The inspection took place on 28 December 2017 and 3 January 2018, only the first visit was unannounced.

Landsdowne Road (67-71) 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 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.

Landsdowne Road (67-71) accommodates up to 26 people across four separate units, each of which have separate adapted facilities. One of the units, the Cedar unit currently specialises in providing care to people with autism, and the Elm and Aspen units for a focus on daily living skills to transition to independent living. There are enclosed gardens to the rear of the service. People living at the home have a learning disability, which may include a mental health disorder. At the time of our inspection there were 24 people who lived at the home.

At the last inspection on 15 September 2015 the service was rated Good.

At this inspection we found the service remained Good.

At the last inspection we asked the provider to take action as some moving and handling practice was not considered to be safe. At this inspection we found people were safe and moved around the service independently and assisted safely by staff. People using the service were from a number of cultures which was reflected by a diverse staff group.

People and their relatives felt staff were kind and caring. People felt their privacy and dignity was respected in the delivery of care and their choice of lifestyle. Relatives that commented were complimentary about the staff and the care offered to their relatives.

People were aware of their care plans and they were involved in care plan reviews, when necessary relatives were include as well. Staff offered people everyday choices and respected their decisions. People had their care and support needs assessed and were involved in the development of their care plan. Staff had access to people’s care plans and received regular updates about people’s care needs. Care plans included changes to peoples care and treatment, and people attended routine health checks.

People were provided with a choice of meals that matched their cultural and dietary needs. Staff ensured people were able to maintain contact with their family and friends and visitors were welcome without undue restrictions. There were sufficient person centred activities provided on a regular basis. People and their relatives felt they could raise any issues with the acting manager or staff.

Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the service. All the staff received a training induction and then on-going training for their specific job roles. Staff were informed about; and were able to explain how they kept people safe from abuse. Staff were aware of whistleblowing and what assistance was available from external bodies to report suspected abuse on to, and follow up alleged incidents. Staff were available in adequate numbers to meet people’s personal care needs.

People, their relatives and staff felt they could make comments or raise concerns with the management team about the way the service was run and were confident these would be acted on.

There was a clear supportive management structure within the service, which meant the staff were aware of who to contact out of hours. The provider undertook quality monitoring in the service and was supported by the acting manager and staff. Staff were aware of the reporting procedure for faults and repairs and had access to maintenance ser

This inspection took place on 15 September 2015 and was unannounced.

Lansdowne Road is registered to provide residential care and support for 26 people with a learning disability who present behaviours which challenge us and may in addition have autism and needs related to their mental health. At the time of our inspection there were 24 people using the service.

Lansdowne Road 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.

Staff told us that training had helped them to understand the needs of people, which included their right to make decisions about their day to day lives. Staff were confident that if they had any concerns about people’s safety, health or welfare then they would know what action to take, which would include reporting their concerns to the registered manager or senior managers.

Staff had received training which reflected the needs of people who used the service which enabled them to provide care in a safe manner. This included supporting people when their behaviour became challenging and through the appropriate support for people who required support with their mental health. We found people received their medication in a timely and safe manner by staff that had been trained in the administration of medication.

Our discussions with staff told us that they received on-going support and development through supervision, appraisal and the accessing of training. The training staff accessed reflected the needs of people who used the service which meant people received effective care and support. Records confirmed staff had received training in a wide range of topics.

People were protected under the Mental Capacity Act Deprivation of Liberty Safeguards (MCA DoLS) we found that appropriate referrals had been made to supervisory bodies where people were thought to not have capacity to make decisions. Staff we spoke with spoke about their role in supporting people to maintain control and make decisions which affected their day to day lives and told us how this was a key part of their role when supporting people.

People’s health and welfare was promoted and they were referred to relevant health care professionals in a timely manner to meet their health needs.

We observed positive and supportive relationships between people who used the service and staff. People were comfortable and relaxed in the company of staff and shared laughter and conversation with them. We noted staff supported people in a timely manner, which included supporting them when they became anxious. We observed people being encouraged to make decisions about their day and records showed people’s comments and views were documented in daily records and within the minutes of meetings.

A range of documents had been produced in an ‘easy read format’, which used pictures and symbols to assist in people’s understanding of the information. However we found that the minutes of meetings, whilst being provided in this format contained words and phrases that did not reflect the ‘easy read’ style and therefore had the potential to exclude people from the information. This was discussed with the registered manager who told us this would be addressed.

People we spoke with were confident that any concerns they had would be responded to appropriately and knew who the registered manager was. Records showed that the service within the last twelve months had received one complaint which had been investigated and acted upon.

The attitude of the registered manager and staff showed they were enthusiastic about their work and committed to providing the best possible care for all those who used the service. All were aware of each person’s individual needs. Staff appeared caring, friendly and talked about their work and were well informed about those using the service.

There were effective systems in place for the maintenance of the building and equipment which

ensured people lived in an environment that was maintained and safe. Audits and checks were effectively used to ensure people’s safety and needs were being met, as well as improvements being made as required. People’s representatives and staff had the opportunity to influence the service, which enabled the provider to review and develop the service.

We spoke with four people who used the service and asked them for their views about the care and support they received. People told us: “I like to go out to the local café by myself, I’ve lived here a long time and I am happy here.” “I like going out. I’m going out later to the shops with (staff name).” “We’re all looked after here and the staff are nice.”

People’s care and support plans had a strong emphasis on promoting the independence of people and their right to make decisions about their daily lives. People met regularly with their key worker to review and discuss their care and support plan. People were supported to make decisions about their daily lives and we saw people accessing a range of community based activities, whilst some people remained at the service and were supported to take part in activities within the service which included cooking. People in some instances received one to one support.

We spoke with staff and found they had a good understanding as to the needs of people and they spoke with us about the support they provided. Records showed staff had undergone a robust recruitment process and had received and continued to receive training which enabled them to meet the needs of people.

We spoke with four people who live at Lansdowne Road and asked them for their views and experiences of living at the home. People told us they were involved in decisions about their daily lives and that they were supported by staff to manage their lives and make decisions. People’s comments included: - “I decide what I want to do and when. I enjoy going out to the local cafe with my friend to eat.” “I go out by myself; I catch the bus and visit my boyfriend at the weekends.” “I like going out, we’ve just been on a day trip to Drayton Manor, I don’t like staying in as I get bored.”

We found people living at the home were supported to access the community, taking part in social and recreational activities. We also saw staff supporting people when they became anxious and upset consistent with guidance as recorded within their support plans. People living at the home were encouraged to ask questions about visitors and were introduced to them and were included in conversations wherever possible. People we spoke with told us they had the opportunity to attend meetings where they talked about issues which affected them as a group and individually and that they were confident to speak with staff.

People we spoke with told us that there had been improvements to the environment. People in some instances were able to tell us the colour scheme of their bedroom which they had chosen. One person proudly showed us the new kitchen that had been fitted.

We asked people who use the service if they felt that their respect and dignity was maintained, responses included, “yes it’s great here, I am very happy, the staff are great.” People who use the service also stated, and records showed, that people were fully involved in the decision making process, which included consent to the content of their care plans. A visitor to the home stated that she was fully informed about the care provided to her relative and confirmed that she was fully involved in the review process of her relatives’ care plans and risk assessments.

People who use the service told us that they enjoyed living at Lansdowne Road and specified that the staff would always respect their decisions as to how they spent their days. One person who uses the service stated, “I can do what I want really, I like helping with the cleaning and helping with meals.” We asked the person if he ever felt that his decisions were not valued by the staff, his response was, “no, never.”

We observed that the interactions between the staff and people who use the service were positive. People who use the service did not express any feelings of insecurity and said they felt safe and well looked after. We also asked a visitor to the home if she was confident that people who use the service were protected from abuse. Her response was, “yes, I have never seen anything that gives be cause for concern.”

People who use the service told use that they were satisfied with the standard of cleanliness at the home and a visitor to the home also expressed satisfaction with the standard of cleanliness in the home.

People who use the service told use that they were satisfied that complaints were managed effectively. A visitor to the home also felt confident that complaints would be addressed in a professional and confidential manner.