At our last inspection on 29 March 2017 we rated the service requires improvement in the key questions of effective, responsive and well led and we rated the service as ‘Requires improvement’ overall. This inspection was unannounced and took place on 06 and 11 December 2018. We found that the required improvements had been made and rated the service as ‘Good’.

18 Bushwood Road 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.

18 Bushwood Road provides accommodation and personal care for up to six people with physical and learning disabilities who require support to live in the community. At the time of our inspection, there were five people living at the home.

The home 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 manager in post 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.

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met.

People were protected from risks associated with their health and care needs because risk assessments and associated care plans were developed, reviewed and monitored. Staff were aware of the risks to people when supporting them. People received support from staff to take their prescribed medicines. Systems and processes were in place to ensure medicines were managed safely.

Staff were caring and treated people with respect. There was a friendly, calm relaxed atmosphere within the home. People were supported by sufficient numbers of staff who had the knowledge and skills they required to care for people safely and effectively.

Staff understood the importance of ensuring people agreed to the care and support they provided and when to involve others to help people make important decisions. The provider was aware of their responsibilities regarding the Deprivation of Liberty Safeguards (DoLS).

Staff understood their responsibilities in relation to hygiene and infection control. There were systems in place to monitor the quality of the service and areas needing improvement were acted on.

This inspection took place on 29 March 2017. This was an unannounced inspection.

At the time of our last inspection in March 2016, the provider was found to be requiring improvement in two out of the five areas that we looked at, namely whether the service was safe and well-led. This was because the staff had not always recognised when an accident or incident that had occurred at the home should have been referred as a safeguarding concern to the local authority for a thorough investigation by an independent body. The registered manager had also failed to notify us of such events, as required by law. During this inspection, we found that improvements had been made in these areas. However, we identified additional shortfalls and further improvements were required.

18 Bushwood Road provides accommodation and personal care for up to six people with physical and learning disabilities who require support to live in the community. At the time of our inspection, there were six people living at 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 2008 and associated Regulations about how the service is run.

People were supported by enough members of staff in order to keep them safe. However, the provider did not always ensure that there were enough staff available to support people to live enriched and fulfilling lives. People did not always have the opportunity to engage in activities that they enjoyed outside of the home because there was not always enough staff available to support them to do this.

People were protected from the risk of abuse and avoidable harm because staff received training and understood the different types of abuse and knew what actions were needed to keep people safe. The provider had also ensured effective systems were in place to report and investigate any concerns raised, which included working collaboratively with external agencies and reporting these to us, as required by law.

Staff had the knowledge and skills they required to care for people safely and effectively. This included the safe management of medicines so that people received their medicines as prescribed.

People were supported by staff that were kind, caring and respectful. People were encouraged to be as independent as possible and were treated with dignity and respect. People had access to enough food and drink in accordance with their dietary requirements. However, meal times were not always person-centred and not all of the people living at the home were given flexible food choices that reflected their personal preferences.

People and/or their representatives were involved in the planning and review of their care, as far as reasonably possible and were aware of the complaints policy and procedure. The provider sought feedback from people who used the service and/or their representatives, as well as from visiting professionals in order to drive improvements.

Whilst the provider had some additional management systems in place to assess and monitor the quality of the service provided to people, these were not always effective in identifying the shortfalls identified during the inspection. The registered manager was open and honest in their communication with us and recognised that further improvements were required in this area.

This inspection took place on 17 March 2016. This was an unannounced inspection.

At the time of our last inspection in November 2013, 18 Bushwood Road was found to be meeting all of the essential standards relating to the quality and safety of care.

18 Bushwood Road provides accommodation and personal care for up to six people who require support to live in the community. At the time of our inspection, there were six people living at 18 Bushwood Road.

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.

The service was not always safe because the provider had failed to alert safeguarding concerns to the local authority or to notify CQC as required by law.

The service was not always well led because the provider had not reliably met the requirements of their registration; they had failed to notify the relevant agencies of information that they were lawfully obliged to share.

People had robust risk assessments and management plans in place to promote their safety within the home.

People were supported by enough members of staff to meet their needs.

People received their prescribed medicines as required.

The service was effective because people received care from staff who had received adequate training and had the knowledge and skills they required to do their job effectively.

People received care and support with their consent, where possible, and people’s rights were protected because key processes had been followed to ensure people were not unlawfully restricted.

People’s nutritional needs were assessed and monitored to identify any risks associated with nutrition and hydration and they had food they enjoyed.

People were supported to maintain good health because staff worked closely with other health and social care professionals when necessary.

The service was caring because people were supported by staff that were kind, caring and friendly.

People received the care they wanted based on their personal preferences and dislikes because staff took the time to get to know people.

People were cared for by staff who protected their privacy and dignity.

People were encouraged to be as independent as possible and were supported to express their views in all aspects of their lives, as far as reasonably possible.

The service was very responsive because people and their relatives felt involved in the planning and review of their care because staff communicated with them in ways they could understand.

People were supported and encouraged to engage in activities that were meaningful to them and to maintain positive relationships with people that were important to them.

People were encouraged to offer feedback on the quality on the service and knew how to complain.

Staff felt supported and appreciated in their work and reported the management team to be approachable.

The management team had systems in place to assess and monitor the quality of the service.

Since our last inspection in December 2012, the provider had made an application to change the regulated activity carried on at the home. This meant that the home was now a residential care home and no longer provided nursing care.

On the day of our inspection six people lived at the home, we met all six people. None of the people were able to verbally share with us their views about their care due to their individual needs. We used different ways to evidence their experiences such as observing care, looking at their records and speaking with staff. Following our inspection we spoke with two relatives.

The registered manager had left their post, we spoke with the improvement manager and the recently appointed service manager as well as three members of staff.

Care was planned and delivered to ensure people's safety and welfare. One relative told us, "I am happy with the care, they are well looked after".

Safeguarding procedures were in place so that staff would recognise and report any allegations of abuse to protect people from the risk of harm. A relative told us, "I have no concerns with the care".

We found that staffing numbers were adequate to ensure people received care and support in a safe and timely manner.

People were cared for by staff who were supported, supervised and trained to deliver care to an appropriate standard.

Care records were relevant to people's individual needs.

On the day of our inspection there were five people living at the home. All of the people had limited verbal communication skills and difficulty expressing their wishes clearly. We spent some time observing what life was like for people who lived at the home. We spoke with three members of staff and the registered manager, we also spoke with one relative. We looked at two sets of care records for people living at the home and followed the care of one person we call this pathway tracking. This involved looking at their records, speaking to their relative and staff as well as observing care to see how their needs where being met.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with the Mental Capacity Act 2005. This meant that people's rights were protected and when necessary decisions were made in their best interest.

People experienced care, treatment and support that met their needs and protected their rights.

Systems were in place to ensure that people received medication safely.

There were not enough staff to keep people safe on the day of our inspection.

There was an effective complaints system so that complaints could be responded to appropriately.

People were not protected from the risk of unsafe or inappropriate care and treatment because appropriate records were not maintained.

We found that the six people living at 18 Bushwood Road looked happy and relaxed in the home. People living in the home were unable to have a conversation with us due to their complex learning and physical disability. This meant that people were unable to verbally communicate their views about living in the home. We spent time observing care practices and the interactions between people living in the home and care staff. Our observations helped to identify how care staff supported people to meet their care needs and vary their day to day life in the home. This would help to show that people receive appropriate care that supports their physical, mental and social wellbeing.

We saw that care staff treated each person as an individual. Care staff had taken time to assess and find out the most effective way to communicate with the people they cared for. Care staff were able to read peoples gestures, facial expressions and their non-verbal communication. We saw that care staff responded to people’s needs in a way that kept them calm and smiling.

Care staff told us that some family members maintain contact with their relative, visit the home and contribute to their relatives care.