The inspection took place on 28 March 2017 and was unannounced.

The last inspection took place on 24 February 2015 when we found that the provider was meeting all the required Regulations.

No 36 is a care home for up to nine adults who have a learning disability. The service is managed by LD Care Limited, a private provider based in the London Borough of Hounslow. The provider has two other care homes which are located close to No 36. Since the last inspection the provider had increased the number of registered places at the service from six to nine because they had built an extension to the property. At the time of the inspection there were nine people living at the service. They all had a learning disability and/or autism.

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. The registered manager oversaw the running of the whole organisation. The day to day management of the home was carried out by an additional manager and house leaders. All of the management team worked across the provider's three care homes.

People received extremely personalised care. Although some people could not communicate their needs verbally, the staff found creative ways to involve them and to understand what the person wanted. They displayed empathy and helped people overcome fears and challenges. This had resulted in positive and measurable changes for the individuals who lived at the service. For example, some people had expressed the way they felt through aggression or self-neglect. Since they had lived at the home the incidents of aggression had reduced significantly and people were happier, more relaxed and were developing a positive self-image. This was confirmed by people's relatives and external professionals who worked with people who lived at the service.

The culture at the service was exceptionally inclusive. The staff, family members and external professionals worked together to support people. This meant that people's best interests were always being discussed and planned for. The provider was willing to adapt and change approaches based on information from the staff, families or others. They constantly reviewed people's care and the staff reflected on their own practice. This meant that the staff anticipated and responded to changes in people's needs and took action to provide the support they needed at all times.

People felt safe living at the service. The staff had a proactive approach to supporting people. There was clear information about situations and environments which might trigger people's anxiety or agitation. The staff were aware of these and responded to triggers by supporting people to feel calm, removing the trigger and diverting people's attention. This approach had a positive outcome for people which was measurable in the reduction of incidents and challenging situations that occurred. Families of people who lived at the home felt it was safe. People received their medicines in a safe way. There were sufficient numbers of suitably qualified staff who had been recruited in a safe way. The staff were aware of the provider's procedures for safeguarding people from abuse and how to prevent avoidable harm.

People were being cared for by well supported and trained staff. The staff were happy working at the service. They had opportunities to learn, develop and reflect on their work. The provider was working within the principles of the Mental Capacity Act 2005 and people were supported to make choices and consent to their care and treatment. When people did not have capacity to make decisions, these were made in their best interests by people who were important to them. People had enough to eat and

The inspection took place on 24 February 2015 and was unannounced. This was the first inspection of the service which had been registered on 8 January 2014.

No 36 is a care home for up to six adults who have a learning disability. The service is operated by LD Care Limited, a private organisation. LD Care Limited manages two other homes for adults with learning disabilities within the London Borough of Hounslow. 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 and associated Regulations about how the service is run.

One person who lived at the home and both relatives we spoke with told us the home was well run, they were happy with the care there and the staff were kind and supportive. One relative said, ‘’we are very happy with the care there and (our relative) is very happy.’’ One of the professionals we spoke with told us, ‘’ As far as I can tell the service appears safe, well led and is meeting clients’ needs in an appropriate way.’’

The provider had systems and procedures to help protect people from harm. The risks to them and the environment had been assessed. People were given the support they needed to take their medicines. There were enough staff employed to meet people’s needs in a safe and caring way. The recruitment procedures made sure the staff were suitable to work with vulnerable people.

People were cared for by staff who were well trained and had the information they needed to care for them. People had consented to their care and treatment and the provider was aware of their responsibilities under the Mental Capacity Act 2005. People’s health care and nutritional needs had been assessed. Their care was planned and delivered to meet these needs.

There were positive caring relationships between the staff and the people living at the home. Interactions were polite, friendly and kind. People’s privacy and dignity was respected.

People received care which met their individual needs and reflected their choices and lifestyle. Their needs were regularly assessed and the provider responded to changes in their needs. The provider responded to complaints appropriately.

People using the service and staff felt it was well managed. They liked the manager and felt the provider offered support, guidance and responded to concerns. There were systems to monitor the quality of the service and to plan for developing it in the future.