About the service:

Manna House is a residential service that was providing personal care to seven adults with learning disabilities and/or autism at the time of the inspection.

Situated close to local amenities, the service appears externally as a domestic property on a residential street. Manna House accommodates seven people in one building. There is ramp access to the front of the house. Bedrooms are situated over three floors. A kitchen, laundry room and lounge are situated to the ground floor. There is a large enclosed sensory garden situated to the rear.

People's experience of using this service:

The service has been developed and adapted 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. (Registering the Right Support CQC policy). People were very much a part of the community and accessed the community and its facilities through socialising and activities. Some people had family members and friends who lived locally and visited them on a regular basis. There was enough staff to support people engage in whatever activity they chose. This helped to promote people’s choice, independence and inclusion. The size, layout and staffing arrangements meant that Manna House felt homely. Without exception, people and their relatives told us they considered Mann House as their home.

People received care from staff who had been supported in their role with appropriate training and supervision. Staff were extremely caring and compassionate and knew people's needs and preferences well. Staff did not wear uniforms which helped break down barriers and promote a less formal atmosphere.

Not everyone was able to verbally communicate with us, but our observations showed people were settled at Manna House and considered it as home.

Regular checks and audits were carried out to determine the quality and safety of the care being provided.

Risk assessments had been undertaken to support people safely and in accordance with their individual needs. The service engaged in positive risk taking as opposed to avoiding risk which helped to ensure people had choice and remained as independent as possible.

People were encouraged to express their views and were actively involved in decisions about their care. Information was presented to people in a way they could understand.

The registered manager and registered provider promoted a person centred and transparent culture within the service.

Rating at last inspection:

At our last inspection, the service was rated "good". Our last report was published October 2016.

Why we inspected:

All services rated "good" are re-inspected within 30 months of our prior inspection.

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

The service met the characteristics for a rating of "good" in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was "good.''

More information is in our full report.

This inspection was carried out on the 12 September 2016 and was announced. As the service was small we gave 48 hour’s notice of our inspection. This was to ensure the registered manager and people who received support were available to speak with.

Care In Safe Hands Healthcare Limited provides care and support to people at Manna House. Manna House is a care home situated in Bootle, located close to public transport links, leisure and shopping facilities. It is registered to provide accommodation for up to seven adults. The building is a three story property with a passenger lift to the first floor. It has a fully accessible large garden to the rear. At the time of the inspection there were seven people living at Manna House.

Care In Safe Hands Healthcare Limited is also registered by the Care Quality Commission to provide personal care to people who live in their own home. This care provision is managed from Manna House. At the time of the inspection the registered provider provided support to six people who chose to share their private accommodation.

Manna House has a manager who is registered with the Care Quality Commission for the care home and personal care provision. 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 registered manager told us they were supported by an area manager and a compliance manager. The registered manager told us they worked closely with the managers to ensure Manna House ran smoothly.

People told us they were happy with the care and support they received from Manna House. People told us staff were caring and were knowledgeable of their individual needs.

Staff were able to define abuse and the actions to take if they suspected people were being abused. People who received care and support from staff told us they felt safe.

We found medicines were managed safely. Staff were knowledgeable of the systems in place for the ordering, storage and receipt of medicines.

We saw appropriate recruitment checks were carried out to ensure suitable people were employed to work at Manna House.

There were sufficient staff to meet people's needs. People were supported in a prompt manner and people told us they had no concerns with the availability of staff.

Staff received regular support from the management team to ensure training needs were identified. We found staff received appropriate training to enable them to meet peoples' needs.

Processes were in place to ensure people's freedom was not inappropriately restricted and staff told us they would report any concerns to the registered manager.

We saw people were offered a variety of foods at Manna House and people were supported to eat and drink sufficient to meet their needs. People told us they liked the food provided and they were involved in planning menus.

People were referred to other health professionals for further advice and support when assessed needs indicated this was appropriate.

We saw staff treated people with respect and kindness and people told us they were involved in their care planning.

Staff knew the likes and dislikes of people who received support in their own home and delivered care and support in accordance with people's expressed wishes. During the inspection we saw people who lived at Manna House were supported in accordance with their needs. We saw people were encouraged to maintain their independence and spend time in the community if they wished to do so.

There was a complaints policy in place, which was understood by staff. Information on the complaints procedure was available in the reception of the home in an accessible format. This was also available to people who lived in private accommodation.

Quality assurance checks

We used a number of different methods to help us understand the experiences of some of the people living at the home. This was because some of the people who lived there had complex needs, which meant they were not all able to tell us their experiences. We spent time observing the support staff provided. We also spent time observing the interactions between staff and the people who lived at the home.

We spoke with one person who lived in the service to gather their views. They spoke positively about the staff. They told us that they made day to day choices about their lives and the activities they took part in. Another person showed us their bedroom, which had been decorated to their personal taste. They told us they had bought a large TV and had Sky television so they were able to watch their favourite programmes.

We spoke with relatives who were visiting on the day of our inspection. They spoke positively about the home and the staff who supported their family member.

On checking medication management we found that people received their medicines as prescribed. We found records regarding medication were accurate.

We spoke to two people who used the service. They said they were getting the

care and support they needed. They said staff were friendly and caring. They said staff respected their wishes and feelings and treated them with dignity. They said that their requests and preferences were listened to and acted upon. Some comments made were:-

" I have a very busy week, attending college, going to the gym and church. I also help out at the stables.”

“I have just celebrated my birthday by going out to a local restaurant with everyone here.”

We contacted three relatives by telephone after our visit. All were very complimentary about the service. They said that a good standard of care was provided. They said the staff kept them informed and that the staff were caring, considerate and helpful.

Some comments made were:-

"Staff are very approachable."

"We are made to feel very welcome each time we visit."

"(name of resident) is always out and about and has a better social life than us."

"The staff take them on holiday each year; they've been to Spain twice."

"Staff are well trained to care for our daughter's particular health needs."

We asked Sefton LINk , Sefton Council and Liverpool Council for information about how the service operated.No up to date information was available.