The inspection was carried out on 5 May 2017 and was announced.

The home provides care and support for up to six people with learning disabilities and/or autism. Some were at higher risk of presenting challenging behaviours which may harm themselves or others. However, staff had the skills and training to support people to participate as equals in their community, living within an ordinary home. At the time of our inspection there were six people living at the home. The accommodation was split over two floors with bedrooms on the ground floor and first floor.

A registered manager was employed at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

The provider’s operational policy about planning for emergencies was not specific to the home. It was generic and did not ensure that managers and staff in the home would understand how to continue people’s care, should the home be evacuated in an emergency. We have made a recommendation about this.

Incidents and accidents were recorded and checked by the registered manager and the provider’s to see what steps could be taken to prevent these happening again. Staff were trained about the safe management of people with behaviours that may harm themselves or others. However, reportable incidents had not been appropriately reported. We have made a recommendation about this.

People were kept safe by staff who understood their responsibilities to protect people living with learning disabilities and autism. Each person had a key worker who assisted them to learn about safety issues such as how to evacuate the building in an emergency and to speak to if they felt unsafe. The registered manager had plans in place to ensure that people who may not understand what to do would be individually supported by a member of staff if there was an emergency. Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

The manager and care staff used their experience and knowledge of caring for people with learning disabilities and complex needs effectively. Staff assessed people as individuals so that they understood how they planned people’s care to maintain their safety, health and wellbeing. Risks were assessed within the home, both to individual people and for the wider risk from the environment. Staff understood the steps to be taken to minimise risk when they were identified. The provider’s policies and management plans were implemented by staff to protect people from harm.

There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely. Where people could retain the information, they had been supported to understand what their medicines were for and when they needed to take them. This was reinforced by staff who administered medicines.

People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Good quality records were kept to assist people to monitor and maintain their health. Staff had been trained

We carried out this inspection on the 18 June 2015, and it was unannounced. We inspected this service due to concerns we had received. It was alleged that a robust recruitment procedure was not being followed.

Insight Walderslade is a privately owned care home, providing care and accommodation for up to six adults. There were six people at the service at the time of the inspection. People had a variety of complex needs including mental and physical health needs and behaviours that may challenge. It is one of a group of five care homes owned by Insight Specialist Behavioural Service Ltd. The home in situated near the amenities of Walderslade.

Due to people’s varied needs, some of the people living in the service had a limited ability to verbally communicate with us or engage directly in the inspection process. People demonstrated that they were happy in their home by showing warmth to the registered manager and staff who were supporting them. Staff were attentive and interacted with people in a warm and friendly manner. Staff were available throughout the day, and responded quickly to people’s requests for help.

The service had a registered manager, who was also the nominated individual for the company. 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.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act (MCA) 2005 to ensure any decisions were made in the person’s best interests. Staff were trained in the Mental Capacity Act 2005 (MCA) and showed they understood and promoted people’s rights through asking for people’s consent before they carried out care tasks.

Staff had been trained in how to protect people from abuse, and discussions with them confirmed that they knew the action to take in the event of any suspicion of abuse. Staff understood the whistle blowing policy and how to use it. They were confident they could raise any concerns with the registered manager or outside agencies if this was needed.

Staff were knowledgeable about the needs and requirements of people using the service. Staff involved people in planning their own care in formats that they were able to understand, for example pictorial formats. Staff supported them in making arrangements to meet their health needs.

Staff were recruited using procedures designed to protect people from the employment of unsuitable staff. Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

Medicines were managed, stored, disposed off and administered safely. People received their medicines when they needed them and as prescribed.

People were provided with food and fluids that met their needs and preferences. Menus offered variety and choice.

There were risk assessments in place for the environment, and for each individual person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. People were involved in making decisions about their care and treatment.

There were systems in place to review accidents and incidents and make any relevant improvements as a result.

The registered manager investigated and responded to people’s complaints and people said they felt able to raise any concerns with staff.

Staff respected people and we saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served and at other times during the day.

People were given individual support to take part in their preferred hobbies and interests.

There were systems in place to obtain people’s views about the quality of the service and the care they received. People were listened to and their views were taken into account in the way the service was run.

Some of the people who used this service had limited verbal communication and therefore were not able to tell us directly about their experiences of the service. We spoke with three people who used the service, one relative and observed staff supporting people with their daily activities.

People were able to make decisions and choices in their daily lives and were involved in setting short and long terms goals. Any restrictions on people’s freedom of choice had been recorded in people’s plans of care, together with the rationale behind these decisions.

Clear guidelines were in place for staff to follow to support people with behaviours that may challenge. Staff demonstrated that they understood these guidelines and put them into practice to help minimise people’s anxieties and behaviours.

People were supported to engage in activities that they enjoyed, to develop independent living skills and to access the local community.

The home was kept clean by the staff and people who lived in the home. Laundry took place in the kitchen, but clear guidance was not in place to ensure staff minimised any risk of infection at all times.

People were involved in meal planning and preparation. People at risk of poor hydration were monitored and action taken to minimise the risk.

There were enough staff on duty to support people’s needs.

People who lived in the home were encouraged to make their concerns and complaints known.