This inspection took place on 6 September 2017 and was unannounced. At our last announced comprehensive inspection of this service on 28 July 2015 we rated the service ‘good’.

This inspection took place on 6 September 2017 and was unannounced. At our last announced comprehensive inspection of this service on 28 July 2015 we rated the service ‘good’.

Living Ambitions Limited - 89 Grosvenor Avenue is a care home that can accommodate up to five adults with personal care and support needs. The home specialises in supporting people with a learning disability and who may be living with an autistic spectrum disorder. There were five people living at the home at the time of our inspection.

The service had a registered manager at the time of the 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.

People were protected from avoidable harm and the risk of abuse by a staff team trained in safeguarding adults and who assessed and managed identified risks. The provider vetted staff to ensure their suitability and there were enough staff available to support people safely. People’s medicines were stored safely, recorded appropriately and administered as prescribed. The care home was clean and the service had plans in place to respond to a number of emergency scenarios.

People were supported by knowledgeable staff who received training to meet their specific needs. Staff were supervised by the registered manager and their performances were appraised. People were treated in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Staff supported people to eat well and to do so safely. People had timely access to healthcare services and received specialist input from health and social care professionals when they required.

People and staff shared positive relationships. Staff were viewed as caring, empathetic, kind and they knew people well. People were supported to make decisions, develop their independence and maintain the relationships that were important in their lives. Staff treated people with dignity and respect.

People received personalised support that met their assessed needs and preferences. Staff sensitively and safely managed people’s behavioural support needs. A keyworker system was used so that each person had a designated member of staff who was responsible for enabling people to meet their changing needs in a person centred way. The service gathered people’s views and relatives felt they were well informed, regularly consulted and listened to by the manager and staff.

The service was well led by an experienced registered care manager. People, relatives and staff spoke favourably about the registered manager. The service had an open culture and the team was stable and well established. The quality of the service that people received was subject to audits and the registered manager used these to drive improvements. The service worked in partnership with other agencies, services and individuals to achieve the best outcomes for people.

This inspection took place on 28 July 2015 and was unannounced. At the last inspection on 25 September 2013 we found the service was meeting the regulations we looked at.

89 Grosvenor Avenue is a care home that can accommodate up to five adults with personal care and support needs. The home specialises in supporting people living with a learning disability or autistic spectrum disorder. There were five people living at the home at the time of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Although staff were suitably trained and knowledgeable about the care and support people required, we found the work performance and professional development of staff was not formally appraised by the registered manager. The meant staff might not be appropriately supported to carry out all the duties they were employed to perform. Furthermore, the registered manager was unable to locate Hospital Passports that we were told had been developed for everyone who lived at the home. Hospital Passports are important documents that contain information medical staff need to know about a person and their health care needs in the event of them being admitted to hospital.

People were safe living at the home. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. There were appropriate plans in place to ensure identified risks to people were minimised. Staff had access to appropriate guidance and knew how to keep people safe in the home and the wider community. The registered manager ensured regular maintenance and service checks were carried out at the home to ensure the environment was safe.

People using the service and their relatives told us they were happy with the quality of the care and support provided by staff working in the home. Staff looked after people in a way which was kind, caring and respectful. Our observations and discussions with people using the service and their relatives supported this. We saw staff spoke with people in a warm and respectful way and ensured information they wanted to communicate to people was done in a way that people could understand. Staff knew how to ensure people received care and support in a dignified and respectful way.

People were encouraged to maintain social relationships with people who were important to them, such as their relatives. There were no restrictions on visiting times and we saw staff made peoples’ guests feel welcome. Staff encouraged people to participate in meaningful social, educational and vocational activities that interested them. Staff also supported people to maintain their independence so far as possible, as well as learn new independent living skills, where appropriate.

Care plans had been developed for each person using the service, which reflected their specific needs and preferences for how they were cared for and supported. These plans gave clear guidance and instructions to staff about how they should care and support people and ensure their needs were met. Consent to care was sought by staff prior to any support being provided. People were involved in making decisions about the level of care and support they needed and how they wanted this to be provided. Where people's needs changed, the service responded by reviewing the care and support people received, which included their care plan.

People and their relatives felt comfortable raising any issues they might have about the home with the registered manager. The service had arrangements in place to deal with people’s concerns and complaints appropriately.

People were supported to keep healthy and well. Staff ensured people were able to access health care professionals and services quickly when they needed them. Staff worked closely with other health and social professionals to ensure people received the care and support they needed. People were encouraged to drink and eat sufficient amounts to reduce the risk to them of malnutrition and dehydration. People received their medicines as prescribed and staff knew how to manage medicines safely.

There were enough suitably trained and competent staff to care for and support people. The registered manager continuously reviewed and planned staffing levels to ensure there were enough staff to meet the needs of people using the service.

The registered manager understood when a Deprivation of Liberty Safeguards (DoLS) authorisation application should be made and how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

The registered manager demonstrated good leadership. It was clear they understood their role and responsibilities, and staff told us they were supportive and fair. The registered manager encouraged an open and transparent culture. They proactively sought the views of people, relatives, visitors, staff and external health and social care professionals about how the care and support people received could be improved.

The provider and managers carried out regular checks of key aspects of the service to monitor and assess the safety and quality of the service that people experienced. The registered manager took appropriate action to make changes and improvements when this was needed.

There were four people who lived at 89 Grosvenor Avenue at the time of our inspection. People at the home had varying levels of difficulties to express and communicate their views about the quality of the service. We spoke with one person and their relative who told us they were “Well looked after” and were happy with the support they received t in order to prepare them for a more independent life. The persons’ relative said that the home was “Absolutely excellent” and that the communication between staff and them was very good. They also said staff were always approachable. Another person who used the service told us they liked living there and that they felt safe in the home.

We saw evidence that the provider operated an effective recruitment process to ensure that only suitably qualified, skilled and experienced people were employed at the service. Staff were supported to deliver care and treatment safely and to an appropriate standard. Staff told us that they felt well supported and enjoyed working at the home.

We found that people were enabled to make day to day decisions about their care and support and their well-being was closely monitored through daily discussions and regular key-working sessions. People were provided with a choice of suitable and nutritious food and drink.

We also found that there was a system in place to monitor the service to ensure people’s well-being and that the quality of the service was adequate.

There were four people living at the home at the time of this inspection. We spoke to one person using the service, to staff and to the manager. Some people communicated non verbally and so we could not interview them to find out their views. However, we were able to observe their mood, behaviour, and how they interacted with staff.

We found that people's care and support was delivered in person centred ways. People were at the core of deciding how they spent their time, what support they needed and when. We spoke to one person using the service who told us about activities she participates in with staff support. We saw that staff support was carefully tailored to each person's needs and preferences.

We found that the service communicated with and involved external service providers appropriately as part of meeting people's needs.

We found that medicines were well managed, with proper administration, record keeping and storage.

We found that people were being cared for in a clean environment and were protected from the risk of infection.

The feedback we received from people who use the service and their relatives we spoke with during our visit was very positive about the overall standard of care and support provided at 89, Grosvenor Avenue. Typical comments made by people, included: “I like living here”, “We are very happy with the home”, and “Staff are marvelous…Like family”.

People we met who use the service were also very complimentary about the staff who worked at the care home. Typical comments we received, included: “Staff are nice to me”, and “Staff knock on my bedroom door”.

Throughout the course of our visit we observed staff always interacting with the people who use the service in a very kind, courteous and respectful manner. People who use the service always appeared very at ease with staff.

The relatives of people who use the service told us there were always enough staff on duty.

People we met were also very complimentary about the quality and choice of the food and drink they were offered at their home. Typical comments we received, included: “I like the food here” and “The fish and chips are good”. The atmosphere during lunch remained very relaxed and congenial. Mealtimes at the care home appear to be a good social experience for everyone who lives and/or works at the care home.

People who use the service told us they were happy with the physical environment of their home. Typical comments people made, included: “I like blue and that’s the colour my bedroom is painted” and “I have got my own bedroom”. All the bedrooms we viewed contained lots of personal affects that seemed to reflect the unique tastes of the individuals who occupied these rooms.

However, although the care home is decorated and furnished to a ‘reasonable’ standard most people we spoke with about the interior décor of 38, Grosvenor Avenue acknowledged it could be improved.

Finally, we received a lot of positive comments from relatives we spoke with about the leadership style of the relatively new acting manager and the way the care home was being run. Relatives we met told us: “We like the new manager and the way they run the place” and “The new manager is great…Very approachable and she always makes time for us”.