This unannounced inspection took place on the 25 November 2016.

Outlook Care - Hedgerows accommodates and cares for up to 22 persons split between two adjacent bungalows, Bluebell and Hawthorn, registered as one service location. There were 15 people in residence when we inspected, with five older people with dementia and nursing needs accommodated in Bluebell. This bungalow was being closed by the provider and the five remaining people were being relocated to other services. Hawthorn bungalow will remain as an active service providing care for adults with learning disabilities.

A registered manager was not in post. 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. An application to register the new manager with the Commission had been submitted.

People were safe. People were safeguarded from harm and poor practice by staff that knew what action they needed to take if they suspected this was happening. There were recruitment procedures in place that protected people from receiving care from staff that were unsuited to the job.

People’s needs were assessed before they were admitted to the home and regularly reviewed to ensure they received appropriate and timely care. People benefited from being cared for by sufficient numbers of experienced staff that had received the training they needed to do their job safely. Staff knew what was expected of them when caring for older people, including those with dementia care needs, and people with learning disabilities. Staff carried out their duties effectively and with compassion.

People’s individual nutritional needs were assessed, monitored and met with appropriate guidance from healthcare professionals that was acted upon when required. People had enough to eat and drink and enjoyed their meals. People that needed support with eating and drinking received the timely practical help they required.

People’s medicines were appropriately and safely managed. Medicines were securely stored and there were suitable arrangements in place for their timely administration. People’s healthcare needs were met and they received treatment from other community based healthcare professionals when this was necessary.

People’s individual preferences for the way they liked to receive their care and support were respected. People’s care needs had been assessed prior to admission and they each had an agreed care plan that reflected their individual needs. Their care plans were regularly reviewed and provided staff with the information and guidance they needed to do their job.

People were enabled to do as much as they were able to do for themselves by staff that were attentive to each person’s individual needs. They understood and acted upon the impact of people's disabilities on their capabilities. People received support from staff that demonstrated that they understood what was required of them to provide people with the care they needed.

People were treated with dignity and their right to make choices was upheld. People and their relatives or significant others, including people’s advocates, were assured that if they were dissatisfied with the quality of the service they would be listened to and that appropriate action would be taken to resolve matters to their satisfaction.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspections, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see evidence supporting our summary please read our full report.

Is the service safe?

Risk assessments were completed for each person using the service to identify potential risks such as falls or poor nutrition. There were systems in place to ensure the environment was well maintained and that people knew how to respond to emergency situations such as fire. Accidents and incidents were recorded and appropriate actions taken to minimise the risk of reoccurrence.

Medicines were stored securely and handled safely and appropriately by staff. Staff had completed training and their competency to administer medicines was regularly assessed. There were systems in place and staff had received training to ensure people were protected from abuse and that their human rights were upheld.

Is the service effective?

People’s health and care needs were assessed with their involvement. A care plan was then developed that reflected the level and type of support each person required to be safe and have an independent lifestyle. People’s mental capacity to make informed choices had been assessed and we saw that their relatives or advocates had been involved to ensure their best interests were considered. People we spoke with told us that they had regular meetings with their key worker who ensured that any changes they requested regarding their day to day care were acted upon.

Is the service caring?

We observed that people using the service had their privacy and dignity respected. We spoke with people and their relatives. A relative said ''The staff are kind and are genuinely caring; I am pleased we chose this place.''

People had been involved in the planning of their care and supported to identify their preferences and what was important to them. Staff demonstrated a good understanding of each person’s needs and how to effectively communicate with them. This ensured that people were supported and involved in decisions about their day to day care. We noted that staff took time to answer people’s questions and provide suitable explanations in a respectful manner. One person we spoke with said ‘’I love it here, they (the staff) really spoil me.’’

Is the service responsive?

People were invited to be involved and make decisions about their environment and group activities such as holidays. We saw that people had access to information about how to raise a concern. Complaints records we saw showed that people’s complaints had been responded to promptly and actions had been taken to address their concerns. We noted that safeguarding concerns had been correctly reported and responded to in a timely manner so that people were protected. There was evidence to show that the service worked well with other health care professionals such as dentists and doctors to ensure people received care they had requested. We observed that peoples wishes about aspects of their care and daily activities were respected and responded to appropriately. We saw that people had access to information about how to raise a concern or make a complaint. People's complaints we reviewed had been responded to appropriately by the service.

Is the service well led?

The manager had completed themed audits to assess the safety and quality of the service and used the information to identify non-compliance with policies and procedures or risks to people using the service. The provider’s quality assurance manager and the area manager had also undertaken unannounced spot checks and audits to ensure people using the service received safe and effective care.

You can see our judgements on the front page of this report.

During our inspection of Hedgerows on 23 April 2013, we saw evidence that staff made every effort to identify and act on the wishes of people who lived there. A relative we spoke with told us they were consulted where necessary in decisions taken about the care and support provided.

Care records we looked at showed that people’s needs and preferences were thoroughly assessed, documented and reviewed. One person told us, “I wouldn’t want to go elsewhere, it’s quite homely here.”

We saw evidence that people were provided with a good choice of food and drink in a way that both encouraged and promoted a healthy balanced diet. A Relative we spoke with said, “The food they provide is great and of good quality.”

The premises were safe, suitable and fit for purpose. Adequate emergency procedures were in place and the safety equipment we saw had been regularly checked and well maintained.

Records showed the provider had put effective recruitment procedures in place to ensure that staff were fit, able and properly trained to meet the needs of people who used the service. This included carrying out appropriate checks before staff began work.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke with the relatives of four people who told us that they were very happy with the care and support provided by the service.

We spoke with a relative during our visit to the service on 23 May 2012 and following the visit, we spoke on the telephone with three other relatives who frequently visited the service. They all told us that they were very satisfied with the care at the home and felt that staff were competent and caring. They told us that they were always told if there were any changes in their relative's care and that any issues were quickly addressed. Several relatives expressed concern that the minibus was no longer in use and felt that there were not enough social activities provided.