Nutbush is a residential home which provides care and accommodation for up to four adults with moderate learning disabilities, autistic spectrum disorders and behaviours that may challenge others. On the day of our inspection four people were living in the home. Some people were able to express themselves verbally using one or two words; others used body language to communicate their needs.

This inspection took place on 13 September 2016 and was unannounced.

The home was run by a registered manager. ‘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 was on annual leave on the day of our inspection.

The provider did not have a robust process that had ensured people finances were managed appropriately which is subject to investigation.

People and their relatives gave positive feedback about the service they or their family member received. People were very happy.

People said that they felt safe and they appeared happy and at ease in the presence of staff. One person said; “The staff help me. I feel safe.” We saw staff had written information about risks to people and how to manage these in order to keep people safe.

People benefited from a safe service where staff understood their safeguarding responsibilities. Staff had received training in safeguarding adults and were able to tell us about the different types of abuse and signs a person may show if they were being harmed. Staff knew the procedures to follow to raise an alert should they have any concerns or suspect abuse may have occurred.

Risks to people’s personal safety had been assessed and plans were in place to minimise these risks. People who may harm themselves or displayed behaviour that challenged others were supported by staff who knew how to calm situations.

People received their medicines as they were prescribed and when they needed them. Processes were in place in relation to the correct storage, disposal and auditing of people’s medicines.

Care was provided to people by a sufficient number of staff who were appropriately trained and deployed. People did not have to wait to be assisted.

Staff recruitment processes were robust and helped ensure the provider only employed suitable staff to care for people.

Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe. The premises provided were safe to use for their intended purpose.

People and their families had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided.

People’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals

People said that they consented to the care they received. The home was meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People said that they were involved in making decisions about their care as much as they wanted to be.

People were cared for by staff that had the specialist training they needed in order to meet people’s needs.

People were supported to have a meal of their choice. Facilities were available for staff to make or offer people snacks at any time during the day or night. Specialist diets to meet medical or religious or cultural needs were provided where necessary.

People received care and support from staff who had got to know them well. The relationships between staff and people receiving support demonstrated dignity and respect at all times. Staff knew, unders

The people who used the service were observed being offered appropriate assistance to enable them to access their chosen activities. The staff on duty demonstrated a good knowledge and understanding of the people they were supporting.

The people who used the service were assessed fully and a detailed person centered care plan was developed for staff to follow when providing support.

We spoke to staff, who were aware of safeguarding procedures, and all had training or refreshers in this area. Staff were aware of other connected policies, such as their responsibility for reporting abuse and whistle blowing, and deprivation of liberty safeguards when it is in the best interest of the person who uses the service.

The staff told us that the manager held regular one-to-one supervisions. We were told that the supervisions were done in private and that they could talk over issues or areas of concern. One member of staff continued to tell us that during the supervisions seasons they were encouraged to discuss further training needs or any other area that the service could offer them.

We were told that the people who used the service have limited verbal communication but they can indicate that they are happy or not. The family members of the people who used the service told us they were asked for their views about the care and treatment provided to their family members at the service. One person "felt that the manager listened to their feedback and acted appropriately".

People who live at Nutbush Cottage have multiple complex needs within the autism spectrum all of whom had challenging behaviour.

The people who lived at the service had either no or very limited verbal communication skills as a result we were unable to ask their opinion of the service.

In order to ascertain the quality of care and support provided by the service, we undertook a telephone survey of the family members and the next of kin’s of the people who lived at the service.

We were told of the stability of the staff team their training and dedication to the people who live at the service.

The quality of the staff and their ability to support the people who live at Nutbush Cottage appropriately was a sentiment felt by the family members we spoke to.

One person stated that this placement was the best their relative had lived in and had made considerable improvement since moving into the service.

Generally people were very positive of the respect and dignity their relative was shown by the staff at the service.

Family members stated that they were contacted by the service and two stated that that they were invited to their relative’s reviews or important appointments. One person however stated that they have not attended a review for considerable time.

One person spoke of the improvement in the general well being of their relative since they moved into the service.

We were able to make limited observations of the people who used the service who were at home during the visit.

Our observations were that people using services, appeared relaxed and at ease in their surroundings and interacted well with staff on duty.

We observed that the staff member on duty was attentive to those at home and they demonstrated a good understanding of their communication styles or body language.