About the service: Litslade farm is a residential care home that was providing personal care to five adults with learning disabilities at the time of the inspection.

The service was a five-bedroom bungalow. It was registered for the support of up to five people. This is in line with current best practice guidance. The building design fitted into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people. At the time of the inspection five people were living in the service.

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

People’s experience of using this service:

• People’s relatives spoke positively about the service and the staff. Comments included “I am extremely happy with the care given to [named person]. They personalise everything. They show a great deal of caring.” “Both I and [named person] are listened to. Things have really improved there since the new manager started. [Registered manager] has taken so much on board I cannot praise her enough. The staff are fab, they are really good.” “The service is wonderful. [Named person] has always been well looked after, they are always happy and content.”

• People’s needs were assessed prior to care commencing.

• Staff were trained to meet people’s individual needs. Staff were committed and focused on providing good quality care.

• The registered manager understood the requirements of their role and played a pivotal part in establishing a high-quality service. People’s mental and physical health was maintained. Their wishes and desires were explored with them to assist them to achieve their goals.

• People lived and participated in village life.

• 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.

• The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways: promotion of choice and control, independence, inclusion] e.g. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Rating at last inspection: The last inspection the service was rated Good. (14 April 2016).

Why we inspected: We inspected the service as part of our scheduled inspection plan.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.

This unannounced inspection took place on 22 and 23 March 2016. At the last inspection in October 2014, we asked the provider to take action to make improvements related to the safety of the premises, equipment, how care was assessed and documented and how the Mental Capacity Act 2005 (MCA) was implemented in the home. During this inspection we found this action had been completed.

The home is registered to provide personal care and accommodation to five people with a learning disability. The home is a bungalow and situated in a village in the north of Buckighamshire. Each person had their own bedroom all other areas of the home including the kitchen, dining room, lounge and bathroom are shared areas. It is managed by 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.

At the time of this inspection five people were living in the home. The registered manager had recently returned to the home after a period of leave. During their absence the home had been managed by the deputy manager and the mobile operations manager. We learnt during the inspection that the registered manager was due to leave their post within the two weeks following the inspection. Most of the information received during the inspection was provided by the deputy manager and the mobile operations manager as the registered manager was not available.

People’s relatives told us they felt people were safe living in the home. Staff knew how to identify signs of abuse and knew how to respond appropriately.

People’s medicines were administered, stored and recorded safely. People’s needs were assessed and care plans reflected how staff would meet their needs. Risk assessments were in place to ensure the risk of injury to staff and to people was minimised.

Records were frequently updated in relation to the care provided, and information about people was shared between staff in the handover meetings which took place each day.

The systems used for recruiting staff included making checks on candidate’s backgrounds. This was to ensure they were safe to work with people.

Staff told us and documentation verified they were being supported by the provider through regular supervision, annual appraisals and training. Staff meetings were held where discussions took place on how the service could be improved.

Staff had a basic understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant where people were unable to make decisions for themselves, staff acted in a way that was agreed was in the person’s best interest.

People’s health was maintained and where professional advice was required to assist people to remain healthy this was sought by staff. For example, dietician and GP.

We observed staff caring for people in a sensitive and appropriate way. They demonstrated a kind and caring nature and they were knowledgeable about people’s needs and how to meet them. Care plans recorded people’s choices and preferences and these were respected by staff.

There was a range of activities in and outside the home to minimise the risk of social isolation. People were very active and this included community involvement.

People’s relatives and staff told us the service was well managed. There was a kind and caring culture to the home and staff believed they worked well as a team and supported each other as well as the people they were caring for.

Quality assurance checks had been completed and were on going alongside introducing feedback from people’s relatives and stakeholders which will be used to improve the quality of the service to people.

The care plans we looked at clearly identified which weekly activities people wanted to participate in and what level of support individuals required, this demonstrated that a person centred approach was in place. We saw people who use the service were supported to participate in discussions and that their contribution was encouraged and received positively.

Two staff told us how they used individual communication methods to ensure people participated in daily activities with an agreed and personalised level of support. One care worker told us, “Communication is central to my role; I always focus on the person and find appropriate ways to communicate with them.”

We looked at range of care files that evidenced the cultural and spiritual needs of people using the service were being supported and each care plan documented the personal beliefs, faith and worship preference of people who use the service.

We observed that the provider offered an extensive range of activities that helped people to be more independent and that staff were available to support with planning, attending and making sure safety and welfare needs were met.

Verbal feedback from staff and our observations of the staff on duty evidenced that the provider had an adequate staff development system in place to ensure the quality of care delivered was underpinned by on-going and responsive training.

Due to the varying levels of communication that the four people who were using the service had, it was difficult to discuss their care with them in any depth. However, within the care files we saw that people and or their families had been involved with, and agreed with the particular care needs that had been identified for them as far as they were able. Despite this, we could not find any evidence to demonstrate that staff always took into account and considered the processes for assessing individuals mental capacity and best interests.

We observed staff interacting with people, listening to them and responding to them in a polite and courteous way. We spoke to two staff and they were knowledgeable about people's needs and demonstrated a clear understanding and awareness of how they should be met.

There were arrangements in place through the provision of training and guidance to supported staff in ensuring people using the service were safe.

When we looked at staff files we saw evidence that recruitment procedures for staff were being appropriately followed in order to ensure that only suitable people were employed by the service.

We reviewed the providers systems and processes for monitoring and responding to the quality of services provided and found that there were some shortcomings in the monitoring and responsiveness to this area.

We were told that the people using this service were supported in being involved in most aspects of life in the home and participating in activities in the local community.

We saw that staff were supportive in their responses to people. People were treated with consideration and respect.

People were involved in the home’s annual garden party, the annual village fete, in regularly attending church events, and going shopping.

One person was involved in delivering the village magazine to homes every few months.

People were supported in going to the gym, to a day centre, Milton Keynes College, to the cinema or theatre, regular outings with staff, and a range of other activities.

This was an unannounced inspection which took place on the 1 and 2 October 2014.

The home is registered to provide personal care to five people with a learning disability. The building is a bungalow and situated in a village. Each person has their own bedroom all other areas of the home including the kitchen, dining room, lounge and bathroom are shared areas. It is managed by 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.

Most of the people living in the home had up to date care plans. One person did not. This was because they moved from another home without a detailed assessment of their needs being completed. Their care plans related to their life in a previous home and were not relevant or up to date.

Most people had risk assessments in place to reflect how care could be provided safely and how people could maintain their independence. However, we found some of the risk assessments did not identify how to minimise or avoid the identified risk. This placed people and others at risk of harm as the risk assessment did not direct staff on how to reduce the likelihood of harm or injury occurring.

Systems were not in place to securely store confidential information or poisonous substances used for gardening and maintenance. A call bell used to summon assistance was not working. None of these things had been identified through the completion of quality audits of the home.

Although staff understood the process of the Deprivation of Liberty Safeguards (DoLS), they were not able to demonstrate an understanding of the Mental Capacity Act 2005 (MCA). People’s mental capacity to make decisions for themselves had not been assessed. Without this the provider could not be certain they were acting in the person’s best interest.

People were unable to explain to us how they experienced the care being provided to them. Three of their relatives told us consistently the care was good. They spoke positively about the staff and the registered manager. In their opinions the home provided a safe environment, with staff that were suitably trained and experienced. They believed each person was happy to live in the home and they were well cared for and treated with respect.

We observed good care practices, for example the interaction between staff and people was respectful and kind. Staff were observant regarding people’s health and reported concerns quickly. They were knowledgeable about the people they supported and worked hard to ensure they were well cared for. People were encouraged to be involved in their care through the use of photographs, this enabled them to make choices about the food they ate and the activities and holidays they participated in.

The provider had not assessed the numbers of staff required to be certain they could provide care safely and meet each person’s needs.

Staff were supported through training, supervision, appraisals and staff meetings. They were encouraged to develop skills in areas of particular interest to them. They told us the registered manager was approachable and supportive. Relatives told us they found the registered manager to be experienced and knowledgeable about the people they cared for. A complaints procedure was in place. At the time of the inspection no complaints had been received. Relatives told us there was an open dialogue with the staff and the registered manager, and they could discuss any concerns they had at any time.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.