This inspection took place on 9 and 13 May 2017 and was announced. The last inspection of the service took place in November 2014 and the service was rated GOOD.

London Road is registered to provide two regulated activities; accommodation for persons who require nursing or personal care and personal care. The care home is registered to provide long and short-term care to 10 people with acquired brain injuries. At the time of the inspection there were 10 people living there. The service does not employ nurses so people’s health needs were met by visiting health care professionals, for example, community nurses. The accommodation had been adapted to meet the needs of people who live with a physical disability. People’s private accommodation comprised of a bed-sit arrangement with washing and toilet facilities and a small kitchenette. The second service supports people with their personal care. They live as a small group in the community. At the time of the inspection three people lived together.

A registered manager manages both services with the support of their senior staff team. 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.

Monitoring processes were in place which ensured care and support was provided in both services, safely and to a high standard. We have however, made a recommendation in relation to the service’s audits.

There were arrangements in place to keep people safe. There were enough staff in both services to ensure people’s care needs were met and to support them with other daily activities. Safe staff recruitment practice protected people from those who may not be suitable to care for them. People in both services received the support they needed to take their medicines safely.

Staff had been provided with appropriate training and support to meet people’s diverse 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 both services supported this practice. People who lacked the mental capacity to make decisions and provide consent for their care, treatment and accommodation were protected. This was because staff adhered to the principles of the Mental Capacity Act 2005. People were supported to maintain their nutritional well-being.

People’s individual choices and preferences were met. People had a voice and were listened to. People therefore received care which was tailored to their individual needs. People were treated with respect and their privacy and dignity maintained. They were supported to maintain relationships with those who mattered to them. There were no unnecessary restrictions applied to when relatives and friends could visit or to people’s social lives. People were supported to take part in activities they enjoyed.

People’s care was planned and reviewed with the involvement of the person (where possible) and relatives and representatives (where appropriate) were fully involved. Care and treatment records were well maintained and gave staff and visiting professionals the information they needed in order to support people’s needs. People’s goals and aspirations were incorporated into these plans and supported.

There were arrangements in place for people to be able to raise a complaint or concern although the registered manager informed us they had not received any. Communication with people, their relatives/representatives and staff was good so this ensured that any queries or worries were addressed and resolved quickly. People’s views and suggestions were sought as were those of their relatives/representatives. These were acted on to improve the overall service.

During this review to look at the outstanding compliance actions we did not visit the service.

We completed this review because when we carried out our inspection on 3 July 2012 the report did not show the outcomes for management of medicines, safety and suitability of premises and records. All these three outcomes had outstanding compliance actions from our inspection in June 2011, where we had asked the provider to make improvements. When we inspected the service in July 2012 we found the provider to be compliant in these outcomes.

During our visit we spoke with three people who were able to tell us about their experience of living in the home. We spoke with most of the other people living in the home but because of their complex communication needs they were not able to express their views of living at 46 London Road.

We gathered evidence of people’s experience by speaking with two relatives and a health care professional who visited the home on the day of our visit.

The health care profession told us, “The home has an open and flexible way of working and puts the service users’ needs first”.

Relatives of people living in the home told us that they were very happy with the staff and the facilities in the home. One relative told us, “The home is very good and my son is so happy here”.

Staff were observed interacting with people in a respectful manner that showed that they understood each individual’s needs and how best to communicate with them.

One person said:

“Love it here.” “Food is good”. “Staff are ok.”

This person confirmed that he had no concerns and indicated that he would talk to staff if he had any.

Another person confirmed that he enjoyed activities, and that he does lots in Gloucester with staff support. He also confirmed that he would talk to staff if he had any worries, and that staff would listen to him and deal with issues.

When questioned about staff he said they were “very good”

He nodded that he had a key worker and indicated that care plans were in the office. He confirmed that he was involved in the review of his care plans and again indicated that he would talk to staff if he had concerns. About concerns he said,” No”- don’t have any.

We talked to a third person. He said that staff were “good.” We talked about care plans and key workers. He indicated that care plans were kept in the office, confirmed individual goals were in place and that staff supported him to achieve these goals. He indicated that if he had any concerns he would talk to staff, confirmed they would listen “good” and would deal with problems. He indicated that he didn’t have any concerns or worries. He confirmed that he knew about advocacy and could have an independent advocate if he wished. He was enthusiastic about the range of activities available and indicated that he really enjoyed skittles, bowling and cinema.

A fourth person did not wish to interact with us but said - “Ok here.” “Staff alright”

We carried out an unannounced inspection of London Road on 11 and 12 November 2014. London Road is a purpose built care home for 10 people with an acquired brain injury. People are accommodated in self-contained flats with additional shared living areas. 10 people were living at the home when we visited. The 10 people living at the home had a range of support needs including help with communication, personal care, moving about and support if they became confused or anxious. Staff support was provided at the home at all times and people required the support of one or more staff when away from the home.

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 and associated Regulations about how the service is run.

People were supported by a caring staff team who knew them well and treated them as individuals. For example, staff understood the ways each person communicated their needs and preferences. People were supported to stay active at home and in the community. Particular consideration was given to finding activities that would help rehabilitate people following the brain injuries they had sustained.

People were encouraged to make choices and to do things for themselves as far as possible. In order to achieve this, a balance was struck between keeping people safe and supporting them to take risks and develop their independence. People’s legal rights to make decisions were respected and the least restrictive options were sought when a decision was made on behalf of a person lacking mental capacity to make that decision.

Staff felt well supported and had the training they needed to provide personalised support to each person. Staff met with their line manager to discuss their development needs and action was taken when concerns were raised. Staff understood what they needed to do if they had concerns about the way a person was being treated. Staff were prepared to challenge and address poor care to keep people safe and happy.

Learning took place following any incidents to prevent them happening again. People and their relatives were encouraged to provide feedback which was used to enhance the service.