailed care plans which were reviewed regularly.

People were supported by staff who had been recruited safely and worked as a team to provide effective care. People and their relatives told us the staff were "kind and caring" and "lovely".

People received their medicines as prescribed. People could see healthcare professionals when appropriate and needed. People had health action plans which contained good detail on all health needs and how they were to be met.

People were supported to follow their own interests. Activities people enjoyed were recorded in their care plan. People were offered choice and supported to lead their own lives.

Relatives and staff told us the service was managed well. The registered manager was approachable and available to people and staff. People’s feedback was sought regularly to make sure people were happy with their care and support.

The service met the characteristics of Good overall; more information is available in the full report on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection in November 2016 (published in December 2016) we rated the service as Good overall.

Why we inspected: This was a planned inspection based on the date and rating of the previous inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

Innovations Wiltshire Limited – 27 Stratton Road is registered to provide accommodation and personal care for up to four people with a learning disability. There were four people living there at the time of our inspection.

This inspection took place on 09 November 2016 and was announced which meant the provider knew the day before we would be visiting.

At a previous inspection which took place in August 2015 we found the provider was not meeting all of the requirements of regulations relating to taking all practical measures to mitigate risk, manage medicines safely, promote infection control, the recording of mental capacity assessments and best interest decisions and the effectively assess monitor and evaluate the quality of the service. They wrote to us with an action plan of improvements that would be made. We found on this inspection the provider had taken all the steps to make the necessary improvements.

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.

Staff knew and understood the needs of the people they were supporting. Relatives spoke positively about the care and support their family member received. People were consulted about their food and drink preferences and their dietary and nutritional needs were met. People were supported to have a meal of their choice and were offered an alternative if they did not want what was on the menu.

Care plans were personalised and contained information about the person’s preferences, likes, dislikes and what was important to them. Staff were knowledgeable about people’s care and support needs and acted in accordance with the guidance in their care plans. People had a range of activities they could be involved in. People were able to choose what activities they took part in and suggest others they would like to try.

People and their relatives told us staff supported them or their family member to staff safe. There were procedures in place to protect people from the risk of abuse and harm. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe. Risks to people’s safety had been assessed and plans were in place to minimise these risks. There were arrangements in place to keep people safe in the event of an emergency.

People’s needs were met by staff who received appropriate training and were supported in their role. New staff members completed a comprehensive induction into their role to enable them to care for people effectively. Staff received regular supervision from managers to identify and support their personal development and learning needs and to monitor the performance of their working practices.

There were sufficient numbers of staff available to meet people’s care and support needs.

Staff were recruited safely. The provider and registered manager carried out all the required pre-employment checks to protect people from the employment of unsuitable staff.

People’s medicines were managed and administered safely. Staff completed training in the safe administration of medicines and had their competency assessed before taking on this responsibility. Regular audits of medicines management were carried out by the registered manager and home manager and action had been taken where required. People’s health needs were monitored and where required they were supported to access healthcare services.

Decisions about people’s care when they lacked mental capacity were guided by the principles of the Mental Capacity Act 2005. People’s care plans evidenced specific decisions had been made in their best interest when they lacked the capacity to make these.

There was a warm and welcoming a

When we inspected there were four people living in the home. We spoke with three people who use the service and three staff. We also made our own observations during the visit.

People who use the service appeared satisfied with the service they received. People felt the staff supported them and met their needs. Two people who use the service said "I like it here."

People told us that staff treated them with dignity and respect. One person said “staff are nice.” We saw staff speaking and responding to people in a kind and respectful manner.

The care records showed us that people's health needs had been assessed. These records included information from health and social care professionals which helped ensure people got the care and treatment they needed.

There were cleaning schedules for the staff to follow and cleaning equipment which helped to keep the home clean and free from infection. The home trained their staff and had procedures which protected people from any form of abuse. People did not have any complaints but would speak to the manager or staff if they had any concerns. One person said “I am able to share concerns.”

The service and the building were monitored and risk assessed to ensure they were suitable for the people who used them.

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

There were four people living at 27 Stratton Road when we visited. Each person had a learning disability. We were able to talk with some people and ask a range of direct questions about their care. We observed the care of those people we could not communicate with and the interactions between them and staff. After our visit we talked with a family member of one of the people who lived at the home by telephone. They told us they were happy with the care, staffing levels, and people being well supported. They said they had "no complaints at all."

The people who could answer our questions told us they were happy living at the home. They said they liked the staff and they were looked after well. We were told people knew the staff who supported them well. They said staff did not make anyone 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, patience, warmth and good humour. We saw people appeared happy and settled in the home and staff supported them well. 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, people were not able to tell us about the service they received. We therefore observed people’s behaviours and interactions they had with the staff on duty.

People were very comfortable and relaxed in the presence of staff. They were well presented with manicured nails and clean coordinated clothing, which reflected their personality. Staff communicated with one person using signage. They ensured any questions directed at other people were short and concise. People were encouraged to choose what they wanted by pointing to the object of their choice. People were assisted to make their own sandwiches at lunch time. All food items were placed on the dining room table and people were prompted to take the items they needed. One person was supported to butter their bread using the ‘hand over hand’ technique. People were fully engaged in this activity and there was a very light hearted approach. Staff talked about a range of topics such as individual interests of people and the activities they enjoyed. They were attentive to people’s needs and encouraged independence according to individual abilities.

Staff told us they completed the majority of domestic tasks within the home. They said however, that people were encouraged to be involved, as far as they were able. One person helped staff hang out the washing. They applied the peg after the staff member had positioned the clothing on the line. They also assisted a staff member make a hot drink. People helped clear the dining room table after lunch. Again, this was linked to people’s abilities, as one person moved things into a particular area on the table. Another person took their plate to the kitchen, whilst another removed most items from the table. Staff gave encouragement and prompted people in a positive manner. There were good interactions between people and staff members.

Staff provided support to ensure people’s individual personal care needs were met. 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.

27 Stratton Road is a care home service, registered to provide personal care for up to 4 people who have a learning disability. The home, a semi-detached house situated in a quiet residential are, is part of Innovations Wiltshire Limited: a provider of several other care home services in the area. The staff who worked at 27 Stratton Road also worked across several of the provider’s other services. We were informed by some staff that there may be a gap of four weeks between their shifts at 27 Stratton Road. Other staff members said they worked more regularly at 27 Stratton Road.

The first day of the inspection was unannounced and took place over the 11 and 12 August 2015.

The service had a registered manager who was responsible for the day to day running of the home. 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 registered manager said they neither worked at nor managed the service because the service was managed by a trainee manager.

We found that the service was not always well led; effective systems to monitor and improve the quality and safety of the service, and to evaluate and improve practice were not in place.

The service did not follow the requirements set out in the Mental Capacity Act 2005 (MCA) when people lacked the capacity to give consent to living and receiving care at the home.

The MCA sets out what must be done to make sure that the rights of people who may lack mental capacity to make decisions are protected in relation to consent or refusal of care or treatment. CQC is required by law to monitor the application of the MCA and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. This includes decisions about depriving people of their liberty so that they get the care and treatment they need where there is no less restrictive way of achieving this. DoLS require care home providers to submit applications to a ‘Supervisory Body’; the appropriate local authority, for authority to do so.

We found that the service had not made necessary applications to the local authority for DoLS authorisations to protect people from being deprived of their liberty without lawful authority.

Most of the risks to people receiving care were assessed by the service, and for the great majority of the time all reasonable steps were taken to keep risks as low as possible. However, we noted there were some areas where all reasonable actions to reduce risks had not taken place. We found that people received the correct medication in a timely way, but that some aspects of medication management needed to be improved.

People said they felt safe living at the home. Staff were aware of their safeguarding responsibilities and showed positive attitude to this, and also to whistleblowing. We have made a recommendation in relation to making safeguarding alerts that can be found in the full version of the report.

The premises were safe, clean, homely and well maintained. The home had been redecorated recently and the service had plans to fit a new kitchen in September this year. Each person had their own room, decorated and furnished according to their choices, and the use of shared bathroom and toilet facilities. These included a level access wet room downstairs.

Checks of records indicated that reporting and recording of incidents and accidents took place.

There was a complaints procedure in place but the service could not provide us with a record of the concerns it had received. We have made a recommendation about the handling of concerns and complaints which can be found in the ‘effective’ section of the full version of the report.

Staff acted in a caring manner; we observed they treated people with warmth and humour; they spoke to people with respect, and asked before carrying out care. People who use the service were helped to make choices and decisions about how their care was provided. People told us that the staff were “good” and kind. One family member said, “To me, they are exceptional” another commented, “I trust [the provider] implicitly.”

We observed that people were given choices and consulted about their care. Family informed us they felt confident to raise any issues or concerns because they were listened to.

Each person who uses the service had their own personalised care plan which promoted their individual choices and preferences. People were assisted to go out into the community to enjoy leisure time and also to attend health appointments.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.