This was the first inspection of the service which changed registration on 16 August 2016. The service was previously registered as a residential care home but applied for a change in registration to a ‘supported living’ service. This inspection took place on the 7 August 2018 and was announced. The service was rated as good in all domains. This means the service is good overall.

Osborne House provides care to people living in a ‘supported living’ environment. Of the eight people living in the house three receive a regulated activity. The service supports people with a learning disability and associated needs. The Care Quality Commission only inspects the service being received by people provided with personal care, help with tasks related to personal hygiene and eating. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living.

The service had a registered manager. A registered manager is a person who has registered with the 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.

People were kept safe by staff and would be confident to raise any concerns they had. The provider’s recruitment procedures were robust and medicines were managed safely. There were sufficient staff to provide safe and effective care at the times agreed by the people who were using the service.

There were procedures in place to manage risks to people and staff. Staff were aware of how to deal with emergency situations and knew how to keep people safe by reporting concerns promptly through processes they understood well.

Staff received an induction and spent time working with experienced members of staff before working alone with people. Staff were supported to receive the training and development they needed to care for and support people’s individual needs.

Family members and external professionals who were involved in people’s care were complementary of the services provided, some describing the care and support as excellent. The comments we received demonstrated that people felt valued and listened to. People were treated with kindness and respect whilst their independence was promoted within the service and in the wider community.

The service remained responsive to people’s individual needs. Staff knew people very well and paid particular attention to finding out about their interests and personal preferences. This enabled support to be focused to achieve people’s desired outcomes. Individual support plans were person-centred and they considered the diverse needs of each person, taking into account any protected characteristics. The service provided flexible support embracing people’s individual wishes.

People knew how to raise concerns or make a complaint and they felt confident they would be listened to if concerns were raised. The service was working to the accessible information standard. Up to date information was communicated to staff as required to ensure they could provide the most appropriate care and support for each individual. Staff knew how to contact healthcare professionals in a timely manner if there were concerns about a person’s wellbeing.

The service was well-led, with strong leadership from the registered manager. Records were relevant, complete and reviewed regularly to reflect current information. The registered manager promoted an open, empowering, person centred culture. The values of the service were embedded in the way staff worked with people. Feedback was sought and used to monitor the quality of the service. Audits were conducted and used to make improvements.

Further information is in the detailed findings below.

Osborne House is registered to provide care for up to nine adults with learning disabilities or autism spectrum disorder. On the day of our visit there were 9 people using the service.

The registered manager has been in post since April 2014 but was on annual leave at the time 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 and associated Regulations about how the service is run.

People spoke positively about the care they received. Comments included, ”They treat me good, they are very patient, I am not rushed” and “They are very really nice, if I have a problem with anything they will help me.”

Staff positively engaged with people and was observed being attentive towards people who needed help. The atmosphere in the home was relaxed and people moved freely around the home, talking to each other in communal areas or spending time in their rooms.

People felt the care provided was centred on their needs and preferences. This was evidenced in rooms which were decorated to people’s personal preferences. Care plans captured people’s personal histories; important relationships; social interests and spiritual and cultural needs.

People said they felt safe at Osborne House and knew who to speak with if they felt unsafe. One person commented, “They treat me well and if I have a problem I will talk to a member of staff.” Staff demonstrated a good understanding of how to protect people from abuse and explained the procedure they would follow if they suspected abuse had occurred.

There was sufficient numbers of staff to keep people safe and meet their needs. We heard comments such as, “When staff is sick there is someone to replace them” and “If we need staff we press the intercom and they will come.”

Necessary recruitment processes and checks were in place and being followed.

People received support from staff with their medicines to ensure they were managed safely. Staff administered and recorded medicines in line with the service’s medicines policy.

Staff was aware of the implication for their care practice in regards to the Mental Capacity Act 2005 (MCA). Where people were not able to make specific decisions, care records showed who had legal powers to make important decisions on their behalf. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People took part in social activities and were supported to follow their interests. On the day of our visit, we observed people preparing to go out for an evening of activity. People appeared enthusiastic and were heard talking to staff about what they should wear and asking what time they were going to leave.

People said they knew how to make a complaint and felt comfortable to do this. Staff knew how to handle complaints and confidently spoke about the procedures they would follow. This was in line with the service’s complaints policy.

People were supported to maintain good health and had access to healthcare services.

Quality assurance systems were in place to improve the quality and safety of people who used the service.

During our inspection we found the provider had put measures in place to improve the safety and suitability of the premises.

Improvement actions were carried out to make sure people who use the service and staff who work there were in safe and accessible surroundings promoting their wellbeing. The provider had ensured the premises were adequately maintained and complied with legal requirements relating to the premises.

At the time of our inspection the provider did not have a registered manager in post. However, we were aware that the service manager was in the process of becoming a registered manager of the home.

We used a number of different methods to help us understand the experiences of people using the service. This was because the people who use the service had complex needs which meant some were not able to tell us their experiences. We spoke with some people who use the service and observed what people did during the day. We also used observations of the interactions between people who use the service and the care workers to inform the judgements reached within this report.

We spoke to people about nutrition at Osborne House. One person told us, “I feel I can choose things I like; I do my own shopping”. People were provided with a choice of suitable and nutritious food and drink.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. Whilst maintenance tasks were completed, some risks identified by the home and others were not adequately addressed. There were risks from Legionella which were inadequately identified, assessed and managed.

We spoke with two people who told us they had no complaints about the service but if they had concerns, they would raise them with the care workers or the home manager. One person we spoke with told us, “If I was worried, I would tell them”.

Records were kept securely and could be located promptly when needed. Records about people's care at the location were readily available. These included people's support plans, the daily records and other health related information.

At the time of our inspection the provider did not have a registered manager in post.

When we visited there was a relaxed and comfortable atmosphere within the home.

We observed the way that staff interacted and communicated with people who used the service and saw that people were treated with respect and dignity. We saw that people were supported to make choices to promote their independence.

We saw people involved in helping staff prepare their evening meal according to their abilities. We saw that people who used the service could choose what they wanted to eat as most people had a different meal on the day we visited. One person told us that staff help them with shopping but they choose their own food, "no point getting something you don't like."

We saw that people were involved in activities of their choosing like drama groups, going to the pictures, day trips and bowling. People we spoke to expressed their enjoyment of the activities they participated in and told us "I love it" when speaking about the gardening club they attended and "I like it, it's good" in relation to the drama group.

We found that people who used the service were involved in making decisions about their care through regular care plan

reviews and meetings to discuss what was important to them.

Staff we spoke to told us they felt well supported in their work both by their colleagues and their manager and told us they enjoyed working at the home. They told us how they would rather encourage and support people to do things for themselves where they were able.

We did not talk to residents about the recruitment records at the home, as we were on a short follow up visit just to check these records. However, we did speak with the few residents who were at home at the time and people seemed happy and relaxed.

On this occasion we did not ask people directly about the cleanliness of the home or about recruitment procedures. This was a follow up visit to see what actions the home had taken in response to some shortfalls in these two outcome areas at our previous inspection. At that time residents commented favourably on both the cleanliness of the home, and on the staff.

We spoke to six of the seven people currently living at this home during our visit, and asked them a variety of questions about their experiences living at this home. All those we spoke with said that staff treated them well, and that they were given choices in their day to day lives, for example about their meals, their activities, and where they wished to go on holiday.

People we spoke to indicated that they got the support they needed from staff, when they needed it, and they were able to give examples of the personalised care and support they received. Some residents told us they had been involved in interviewing new staff.

There were no complaints about the food, and those who were able to discuss their meals confirmed their involvement in both drawing up shopping lists, and going out to do food shopping. All those spoken to said they felt safe at this home and would know who to complain to if they had any concerns.