The inspection took place on the 22 August 2018. The service was last inspected in December 2016, when it was rated ‘Good’. At this inspection we found the majority of the evidence continued to support the overall rating of good and there was no significant evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. However, we have made a recommendation for improvement in ‘effective’ and this key question has been rated ‘requires improvement’. This does not affect the overall rating which remains ‘good’. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service is a small service registered to provide care and support to people with a learning disability. It is registered to care for nine people. At the time of the inspection eight people lived there. Larwood House is a purpose built property all on one level with level access to a large outdoor space.

Larwood House 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.

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.

Care plans were developed in line with current legislation and guidelines. They were person-centred and included the views and preferences of people. However, we found they were not always reviewed and up-dated in a timely manner when people’s needs changed. People had a varied and nutritious diet based on their preferences and staff knew if people needed further support or monitoring if they were at nutritional risk. However, we found the records were not always consistent with what was actually taking place and guidance was not always followed. We made a recommendation regarding nutrition and hydration.

The provider took responsibility to ensure that they were operating under the principles of the Mental Capacity Act 2005 (MCA) and were not placing unlawful restrictions on people. Where required, Deprivation of Liberty Safeguards (DoLS) were in placed or had been requested, and any conditions had been met. 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.

Staff understood how to keep people safe at Larwood House and there were policies in place to support this. Risk assessments were used to identify risks to people and plans put in place to reduce the likelihood or impact of such risks. Medicines were managed safely and people received their medicines as prescribed.

Staff were kind and compassionate and developed positive and friendly relationships with people. They respected people’s choices and personal space and promoted their independence and dignity.

Staff knew people’s preferences and encouraged people to access activities of their choosing, either within the home or in the local community. People were supported to become active citizens in their local community. People received information in a format that they understood and they were supported to participate in meetings and decisions about their care. Discussions ha

We inspected the service on 23 December 2015. Larwood House is registered to accommodate up to seven people living with a learning or physical disability. The service registered with us in September 2015 and is a new service. On the day of our inspection four people were using the service.

The service had a registered manager in place at the time of our inspection. 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.

Although the service is new, we received consistently positive feedback about the way people had been supported to move into the service and about the overall quality of the service. Relatives and visiting professionals told us that the registered manager and staff had worked hard to make the transition to the new service from people’s previous placements as smooth and easy as possible. We were consistently told that people had improved significantly both emotionally and physically due to a staff team who were knowledgeable and committed to working with people who had a learning and/or physical disability.

People were supported by staff knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions and staff knew how to act if people did not have the capacity to make decisions.

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

People lived in a service where staff valued and listened to them. People’s emotional needs were recognised and responded to by a staff team who cared about the individual they were supporting. People were supported to enjoy a social life and to make links with their neighbours.

People were involved in giving their views on how the service was run and there were systems in place to monitor and improve the quality of the service provided.