This inspection was completed on 27 February 2108 and was unannounced.

Machlo is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Machlo primarily supports people with a learning disability and accommodates four people in one adapted building. There were three people living at Machlo at the time of the 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.

There was a registered manager in post at the home. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The previous comprehensive inspection was completed in December 2015 and the service was rated ‘Good’ overall. At this inspection, the service was rated ‘Outstanding’.

Machlo is an outstanding service. It is focussed on the individual needs of the people using the service. The service ensured that everyone received excellent, high quality, care regardless of diagnosis, age, ethnic background, sexual orientation, gender identity, disability or social circumstances.

People and carers spoke overwhelmingly of the positive support, guidance and healthcare interventions people had received. They were full of praise for the staff in terms of their kindness and compassion. People were 'very happy' with the service they received. We received positive comments about their views and experiences. People told us they felt safe because the staff were 'Caring and enjoyed what they did'.

People and relatives we spoke with told us staff were outstandingly caring. They used words such as “Compassionate”, “Caring”, “Excellent” and “Highly motivated” to describe the staff. People and their families spoke of a service that was tailor-made for them and their families saying that staff went 'the extra mile'. Care staff spoke highly about the service provided. One said, “I love working here”. Another person said, “I am proud to be working here”. People told us they would recommend the service to others. There was a genuine sense of fondness and respect between the staff and people.

Care staff were highly motivated to providing excellent levels of personalised care. People and their relatives were positive about the care and support they received. They told us staff were very caring and kind and they felt safe living in the home. Staff worked creatively and in a highly personalised way to support people to make their views known so that they could support them to realise their aspirations. For all of the people living at Machlo, this led to significant improvements for the physical and emotional well-being.

The service was exceptionally responsive to people’s individual needs and how they chose to lead their lives. The registered manager and staff had a ‘can do’ attitude and were creative in enabling people to overcome any perceived limitations and empower people to maximise their independence. Staff worked closely with people to build their confidence, learn new life skills and maximise their independence. The registered manager and staff had an excellent understanding of people’s emotional well-being and provided appropriate support to people.

Staff had been trained in safeguarding and had a good understanding of safeguarding policies and procedures. The administration and management of medicines was safe. There were sufficient

This inspection took place on 14 and 18 December 2015 and was announced. Machlo provides accommodation for up to three people with a mental health condition and/or a learning disability. Machlo also provides personal care to people living in their own homes. At the time of the inspection they were visiting three people but just one person was supported with their personal care.

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’s care and support was individualised based upon their preferences, routines and aspirations. They were fully engaged in developing how they wished their support to be delivered. Their care records confirmed their involvement and were kept up to date to reflect their changing needs. A person told us, “Cardell (provider) see the person, they deliver my personal care the way I want and when I want it”. When people were anxious they were supported by staff who understood them and how to help them. A relative commented, “Staff have insight into [name]’s habits and moods and they have developed strategies to cope with the difficulties she can present at times.” New ways of working concentrated on how to help people learn new skills and how to help them cope when they were unwell. Creative systems had been developed to support people to manage their own medicines. People told us they were safe and knew how to raise concerns if they needed to. They enjoyed a busy lifestyle meeting with friends and family in their local community.

People were supported by staff who knew them well and worked consistently together to make sure people received continuity of care. Staff had access to training to keep their knowledge and skills up to date and had individual meetings with the registered manager to review their performance and their training needs. Staff were asked for their opinions about the service and as a team had discussions about the care provided making team decisions about the way forward.

The registered manager monitored the quality of the service provided and promoted the rights of people living in the home, ensuring they received the care and support they wanted to receive. She made sure the checks required by law were completed including the recruitment of staff, health and safety systems, and the management of medicines and prevention of infections. The registered manager and staff kept up to date with best practice and changes in legislation by networking or membership with local organisations and attending conferences. The registered manager commented, “We have a well-motivated team, who have an understanding of what to do, how and what to achieve and doing it consistently to the benefit of people living here.” A person said, they “really have been angels, phenomenal.”

We spoke with one person who lived in the home. They said they were well and we observed them happily and positively interacting with staff. Their feedback did not relate to the standard we were inspecting.

At our inspection on 4 January 2013 we found that people were not protected against the risks of unsafe or inappropriate care arising from the poor maintenance of their care records. The provider sent us an action plan telling us how they would address these shortfalls.

At this inspection we found that people's care plans and risk assessments were being reviewed at appropriate intervals. They were being amended to reflect changes in people's needs. A new person centred care plan had been developed with the staff team. Each person and their representatives had been involved in writing their new care plans. Other guidance and protocols about the way staff should support people had been dated and noted the author of the record. Arrangements were in place for the staff team to monitor and audit care records to ensure they were kept up to date.

The fire risk assessment and environmental risk assessments had been amended to reflect current practice. These records and policies and procedures had been reviewed. This standard was met.

We looked at the care provided to three people who were living in the home and two people who were receiving a domiciliary care service. We spoke with three people living in the home but did not speak with people using the domiciliary care agency. A person living in the home said everything was fine and that they were alright. Another person showed us around the home and was observed happily interacting with staff during our visit. People using the domiciliary care service had told the provider they were "pleased with the service" and "staff treated them with dignity and respect".

We found that the care provided was person centred and reflected people's wishes and aspirations. People had access to advocates and they and their representatives were involved in discussions about their care needs. A range of social and health care professionals were involved in supporting and treating people's physical and mental health needs.

People told us they liked to go to the gym and swimming. They had been to the theatre and would be starting a new term at college. Staff supported people with sensitivity and respect. A system was in place enabling people to express concerns.

The home was well maintained, decorated and clean. The ground floor was accessible for people who use wheelchairs. Each person had a room which reflected their likes and lifestyles.

We found that care records for people living in the home were not being maintained satisfactorily. This standard was not met.

People said they were happy living at the home. One person said, "I love living here". They told us they liked to go out to clubs, shopping and to church. They liked their rooms and the areas they shared. We observed people choosing what to do and where to spend their time. A person was supported by staff to go out horse riding. Another person went to a luncheon club which they said they enjoyed.

A person said they would talk to staff if they had any concerns. We observed staff helping people, listening to them and treating them respectfully.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This inspection was completed by one inspector. Machlo provides care to three people living in the home as well as providing personal care to people living in their own homes. We visited people who live at Machlo as well as a person who receives support in their own home. This is a summary of what we found based on our observations, speaking with two people who use the service, talking with four staff and looking at records.

Is the service safe?

People were safe because when they displayed behaviour which challenged others, staff dealt with it safely and respected people’s dignity and protected their rights. Clear strategies were in place describing what caused distress to people and what staff needed to do to help them become calmer. There was evidence health professionals were asked for their input where needed. Where they made suggestions which would help people such as the use of equipment this had been put in place.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

People were safe because staff knew what to do when safeguarding concerns were raised and they followed policies and procedures. A person told us, "I feel safe with staff, they all bring something different and they genuinely care for people". They also said, "they make sure I am safe, living a healthy life and doing what I want to do".

People were protected from healthcare associated infections because the home was kept clean and hygienic. Systems were in place to assess and prevent the spread of infections which made sure people stayed healthy and well.

Is the service effective?

The service people received was effective because their individual needs, choices and preferences were reflected in their care plans. People had the support they needed to enable them to be as independent as possible. People told us, “staff help with personal care, dressing and menu planning”, “staff understand me completely”, “see the person as an individual, develop you as an individual”. Staff said, "I love the way they (the provider) promote people's independence".

People were supported to access a range of health professionals. Referrals had been made quickly when needed.

People received an effective service because their assessed needs, preferences and choices were met at all times by staff that had the necessary skills and knowledge. Staff had effective support, supervision, and training. A person commented, "Staff don't see you as a job. They understand me completely. They have completely transformed my life".

Is the service caring?

People received a caring service because they were treated with kindness, compassion and dignity in their day to day care. We observed staff treating people patiently and kindly. People were offered choices about how to spend their time and were supported to maintain their independence.

People’s needs had been assessed and care plans described the way they wished to be supported. Care plans noted that people had been involved in developing and planning their care and support. A person told us “Cardell are absolutely fantastic, wouldn’t change it for the world”, “Staff genuinely care for people”.

Is the service responsive?

The service was responsive because people received care and support in accordance with their preferences, interests and aspirations. People had their individual needs regularly assessed and met. One person said they, their family, social services and staff discussed their care needs. A person receiving care in their own home said they received support when they needed it.

People knew how to share their experiences or raise a concern or complaint and felt comfortable doing so. A person said if they had any concerns or issues they would contact the provider and tell them. They said, “I would always call Cardell in an emergency, they are my lifeline and they give me advice.”

Is the service well led?

The service was well led because they worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service development. Staff had a good understanding of the ethos of the home. They told us, "They (Cardell) are on the ball, they address issues as they arise."

Management enabled and encouraged open communication with people, those that mattered to them and staff. People had almost daily contact with the registered manager and raised issues or concerns as they arose. One person said, “Cardell are absolutely fantastic, wouldn’t change it for the world.”