This inspection took place on 13 December 2018 and was unannounced. This was the first inspection of this service since registration with the Care Quality Commission in December 2017.

Paxton House provides care for people with a learning disability. The service has accommodation for up to eight people. There were five people receiving a service at the time of our inspection.

The service did not have a registered manager. The registered manager had recently left the service and notified us of this. A deputy manager from another home owned by the provider was supporting the staff with the area manager. 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.

Paxton House 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. The care service was developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values were displayed including choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Staff understood what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. People were protected against the risk of abuse, as checks were made to confirm staff were of good character and suitable to work in a care environment. There were sufficient staff available to support people. Medicines were managed safely and people were supported to take their medicine as prescribed. The provider analysed accidents and incidents and used this information as a learning tool to improve the service.

Staff were supported and trained to ensure that they had the skills to support people effectively. People had access to health care facilities and the staff knew about any care and treatment that was being provided. When people required assistance to eat and drink, the provider ensured that this was planned to meet their preferences and assessed need.

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 support this practice. People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. Staff sought people’s consent before they provided care and people were helped to make decisions which were in their best interests. Where restrictions were identified, applications were sought to ensure these were lawful.

People were supported by staff who were caring and kind and who knew their needs, preferences and what was important to them. Staff understood how people communicated and they promoted different ways of communicating. Staff respected people’s privacy and dignity, encouraged people with making choices, and promoted independence. Relatives and health and care professionals were involved with how care and support needed to be provided. People continued to have relationships with people who were important to them.

People’s care was reviewed to reflect any changing support needs. People received support from staff to enable them to be involved with activities and do the things they enjoyed. People were encouraged and supported to express their views about the care and support provided and staff were responsive to their comments and any concerns.

There were systems in place to monitor the quality of the service and enable the provider to drive improvement. Staff felt sup