About the service:

• Nicholas Court is a care home providing personal care and support for people with learning disabilities and complex needs. The care home is registered for eight people.

• At the time of this inspection there were three people using the service and one person about to start their transition into the service.

• The care service had 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.

People’s experience of using this service:

• People were protected from avoidable harm and abuse.

• People’s risks were assessed, and plans were in place to minimise the risks.

• Staff were recruited safely and were supported with training, supervision and appraisals.

• People’s care needs were assessed before they began to use the service to ensure the appropriate support could be given.

• People were supported with their healthcare needs and their medicines were managed safely.

• People and their relatives were involved in decisions about the care.

• Staff knew how to provide an equitable service.

• People’s privacy and dignity was promoted, and they were encouraged to maintain their independence.

• People received personalised care which included their preferences and the goals they wished to achieve. This included their choice of activities.

• 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 the service supported this practice.

• People’s communication needs were met.

• Staff and relatives gave positive feedback about the leadership within the service.

• People were asked to provide feedback on their satisfaction with the service.

• Quality checks were carried out to identify areas for improvement.

Rating at last inspection:

• Good (report published on 19 March 2016).

Why we inspected:

• This was a scheduled inspection based on the previous rating.

Follow up:

• We will continue to monitor the service through the information we receive.

• For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Nicholas Court is a residential service designed to provide support with personal care for up to eight adults with learning disabilities. The premises consist of three flats with two bedrooms and two flats with one bedroom. At the time of the inspection there were five people using the service. At the last inspection in August 2013 the service was found to be compliant with all regulations inspected.

There was a manager for this service who was in the process of becoming registered with the Care Quality Commission (CQC). 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 had safeguarding and whistleblowing policies in place and staff knew what action to take if they suspected someone was being abused. Safe recruitment checks were carried out and there were adequate numbers of staff to meet people's needs. People had risk assessments carried out to ensure safe care was provided and potential risks were minimised. We found people consistently received their medicines safely and as prescribed. There were systems in place to check and maintain the safety of the premises and these checks were up to date. The service had systems in place to deal with foreseeable emergencies.

Staff received regular training, opportunities for skill development and supervision. The manager and staff were aware of their responsibilities around the Mental Capacity Act (2005) and when they needed to obtain consent from people. We found the service was depriving people of their liberty within the legal framework and only when they had the legal authorisation to do so. People planned their own menu and went shopping to buy their own food. We found people were encouraged to eat nutritionally balanced meals. Staff assisted people to access healthcare professionals as required.

We found staff treated people with respect and dignity and spoke to people as they supported them. We found that staff knew the people they were supporting and their preferences. People who used the service had a communication passport to enable staff to use appropriate methods of communication with people who did not use language. Staff were knowledgeable about encouraging people to carry out tasks independently when they were able.

People's care plans were comprehensive and were written in a person-centred way. Staff demonstrated they understood what personalised care was. We found care plans were reviewed and updated regularly. People had their own individualised timetable of activities and relatives told us these were appropriate for their family member. Relatives told us they knew how to make a complaint and the complaints procedure was visible in each flat.

The provider had systems to check the quality of the service provided. Staff had regular staff meetings to receive updates on the service. Relatives told us they were not asked for feedback. However the manager showed us a newly designed customer feedback form which they were planning to give to people to complete with the assistance of their relatives or representative.

We spoke to three out of seven relatives. On the day of our visit some people had gone out. We observed three out of seven people who used the service as they were non verbal. We saw that staff asked for consent by using signs, pictures and body language.

We found that care plans were up to date and reflected individual preferences. People had health action plans and care plans were available in a pictorial format which was understood by people who used the service. Relatives told us that they were involved in circle of support meetings and care review meetings. One relative said, “I am kept informed of any changes and get involved as much as I can."

People were cared for in a clean environment. Laundry was done separately for each person and there were adequate hand washing facilities. We observed staff washing hands before and after direct contact with people.

There were enough staff to meet people's needs. We found that people had one to one support which enabled them to go out everyday. We were told that there were appropriate recruitment checks before staff started work. However we did not see documentary evidence to support this due to staff being transferred from another provider.

Staff told us that there was a complaints procedure. We found that the complaints procedure was available in easy read format. Relatives told us that complaints were dealt with promptly and that none of the complaints were unresolved.

The people that we met at Nicholas Court on the day of this inspection were not able to tell us their views. Some people had very limited verbal communication or they communicated non-verbally. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We saw that people communicated well with the staff, who used sign language and were able to interpet people's wishes through observing their behaviour. We saw that staff enabled people to participate in household chores and promoted individual choices. For example, one person wanted to clear up after snacks had been served on their unit. Staff provided support, encouragement and positive feedback.

The people we met during this inspection were not able to verbally tell us their views about living at Nicholas Court. One person showed us their collection of music CD's and DVD's of films starring their favourite artist. Staff told us this person was supported regularly to go to tribute concerts and to watch these films. They had also been on holiday to the United States to visit places of interest to them.

We gathered more information by observing people in the home, reading people's care plans and talking to staff.

We noted that people living in the home had a good relationship with staff and the staff team showed a good awareness of individual's interests, routines and care needs.

During our visits we saw four out the seven people who used the service. None of the people could communicate verbally. They responded by non-verbal means such as smiling and signing the thumbs up sign to indicate that they were well.

We observed care and interactions between staff and people who used the service and found that staff were attentive to people's needs. Staff were aware of people's moods, triggers and how to respond appropriately.

Medicine was stored and handled safely. Staff had completed practical and online medicine administration training and were aware of how to administer, order and dispose of medication according to the home’s Medication policy.

People were supported to eat a balanced diet. Cultural and medical needs were reflected in the individual menu plans we saw. There was adequate supply of fresh fruit and snacks, which staff told us could be accessed by people in between meals.

The premises were clean and in a good state of repair. The rooms had adequate space for furniture and were well ventilated. We saw evidence that annual fire safety checks, gas checks were completed.

At our last inspection, we had concerns regarding the lack of employment checks in staff files. On this visit we looked at three out of seven staff files and found that qualifications, job contracts and references and proof of right to work were available. Records of disclosure and barring checks were kept at the head office.