We inspected this service on 21 February 2018. Little Acres is a care home for people with a learning disability, physical and sensory needs, including autistic spectrum disorder. 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.

Little Acres provides accommodation and or personal care for up to 25 people. The accommodation is provided in a two-storey adapted house with garden and patio seating areas. At the time of our inspection, 23 people were living at the home.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive safe care. People were protected from the risk of avoidable harm by staff who understood their responsibilities to identify and report any signs of potential abuse. We saw that incidents and accidents were investigated thoroughly to ensure lessons were learnt. Risks associated with people’s care and support were managed safely and relatives were confident their family members were safe and well cared for. People received their medicines when needed and there were suitable arrangements in place in relation to the safe administration, recording and storage of medicines. There were sufficient, suitably recruited staff to meet people’s needs.

People continued to be effectively supported by staff that were trained and supported to meet their specific needs. 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. People had sufficient amounts to eat and drink and were supported to access other health professionals to manage their day to day health needs. The home environment was adapted to meet people’s needs and preferences.

The care people received remained good. People had positive relationships with the staff who were kind and caring and supported them to make choices about their care. People’s privacy, dignity and independence were promoted at all times. People were encouraged to maintain their important relationships.

The service remained responsive. People received personalised care that met their individual needs. Staff understood people’s diverse needs and encouraged them to take part in activities that they enjoyed. People and their relatives were able to raise any concerns or complaints and were confident these would be acted on.

The service remained well led. There were suitable systems in place to assess, monitor and improve the quality and safety of the service. The provider encouraged people, their relatives and staff to give feedback on how they could make improvements in the service. This was acted on wherever possible.

Further information is in the detailed findings below.

We carried out an unannounced inspection of the service on 12 January 2016.

Little Acres provides accommodation and personal care for up to 25 people living with a learning disability, physical and sensory needs, including autistic spectrum disorder. At the time of our inspection there were 15 people living at the service.

Little Acres is required to have 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. At the time of the inspection there was not a manager registered with the Care Quality Commission. The previous registered manager deregistered in September 2015. A manager was in place and told us that they would be shortly submitting their registered manager application. We will monitor this.

People received a safe service. Staff were aware of the safeguarding procedures to protect people from abuse and avoidable harm and had received appropriate training. Risks were known by staff and managed appropriatly. However, some shortfalls were identified with care and risk plans. These were not always as detailed as they should have been or reviewed in line with the providers review system.

People received their medicines as prescribed and these were managed correctly. Some action was required with regard to medicines prescribed for use as and when required. Safe recruitment practices meant as far as possible only people suitable to work for the service were employed. Staff received an induction, training and appropriate support.

Accidents and incidents were recorded and appropriate action was taken to reduce further risks. However, there was no analysis or review of this information to help identify any themes, patterns or concerns.

There were sufficient experienced, skilled and trained staff available to meet people’s needs. People’s dependency needs had been reviewed and were monitored for any changes.

People received sufficient to eat and drink and were positive about the choice, quality and quantity of food and drinks available. People’s lunchtime experience could have been better. People were supported to access healthcare services to maintain their health. People’s healthcare needs had been assessed and were regularly monitored, feedback from healthcare professionals were positive about how people’s health needs were met.

Staff were kind, caring and respectful towards the people they supported. They understood people’s individual needs, preferences and routines.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and to report on what we find. This is legislation that protects people who are unable to make specific decisions about their care and treatment. It ensures best interest decisions are made correctly and a person’s liberty and freedom is not unlawfully restricted. Assessments and best interest decisions had been made for some people but had not been reviewed when required. Some people had not had MCA assessments completed where these were required. The provider took action to immediately address this.

People who used the service including their relatives were supported to share their experience and wishes about the service through regular meetings and annual feedback questionnaires. Communication between relatives and external professionals was good.

People told us they knew who was in charge and they would raise any complaints or concerns with them. Information about how to make a complaint was available but not presented in an easy read format for people with communication needs. Confidentiality was maintained and there were no restrictions on visitors.

The provider had checks in place that monitored the quality and safety of the service. These included daily, weekly and monthly audits. Some shortfalls were identified with record keeping; this was acknowledged by the manager and regional director who took immediate action to address this.

During our visit we spoke with seven people who used the service and two members of staff.

People told us they were happy living in the home. We observed a relaxed atmosphere and staff interacted well with people who used the service.

People told us they were able to make choices in what they wanted to do each day. One person said, “It’s my choice.” Another person said, “I can go out if I want to.”

The manager told us there was an advocacy service that supported people to have their say and get their views heard.

We observed staff encouraging people to complete tasks and activities at their own pace. Staff we spoke with told us they asked for people’s consent before they delivered care or came into close contact with them while care was delivered.

The home was clean and tidy. Staff wore the appropriate equipment when providing support to the people who used the service. The staff told us they had completed infection control training and refresher courses when required.

Staff told us they had completed a robust induction when they first started at the service and they said they felt supported by the management.

We used a number of different methods to help us understand the experiences of people using the service, because they had complex needs which meant not all the people were able to tell us their experiences. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

The people we did speak with told us they were happy living in the home. One person said, “I like it, it’s all right.” Another person said, “I am happy with what I do.”

People were given choices in what they wanted to do, they told us they were able to get up and go to bed when they wanted. They also said they can choose what they wanted to do each day.

We saw weekly activities were offered over a two week period this included things like, wii fit (computer exercise games), gardening and baking. The people told us they enjoyed baking and other activities that the service provided. There was a group of people participating in painting pictures on the day of our visit. Staff were very supportive to the group and gave one to one support where required.

We saw staff encouraged people to be independent. One staff member asked a person if they were going to make a drink. The person told us they always made their own drinks. We ask if everyone was able to do this task and the manager told us there were some people who needed more support than others, however staff made sure this happened where possible.

The people living in the home looked relaxed and content. We observed them communicating well with each other and with staff. The staff spoke to people in a calm and respectful manner.

People who use the service confirmed that their privacy and dignity are respected. They make most of their own decisions and choices without the need for staff help. One relative said that staff encourage people’s independence. People described taking part in a range of interesting and valued activities and making good use of community facilities. One relative told us that since the change of provider, “residents are so much more relaxed and happier”.

People told us they enjoy the meals at Little Acres and are able to choose what they eat. They described a nutritious diet. Relatives told us that the people who use the service are enabled to use appropriate external health professionals. People had a key worker who oversees their day to day care. They felt safe living at Little Acres and were able to tell us who they would speak to if they felt unsafe. People told us that they do not take any medicines themselves without staff help. People told us that staff are good at communicating with them and treat them with consideration and respect. One person said, “I’m happy here… with the staff and with the residents… we get on well”.