About the service: Ivy Cottage is a residential care home that was providing personal and nursing care to 13 people with a learning disability at the time of the inspection.

People’s experience of using this service:

People were happy living at Ivy Cottage. They were comfortable in the company of staff and others they lived with. People were supported to maintain relationships with family and friends.

The service did not always consistently apply the principles and values of Registering the Right Support and other best practice guidance. This ensures that people who use the service 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 control, choice, and independence. The service promoted independence for those who expressed a wish to move on, and encouraged people to access the community and carry out person centred activities. The provider was improving the environment and creating more opportunities for people to gain new skills. This would help ensure the principles and values were applied consistently.

People talked to staff about how to stay safe. There were enough staff to meet people’s needs and the same workers provided support so people received consistent care. However, the recruitment process was not always robust. Medicines were managed safely although the auditing system did not pick up when the incorrect number of tablets were carried forward to the next medicine cycle.

Staff received support through regular training, supervision and appraisal. We have made a recommendation about meeting people’s health care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the policies and systems in the service did not always support this practice.

People felt well cared for. The service was making improvements to the support planning process to make sure people's needs were fully reflected. They had introduced individual weekly activity planning meetings.

The manager had not been in post very long and had spent time getting to know people who used the service and staff. They were enthusiastic and had a clear vision about service improvement. Quality management systems were in place but these were not always effective because they did not identify some of the issues picked up during the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to review intelligence about the service and visit again within our recommended return inspection timescales. If any concerning information is received we may inspect sooner.

The inspection took place on 14 June 2016. The inspection was unannounced which meant the staff and the registered provider did not know we would be visiting.

Ivy Cottage provides accommodation and personal care and support for up to 14 people who have a learning disability. People using the service have complex needs and are supported and encouraged to use ordinary community based health and leisure services. People are also supported to do as much for themselves as possible in the pursuit of living an independent ordinary lifestyle.

The service had a registered manager. 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 service was split into two sections a large house where 10 people lived and a smaller unit where four people lived. The smaller unit provided a forensic mental health service. Forensic services are specialist services for people who have a mental health problem but have also been arrested or convicted of a crime.

Staff we spoke with knew how to administer medicines safely and records showed that medicines were being administered and checked regularly.

Accidents and incidents were monitored and analysed each quarter to see if any trends were identified.

We saw safety checks and certificates that were all in date. We saw fire drill were taking place but the information provided did not evidence that all members of staff had received at least one fire drill in the last year or if a fire drill had taken place for night staff. The operations manager said they would make sure this happened and update the staff list which still had names of people who were no longer working at the service. Water temperatures were not recorded routinely and fire alarm testing had not taken place since 23 May 2016.

Policies were in place to ensure people’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were protected. Where appropriate, the service worked collaboratively with other professionals to act in the best interests of people who could not make decisions for themselves. At the time of inspection three people were subject to a DoLS authorisation. Staff demonstrated a clear understanding of DoLS.

People were supported to maintain their health through access to food and drinks. Each person had their likes and dislikes documented and the majority of people shopped for their own food.

People who used the service chose what activities they wanted to do. In house activities also took place.

Staff we spoke with understood the principles and processes of safeguarding. Staff knew how to identify abuse and report it to the appropriate authority. Staff said they would be confident to whistle blow [raise concerns about the service, staff practices or provider] if the need ever arose.

The registered provider followed safe processes to help ensure staff were suitable to work with people living in the service. There were sufficient staff to provide the support needed and staff knew people’s needs well.

Staff had regular supervisions and appraisals to monitor their performance. Staff received regular training in the areas needed to support people effectively and were suitably trained to manage behaviours that challenge whilst ensuring people’s rights were protected.

People and a relative we spoke with spoke positively about the support they received. Throughout the inspection we saw people being treated with dignity and respect. People were actively involved in decisions about their care and support needs.

Three people using the service were using an advocate at the time of the inspection. Information on advocacy was available. Care plans for people who were older documented their end of life

People told us they like living in the home. One person told us that they hoped to be moving out of the home into a flat of their own. They said that they were looking forward to this, however it might be a while before they moved. They told us “I still like living at Ivy Cottage and I have lots of choices in what to do.” They also said that staff “Talked them through their care plans and gave them a copy to keep.”

Another person told us they were looking forward to their birthday and going out to celebrate with their relatives. People who used the service told us they felt safe. People also told us that they had a say in what they do and what happens to them. . One person said that “People living in the home have meetings to discuss what meals everyone likes and what to put on the menu”. Another person said they had meetings to discuss what they are going to do and where they are going to go.

People told us they liked the people caring for and supporting them. One person told us that they helped with interviewing new staff and asking them questions. People told us that it was always clean and tidy and everyone helped to do the cleaning.

They told us they liked washing up and helping with the cooking. They went on to say that they liked sitting with the staff and chatting with them over a cup of coffee in the in the lounge”.

The provider had a system for checking the quality and safety of the service and records were maintained and held securely.

People told us they like living in the home. One person told us that they hope to be moving out of the home into a flat of their own. They said that they are looking forward to this, however, these homes are still being built and it might be a while before they move. They told us they still like living at Ivy Cottage and enjoy their part time job delivering leaflets in the local area. Another person told us they are looking forward to their birthday and going out to celebrate with their relatives.

People using the service told us they feel safe. People also told us that they have a say in what they do and what happens to them. One person said they have meetings to discuss what they are going to do and where they are going to go.

People told us they like the people caring for and supporting them. One person using the service told us that they help with interviewing new staff and asking them questions.

People told us they like the people caring for them. One person helping in the kitchen told us that all of the staff are good and that they did not have any favourites. They told us they liked washing up and helping with the cooking. They also said they like having take away meals occasionally and that they particularly liked Chinese food. They went on to say that people living in the home have meetings to discuss what meals everyone likes and what to put on the menu.

People told us they like living in the home and the people caring for them. One person told us that they liked Christmas and the meals provided. They said they particularly like carrots and Yorkshire pudding. They went on to say that they liked sitting in the manager’s office having a cup of coffee.

People said they like living in the home. One person was preparing to out into the local community independently. Another said that they are fully involved in their assessments and care plans and has a say in how they are to be supported. They also said they have a job and like delivering leaflets in the local area. Another was excited as they were having a visit from their Social Worker to review their progress. Another said they are looking forward to going to the coast on holiday.

People using the service said they feel safe. People said they like the people supporting them as they listen to what they say and help them.

People say they like the people caring for and supporting them. People we could not communicate with appeared to be happy and comfortable, and positive relationships were observed being fostered between those using the service and those supporting them.

People say they like the people supporting them. One person says they are supported to go on holiday and like the people that take them.

People using the service say they like the people supporting them. One person said they have a favourite support worker that they like best but others are alright as well.