This inspection took place on 30 November and 1 December 2017. Both days were announced. We gave the provider short notice of our inspection due to the nature of the service. This was so the registered manager could be available to assist us with our inspection.

No 9 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. No 9 provides personal care for up to six people with a learning disability and/or autistic spectrum disorder. At the time of our inspection there were five people living at the home. The home has five large bedrooms and a separate self-contained flat where one person lives. The home is located next door to another of the provider’s services, both of which are managed by the same registered manager and deputy manager.

A registered manager was in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We last inspected this service on 3 September 2015 when it was rated 'Good' overall. During this inspection we found the service remained good and rated the key area of responsive as 'Outstanding.'

People’s lives were enhanced through access to an excellent range of activities which made them feel socially included. Relatives told us how people’s independent living skills had greatly improved since living at the home. Relatives told us staff knew people’s needs exceptionally well. The service had an innovative approach to how technology could be used to improve people’s quality of life.

Relatives described the progress people had made since living at the home as 'Outstanding.' People had made substantial progress due to the use of the SMART (specific, measurable, achievable, realistic and timely) target system. These targets were a way of setting goals for people to work towards in areas that really mattered to them and which improved their quality of life. These targets and other positive proactive support strategies had resulted in a reduction in the number of incidents that could be challenging for people. The strong focus on person-centred care had a very positive impact on people.

All of the relatives we spoke with said staff were kind and caring. Staff were highly motivated to provide compassionate care and spoke about the people who used the service with great affection and respect.

There were appropriate systems in place to protect people from harm. Staff were trained in how to safeguard vulnerable adults and told us they felt able to approach the registered manager with any concerns about people who used the service.

Staffing levels were suitable to meet the assessed needs of people in the service. Staff recruitment was thorough with all checks completed before new staff had access to vulnerable people.

Risk assessments were in place for people and staff. Regular planned and preventative maintenance checks and repairs were carried out and other required inspections and services such as gas safety were up to date.

Accidents and incidents were recorded accurately and analysed regularly. Each person had an up to date personal emergency evacuation plan should they need to be evacuated in the event of an emergency.

Staff received induction, training and supervision that helped them to give good levels of care and support. They were trained in principles of care in relation to people living with a learning disability and/or autistic spectrum disorder.

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

The inspection took place on 3 September 2015 and was announced, which meant the provider and staff knew we were coming. The provider was given 48 hours’ notice because the location was a small care home for younger adults who are often out during the day, so we needed to be sure that someone would be in.

The last inspection of this home was carried out on 7 August 2013. The service met the regulations we inspected against at that time.

No 9 provides care and support for up to six people who have autism spectrum conditions. At the time of this visit five people were using the service. The accommodation was over three floors and consisted of six bedrooms. People had access to a communal lounge, kitchen and dining room.

The home is a semi-detached house in a residential area. The service is situated next door to another small care home and they are both managed by the same registered manager, who was present on the day of our visit.

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.

People were unable to tell us about the service because of their complex needs. Relatives made positive comments about the service and told us their relatives were always happy to return to the home after visits.

Staff had a good understanding of safeguarding and said they would speak up if they had any concerns. Any concerns had been investigated to make sure people were safe.

Staff understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision and Deprivation of Liberty Safeguards to make sure any restrictions were in people’s best interests. For example, all of the people who lived there need staff support and supervision when in the community because they had a limited understanding of road safety.

Medicines were managed in a safe way and records were up to date with no gaps or inaccuracies. A signature chart was in place so records could be audited.

There were enough staff to make sure people were supported. Staff training was up to date and staff received regular supervisions and appraisals.

People were encouraged to be as independent as possible, and were supported to do household tasks and take part in activities they enjoyed. People were supported to have enough to eat and drink, and to maintain a balanced diet.

Care plans were person-centred, well written and reflected the interests of individuals.

In a survey carried out by the provider earlier this year, 86% of relatives said they were very happy or happy with the care their relatives received in the home. A relative we spoke with told us, “The staff are lovely; they really get to know you. My [relative’s] welfare is at the height of everything the staff do”.

We saw that systems were in place for recording and managing safeguarding concerns, complaints, and accidents and incidents. Detailed records were kept along with any immediate action taken which showed the service took steps to learn from such events, and put measures in place to reduce the risk of them happening again.

We haven’t been able to speak to all of the people using the service because they had complex needs, which meant they were not able to tell us their experiences. However, we gathered some evidence of people’s experiences of the service by observing care practice.

We also undertook a short observational framework for inspection (SOFI) exercise to observe the interactions between them and the staff. SOFI is designed to be used when inspecting services for people who had some difficulty in communicating their opinions on the services they receive.

During the SOFI, we observed people being supported to express their preferences; for example, one member of staff was observed using pictorial cards to communicate with one of the people. Staff were attentive and gave people the information about their activity options in a way that was appropriate to their needs. One person was being supported to put their shoes on as they were going to the pub that evening and another was discussing what they were having for their meal that evening. In addition, we observed staff trying to engage people in discussions about the activities they had taken part in that day and what they wanted to do that evening.

We found that people who were using the service were receiving the care and support they needed. For example, the staff we spoke with could describe how they met the assessed needs of the people they were providing with care.

We found that the people who were using the service were protected from abuse as the provider had procedures in place for the staff to follow if they suspected anyone was at risk of abuse.

We found that records, which the provider is required to keep, to protect the peoples' safety and wellbeing, were being stored securely and could be located promptly when needed. For example, the care records were kept in secure cabinets.

During the inspection, the staff members on duty were observed speaking to people in a kind and respectful way. We also observed that the people were clean and well groomed.

We haven’t been able to speak to the people using the service because all who were using it had complex needs, which meant they were not able to tell us their experiences. Although one person did provide us with some comments. However, we gathered some evidence of people’s experiences of the service by reviewing the care records, surveys and observing care practice.

Staff members on duty were observed speaking to people in a kind and respectful way. We also observed that the people looked clean and well groomed. One person commented, when asked if they were happy at the home “Yes”.