About the service: Old Dairy is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. It provides personal care to adults living with a diagnosis of autism or Asperger's.

The Old Dairy consists of a care home for five people and a self-contained flat (The Flat) for one person. The service supports people with a diagnosis of autism or Asperger’s. The service size reflected the principles and values of Registering the Right support, although the service was commissioned before this guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

There were no deliberate signs to indicate the Old Dairy was a care home. Support staff wore their own clothes when working with people including accessing the community. Six gentlemen were living at Old Dairy at the time of our inspection.

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways:

• Staff understood how to communicate with people effectively to ascertain and respect their wishes.

• People’s independence was respected and promoted. Staff prompted people during household tasks and activities, to enable them to do things for themselves and learn new skills.

• People's support focused on them having opportunities to be part of their community, meet others and maintain existing relationships.

• Health and social care professionals guided staff to support people with their behaviour in accordance with national best practice guidelines.

• Risks to people had been assessed and plans were in place and followed by staff to keep people safe.

• Safe recruitment practices were followed to protect people from unsuitable staff. There was minimal staff turnover which promoted a high continuity of care and support.

• Staff were knowledgeable around safeguarding and understood provider policies and procedures in this regard. There were good links with local safeguarding bodies.

• Systems were in place to ensure people received appropriate support to take their medicines safely.

• Staff received supervision, felt supported in their role and received the training they needed to support people’s needs.

• All staff had a good understanding of the principles and application of the Mental Capacity Act. No one was living under the Deprivation of Liberty Safeguards.

• Staff attitudes and behaviours were responsive, respectful and caring.

• People were supported through appropriate communication methods by staff that knew how to involve people in their own care.

• People were supported to take positive risks and their goals and wishes were acknowledged and worked towards.

• Interactions between staff and people demonstrated personalised, collaborative, action-oriented care and support.

• There were processes in place to manage adverse incidents and complaints. There was evidence that learning from incidents was shared across the service.

• Effective quality monitoring systems were in place and regular audits and checks supported the registered manager and senior staff to identify concerns promptly to take action to improve the service.

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

We received positive feedback about the service and the care people received. The service met the characteristics of ‘Good’ in all areas. For more details, please see the full report which is at the CQC website at www.cqc.org.uk

Rating at last inspection: We last insp

We undertook an announced focused inspection of Old Dairy on 31 January 2018. This inspection was done to check that improvements to meet legal requirements planned by the provider after our 10 August 2016 inspection had been made. We inspected the service against two of the five questions we ask about services: is the service safe, is the service well led? This is because the service was not meeting some legal requirements. At this inspection we found the legal requirements had been met.

No risks, concerns or significant improvements were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Old Dairy is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Old Dairy accommodates six people in one adapted building. One of these people lives in a self-contained flat which was attached to the Old Dairy.

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 2008 and associated Regulations about how the service is run.

At our previous inspection in August 2016 we found the service was not complaint with the regulation relating to the safe management of medicines. We found improvements to the way people’s medicines were managed. People’s prescribed medicines were recorded on their administration record. Records showed medicines no longer required had been disposed of.

Staff and management understood how to protect people from harm and abuse. Risks to people's safety were identified, assessed and appropriate action was taken to keep people safe. People were supported by sufficient numbers of staff.

The registered manager was accessible to people using the service and staff. Quality checks were made with the aim of improving the service in response to people's needs.

This was an announced inspection which was completed on 10 August 2016. The reason the inspection was announced was to ensure the people living in the home were available for us to speak with and to provide them with assurances about our visit. This was because some people with Asperger’s syndromes become anxious when in the company of unfamiliar people. We gave 24 hours notice of this visit.

The Old Dairy provides accommodation and personal care for 6 people. There were six men living at the home when we inspected. One person lived in a self-contained flat which was attached to the Old Dairy. The registered manager told us people had a diagnosis of Asperger’s Syndrome in the completed provider information return. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they planned to make.

The Old Dairy is situated in the village of Nailsworth close to local shops and amenities. Where people had been assessed as being safe to do so, they accessed the village independently. The home is situated over two floors which are accessible by stairs. All bedrooms were single occupancy which they could personalise to suit their individual taste. On the ground floor there was dining/ kitchen area which was shared by five of the people living in the home. The lounge and a large activity room was accessed via the garden and was separate to 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 2008 and associated Regulations about how the service is run. The registered manager had responsibility for three other homes owned by Gloucestershire Group Homes Ltd.

People’s medicines were not always managed safely. This was because some prescribed medicines were not recorded on the medicine record.

People were receiving care that was responsive and effective. Care plans were in place that described how the person would like to be supported. This included how the person’s Asperger’s syndrome impacted on their day to day live. The care plans were tailored to the person and provided staff with information to support the person effectively. Some important information about people was not clearly recorded for example daily routines. However, staff knew about this and described how they supported the person. People had been consulted about their care needs and their views sought about the service.

People were supported to make decisions and take proportionate risks. Systems were in place to ensure that complaints and any concerns in respect of abuse were responded to. Systems were in place to ensure people were safe including risk management, checks on the environment and safe recruitment processes.

People were supported to access the community either with staff support or independently. There was usually one member of staff working in The Old dairy and one support worker in the self-contained flat providing 24 hour support. There were day care staff who complimented the residential staff, supporting people to take part in activities of their choice. There was a day centre that people could access if they wanted during the day and two evenings a week.

Health and social care professionals were involved in the care of the people living at the Old Dairy.

The staff were knowledgeable about the people they supported and caring in their approach. Staff felt supported by the management team. Staff received training relevant to their needs. There was a training plan in place which was being monitored by the senior management team. Staff were receiving regular one to one meetings with their line manager.

Systems were in place for monitoring the quality of the service. However, the auditing of medicines needed

The on call registered manager and support staff were available throughout the day and were very knowledgeable about people in their care, the policies, procedures and systems in place to ensure the continued smooth running of the home.

People shared their experiences with us about living in the home and we spoke with two people at length. Everyone expressed positive comments.

There was a happy, homely atmosphere throughout the day. People were relaxing and socialising in communal areas, spending private time in their rooms, one person was outside gardening.

People we spoke with during the day told us "It is a nice place to live, we have good fun and I have my own freedom".

It was a positive visit and we found that the provider was compliant in all five outcomes that we looked at.

Not all people wanted to speak with us about their experiences. We therefore relied on observation of staff and people who used the service.

We also spoke with two relatives who told us that they were very satisfied with the care their relative received. They told us that staff were “totally amazing" They told us "my relative has come on leaps and bounds in their care and I am proud of what they have achieved”.

People were protected from the risk of infection because appropriate guidance had been followed. Procedures were in place to minimise the risk or spread of infection and some staff had received training in this area.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Staff had a good understanding of people's medication needs.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Staff had undertaken both core and specialist training.

The provider had an effective system to regularly assess and monitor the quality of service that people received. The provider had a sound knowledge of the people they were providing a service for and systems were in place to ensure standards were maintained.

People told us staff were very helpful. They said they liked going out to the neighbouring

town and to local pubs and cafes. They told us staff supported them to visit their friends

and relatives.

We observed staff treating people with sensitivity and respect. Staff listened and

responded to people supporting them to make decisions and choices about their lifestyles.

One person said they felt safe in their room and in the home. They liked the staff and looking after their pet fish which they kept in their room. They were happy living in the home and the support they received from staff.

The home had a comfortable environment and we saw throughout, that people had places to keep personal items in the communal area's, for example, a guitar, keyboard and other hobby items. People enjoyed having their own rooms and space and had personalised them with momento's and pictures.