Pathways provide accommodation and personal care without nursing for up to 12 people. It is a service for people who have a learning disability and/or autistic spectrum disorder, physical disabilities and sensory disabilities. Some people had complex needs.

The service is split into two bungalows. There were six people living in bungalow 56a and four people living in bungalow 56b when we inspected on 19 September 2016. This was an unannounced inspection.

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.

People received care that was personalised to them and met their individual needs and wishes. People were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner. Staff respected people’s privacy and dignity and interacted with people in a caring, compassionate and professional manner.

There were sufficient numbers of staff who had been recruited safely and who had the skills and knowledge to provide care and support to people in the way they preferred. Staff had developed good relationships with people who used the service and understood the need to obtain consent when providing care.

Systems were in place which safeguarded the people who used the service from the potential risk of abuse and staff understood the various types of abuse and knew who to report any concerns to.

Staff knew how to minimise risks and provide people with safe care and there were procedures and processes which guided staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how risks to people were minimised.

Appropriate arrangements were in place to ensure people’s medicines were obtained, stored and administered safely. People were encouraged to attend appointments with other health care professionals to maintain their health and well-being and people’s nutritional needs were assessed and met.

There was an open and transparent culture in the service and staff were very motivated. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. Processes were in place that encouraged feedback from people who used the service, relatives, and visiting professionals. An effective quality assurance system was in place and as a result the service continued to develop and improve.

During our inspection we spoke with seven people using the service and a relative. We spoke with the manager and three members of the care team. We reviewed five care records and a number of documents relating to the management of the service.

People told us they were well supported by staff they trusted. They told us that they felt safe and knew how to pursue concerns and complaints. People said they felt listened to and involved in determining how their care was planned and delivered. We saw that care and treatment was planned and delivered according to individually assessed need. We observed that interactions between staff and people who used the service were positive and warm and that people using the service were confident to share jokes and display affection to members of the care team. One person told us, “I have lived here for many years and I love it.” A relative told us, “I have no concerns about the service. Staff are superb.”

We discussed with people using the service what they thought about their meals. We sat with people as they ate their evening meal and saw that everyone had a meal that they enjoyed. Everyone ate well.. The service supported people to access health eating choices.

We saw that staff recruitment and training provision helped ensure the delivery of safe and effective care and treatment. We reviewed care plans, staffing records and management records and saw that these were fit for purpose.

Where people using the service were able, we chatted with them about the support they received. Six people were able to give us a detailed picture of their daily lives and confirmed to us that they were receiving a good level of support from staff who they liked and trusted. One person told us, "The person helping me today is my friend. They help me to use my computer. I am going to make lunch with them. I like living here." Another person confirmed, "My key worked helps me to ring my relative and I visit them every week. Staff are good to me." Where people were unable to communicate their thoughts to us, we sat with them whilst they engaged in activities of their choice. We saw that people were able to make choices for themselves and could access communal areas when they wanted. We saw that people were supported at mealtimes, both to prepare and to eat their food. We saw that people could choose what they preferred to eat. One person was enjoying having their hair platted by a staff member. One person was sewing and another person was enjoying their choice of music.

We found that staff were aware of the needs and preferences of people using the service. Staff told us it was important for them to support people to make independent choices. Care plans were detailed and person specific. People were supported to make healthy lifestyle options and to maintain contact with people who were important to them. Quality assurance measures were in place to ensure people's safety.