This inspection was unannounced and took place on the 12 and 13 September 2018.

Pathways and Community - Warford is a ‘care home’ operated by The David Lewis Centre. 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. Pathways and Community - Warford accommodates people in 16 separate buildings, each of which has separate adapted facilities.

Pathways and Communities Warford is made up of 16 separate homes across a single private site in a rural area of Cheshire. The homes are mixed gender and mixed ability. The homes are varied from minimum occupancies of two to a maximum of 18. The service supports people with complex needs in a residential village setting. The homes are registered to care for people living with dementia, learning disabilities or autistic spectrum disorder, older people, young adults and people with a physical disability. The service specialises in supporting people with epilepsy. At the time of inspection there were 123 people living at the site.

The service followed a multi-disciplinary approach with socially registered homes and on-site clinical facilities including a GP surgery, physiotherapists, occupational therapists, speech and language therapists, specialist nurses, pharmacy and psychologists. The service had a working farm, leisure facilities including a swimming pool and community based day services on site. All of which were accessible to the people living there.

The service has been developed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service is unique in size, it spans 50 acres, people had access to wide open spaces and were kept safe within this community. The entrance to the site is secured with a barrier, the site is not accessible to the general public. Because of this the site felt safe, people and staff walked or drove around the large site.

The service had 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 overall responsibility of the 16 homes. Each home had a manager, team leaders and care officers. Each home completed quality audits and presented these at management meetings. People and staff spoke positively about the management team.

At the last inspection which was published in June 2015 the service was rated good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were supported to receive safe care from staff who received a high level of safeguarding training. Safeguarding policies and procedures were robust. Recruitment was completed safely and thoroughly with appropriate pre-employment checks. Medicines were well managed and people were protected from the risk of infection. People were protected from the risk of discrimination.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. There was a multi-disciplinary approach to care and a proa-active approach at sup

During our unannounced inspection on 5 February 2014 we spoke to the Registered Manager, two residential managers, four team leaders, the Training Manager, the Maintenance Manager, five carers, seven people who used the service and two of their relatives.

During the inspection, we looked at four care plans and in each of them we saw evidence that the provider had followed guidance and legislation relating to capacity assessments and best interests meetings.

People we met were happy with the care and support they received. One person said; “It’s good here I like it.” Another person said; “They’re alright” they then laughed and smiled at the staff and said; “Yep, really nice.”

We were told that the Director of Clinical Services was the Centre lead for infection control and that a comprehensive infection control policy was in place.

We checked a number of pieces of equipment, including fire alarms, fridges, freezers and electrical equipment and saw that it had been checked and maintained within applicable timescales.

It was clear that the provider sought people’s views. We saw that there were residents meetings held weekly where people could make suggestions and raise concerns.

We visited five of the eleven houses that make up the Pathways and Community service within the David Lewis Centre during our inspection. We also looked at the care records for five people who used the service. We saw that their care records were personalised and that they contained, for example, information about each person’s daily routine and chosen activities. However we noted that one persons care records had not been updated to reflect their current needs. We also observed how staff cared for and interacted with people who used the service, particularly people who had limited verbal communication.

We spoke with four people who used the service. One person told us about their daily life at the service and said they were happy living there. Another person said “they help me to look after myself.”

We saw that the service had implemented regular audits as well as consulted with people who used the service and family members to monitor the quality of service provision.

We saw that systems were in place that ensured people were protected from the risk of harm and abuse. We were provided with a copy the staff training records. This showed that staff received training and were supported to access courses that enabled them to deliver safe and effective care to people who used the service.

The inspection was unannounced and took place on 11 February and 18 March. This location was last inspected in February 2014 when it was found to be compliant with all the regulations which apply to a service of this type.

The Pathways and Community – Warford service supports adults with complex needs to attain quality of life and to maximise their potential in a safe residential environment. Pathways and Community – Warford provides care for adults of all ages and some people who use the service spend their whole adult life with the service. The service draws on the rest of the David Lewis Centre for certain support arrangements most notably clinical, social work and administrative services as well as other central facilities such as kitchens.

The service is located on the site of the David Lewis Centre which provides a range of assessment, treatment and care for people with severe epilepsy and associated conditions such as autism and learning and physical disabilities. Pathways and Community – Warford uses a number of separate buildings on the main site as well as some houses close by. There are 126 places spread out between 16 separate units. Units vary in size from a single person to the two largest which have places for 21 people in each.

There is a registered manager at Pathways and Community – Warford. 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.

We found that the care provided took account of individual preferences and needs whilst providing high levels of clinical and other support. We found that staff were professional and that there was a relaxed approach with people who used the service who were generally at ease

People who used the service had access to a range of activities on a daily basis. There were good arrangements for people to eat and drink. Staff were well trained and the provider checked to make sure that they were suitable to work in the service. The service was managed proactively and could draw on the resources of the wider David Lewis Centre.

We found that unexpected staff shortages could occasionally compromise the level of care when there was a lower staff ratio which in turn might curtail the range of activities available to a person. Medicines were administered safely.