This inspection took place on 2 November 2017 and was unannounced. This meant the staff and provider did not know we would be visiting. We also contacted family members by telephone on 7 November 2017.

Mowbray House 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. Mowbray House accommodates up to five people with learning disabilities. On the day of our inspection there were five people using the service.

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.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

We last inspected the service in September 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service, and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff.

Staff were suitably trained and received regular supervisions and appraisals.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

Family members were complimentary about the standard of care at Mowbray House.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Staff said they felt supported by the registered manager. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.

This inspection took place on 14 September 2014 and was unannounced. This meant the registered provider was not aware we would be inspecting on that day.

The last inspection took place in January 2014 when the registered provider was found to be complaint with the regulations we assessed.

Mowbray House is a large detached house in its own grounds situated in Crook, County Durham. It provides care for up to five young adults with learning disabilities and primarily those on the autistic spectrum. Some of the young people were unable to use speech as a communication method. Nursing care is not provided.

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. Prior to the inspection we noted the manager had applied to become the registered manager. On the day of our inspection the manager received a letter to state their application was successful and they had now been registered with the CQC.

Staff had received training in safeguarding vulnerable adults from abuse and were supported by the registered manager to increase their knowledge.

The registered provider had put in place arrangements for the maintenance of the building to keep people safe.

Individual risk assessments had also been put in place by the registered provider to ensure risks to people were identified and we saw actions had been put in place to mitigate those risks.

We found the accidents and incidents were closely monitored by the registered manager using an electronic system which delivered the information to their mobile phone. These meant the registered manager could monitor any accidents or incidents when off duty, and provide support to staff or people who use the service as required.

The registered provider met the requirements of the Deprivation of Liberty Safeguards (DoLS). DoLS aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We observed arrangements were in place to ensure when people needed to be deprived of their liberty to keep them safe this was appropriately carried out and least restrictive practice was promoted.

We found work was in progress to improve the premises including the development of a downstairs accessible ensuite bedroom. In addition a sensory garden and a sensory room had been created.

Staff used appropriate communication aids such as pictures and gestures to communicate effectively and help people in the home to understand and make decisions and choices for themselves.

Staff had received appropriate training to enable them to be able to care for people. They also received regular supervision and an annual appraisal to support their learning needs.

We found there was comprehensive evidence that people were supported to maintain good health through accessing other healthcare professionals such as GPs and specialist health care services.

We saw that positive and enabling approaches were taken by the registered provider to support people with their learning needs.

During our inspection we consistently saw patient and caring interactions between staff and people using the service. We saw people were calm and relaxed in the presence of staff.

We found people’s privacy and dignity were respected.

We saw the registered manager had introduced health and well-being documentation based on people’s care plans. Staff monitored people’s care plans using these documents.

Each person’s care file contained a pen picture of the person. We saw the pen pictures matched what staff told us about each person and our observations during the day.

We found there was clear leadership in the home and the registered manager gave people support and direction.

Each month the registered manager completed a comprehensive audit report and submitted the report to the provider. The registered manager when required identified actions to be taken to improve the service and timescales in which the improvements were to be made.

The registered manager had put in place competency tests for staff so they were aware of the staff developmental needs.

We saw the registered manager had carried out an unannounced visit to the home during a weekend and found that the home was working well.

Some of the people using the service had complex needs which meant they were unable to tell us their views. Because of this we used a number of different methods to help us understand their experiences.

The service planned and delivered care and support so that people’s needs were met. Staff supported people in an engaging way and regular activities were arranged. Relatives we spoke with told us “They look after him very well” and “He’s always happy to go back.”

The service had an effective recruitment and selection procedure in place and carried out relevant checks when recruiting staff.

The home was clean and well maintained and there were systems in place to regularly check the quality of the care and the maintenance and safety of the premises. People were consulted about the care they received and the service had an effective complaints procedure in place.

When we visited Mowbray House we saw four young people lived at the home. Their ages ranged from 19-24 years of age. All four were out of the home throughout the duration of our inspection undertaking a variety of activities, supported by their residential worker.

The deputy manager told us most people who lived at the home found it difficult to express their overall views about the service directly. To overcome this they had used their knowledge of peoples’ preferences, behaviour and responses to organise the support people needed in a way that was acceptable to them. They had also carried out a survey with people to see what they thought about life at the home. In the survey everyone said they liked living at Mowbray House and they felt safe in their home.

We saw the premises were well maintained and had a welcoming, homely feel.

The young people who lived at Mowbray house had complex communications needs. It was therefore difficult to find out what they thought about the service through conversation. However, one young person was able to us that staff always helped him and that he liked his bedroom.

The young people completed a survey every six months which was used by the provider to help find out what the young people think about the support they get. We looked at three surveys that had been completed by three different young people in the last twelve months. We found that the booklets used were in an easy read format with pictures to illustrate the questions being asked. The feedback from the surveys showed that the young people were very happy with the care and support they received.

The young people completed a survey every six months which was used by the provider to help find out what the young people think about the support they get. We looked at three surveys that had been completed by three different young people in the last twelve months. We found that the booklets used were in an easy read format with pictures to illustrate the questions being asked. The feedback from the surveys showed that the young people were very happy with the care and support they received.