Peel House is a residential care home for 8 people with complex learning and physical needs. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we rated the service 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 ongoing 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.

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Staff knew how to protect people from avoidable harm and abuse. Support plans contained risk assessments and plans provided clear guidance for staff on how to keep people safe. Relatives of people using the service said they were confident their loved ones were safe. The service followed safe recruitment practices. Medicines were managed safely.

Staff were trained to carry out their roles. All of the staff we spoke with said they felt well supported by the registered manager. Staff remained knowledgeable about the requirements of the Mental Capacity Act. 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.

Staff interactions with people using the service were positive and caring. Staff demonstrated respect for the people they supported. People using the service were relaxed and responded positively to staff. We saw and heard lots of smiling, laughter and singing. Feedback about staff included, “The staff are very friendly, helpful and smiley” and “The staff are really good. They bend over backwards for people.”

Support plans were person centred and very detailed about people’s choices and preferences. People had access to a range of activities within the local community. There was a complaints process in place. No complaints had been received. The service had received positive feedback from people using the service and their relatives.

Staff spoke highly of the registered manager. The values of the provider were embedded in the day to day running of the service. There was a friendly and supportive atmosphere throughout the building. There were robust quality assurance processes in place.

Further information is in the detailed findings below.

Peel House can provide accommodation and personal care for up to eight people with complex learning and physical needs. This is the first inspection since changes in the registration of the provider. The inspection visit was unannounced and took place on 17 February 2016. At the time of our visit eight people were living at the service.

A registered manager was 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.

We saw people welcome staff attention and responded in a positive manner towards staff. Members of staff were knowledgeable about the procedures for safeguarding vulnerable adults from abuse.

Systems to manage risk were in place. Members of staff knew the actions needed to minimise the risks. For example, regular repositioning of people at risk of pressure ulcers and how meals must be served to people at risk of choking. Risk assessments and support guidance were combined and action plans informed staff on the measures in place to maintain people’s safety.

Staff said the staffing levels were appropriate to meet people’s needs and to support people with a range of activities.

Safe systems of medicine management were in place. Members of staff were competent to administer medicines. Medicine administration record charts were signed by the staff to indicate the medicines administered. Protocols were developed for medicines to be administered “when required” which gave staff guidance on administering the medicines consistently as needed by the person.

Staff attended training to develop their skills and they were supported to perform their role and responsibilities.

People were enabled to make decisions and staff knew how people made choices. Applications for authorisation of restrictions under the deprivation of liberty safeguards (DoLS) were made for people subject to continuous supervisions. Mental Capacity Act 2005 (MCA) assessments were not in place for specific assessments such as bed sides and audio monitoring systems. The registered manager said DoLS applications to authorise these restrictions had been made.

We observed good interactions between people and staff. We saw staff took prompt action when they noticed people making attempts to gain attention for refreshments by eye pointing.

Staff said gaining people’s trust helped them develop relationships. We saw staff use their knowledge of the person to provide care and treatment in people’s preferred manner.

Quality assurance systems were developed, which included the views of relatives and external professionals. Where shortfalls were identified, action plans were devised to make improvements. For example improving the frequency of one to one meetings with staff to help them with their roles and responsibilities.