This inspection took place on the 12 July 2017 and was unannounced. At the previous inspection of this service in May 2015 we found they were meeting all the regulations we looked at during that inspection.

Perrymans is a six bed service providing support with personal care and accommodation to people with learning disabilities. At the time of the inspection six people were using the service.

The service had a registered manager in place. 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.

There were enough staff working at the service to meet people’s needs and robust staff recruitment procedures were in place. Appropriate safeguarding procedures were in place. Risk assessments provided information about how to support people in a safe manner. Medicines were managed in a safe way

Staff received on-going training to support them in their role. People were able to make choices for themselves and the service operated within the spirit of the Mental Capacity Act 2005. People told us they enjoyed the food. People were supported to access relevant health care professionals.

People told us they were treated with respect and that staff were caring. Staff had a good understanding of how to promote people’s privacy, independence and dignity.

Care plans were in place which set out how to meet people’s individual needs. Care plans were subject to regular review. People were supported to engage in various activities. The service had a complaints procedure in place.

Staff spoke positively about the senior staff at the service. Systems were in place to seek the views of people on the running of the service.

We have made one recommendation that service user meetings cover more issues then just menu planning.

This unannounced inspection took place on 13 May 2015. At the last inspection in January 2014, the registered provider was compliant with all the regulations we assessed.

Perrymans is a six bed service providing support and accommodation to people with severe learning disabilities. At the time of the inspection five people were living there. People are accommodated in a spacious, purpose built house. It is a single floor building with wheelchair access. It is close to public transport and other services.

The service has a registered 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 and associated Regulations about how the service is run.

People were safe at the service and were cared for by staff who were knowledgeable about safeguarding people. They knew how to report concerns. Medicines at the home were managed safely. There were sufficient qualified and experienced staff to meet people’s needs.

Due to their health conditions and complex needs not all of the people were able to share their views about the service they received. However, during our visit we saw that people were relaxed and enjoyed good relationships with the staff. Staff spent time with people and they told us they enjoyed working at the home and had adequate time to complete their duties.

People were supported by caring staff who treated them with respect. Systems were in place to minimise risk and to ensure that people were supported as safely as possible.

Staff received the necessary training to carry out their role and was knowledgeable about the people they supported and how to meet their individual needs. Staff received the support they needed to carry out their role.

The staff team worked closely with other professionals to ensure that people were supported to receive the healthcare that they needed. Staff supported people to make choices about their care. Systems were in place to ensure that their human rights were protected and that they were not unlawfully deprived of their liberty. Activities and outings were provided according to people’s preferences.

The menus were varied and staff were aware of people’s likes, dislikes and special diets. People were happy with the food provided which met their nutritional and cultural needs.

Audits were carried out to check the quality of the service provided to ensure that people received a safe and effective service that met their needs. Action plans had been put in place so any suggestions could be addressed and service improvements made.

When we last visited the service in May 2013 we found that improvements were needed. We asked the provider to take action. On this follow-up visit we checked whether the required standards were met.

The May 2013 inspection found that some people's needs had not been appropriately assessed by the service. They did not have up to date support plans. This meant they were at risk of receiving unsafe and inappropriate assistance. On this visit records confirmed that the provider had clarified people's current needs. We saw evidence that people received appropriate assistance. Support was planned and delivered in a way that ensured people's welfare and safety.

The last inspection found the service had not acted in accordance with the Mental Capacity Act 2005. People's mental capacity to make decisions about their health treatment had not been appropriately assessed. Relatives and professionals had not been involved in making 'best interests' decisions about their medical treatment. On this visit we found that people's records included assessments of their mental capacity to make decisions. When it was appropriate, a 'best interests' decision about treatment was made on a person's behalf. The service had met legal requirements in relation to people who do not have the mental capacity to make a decision.

In May 2013 we found that the provider did not have an effective process to improve the quality of the service. An audit had identified that people's support plans were not up to date. The provider had set a date for them to be updated. However, this had not occurred. On this visit we found that the quality of the service was monitored regularly. When improvements were required timely action had been taken. The provider's arrangements to assess and improve the service were effective.

The previous inspection found that the provider had not always responded appropriately to people's complaints. On this visit we saw that a person had received a full written response to their complaint. They had received it within the timescale specified in the organisation's complaints procedure. People's complaints were fully investigated and resolved where possible to their satisfaction.

Five people with severe learning disabilities live at Perrymans. The service was not always assessing and recording people's mental capacity to make a specific decision. 'Best Interests' meetings, which should ensure that those who understood the person's needs were involved in decision making, were not being held. Not all of the people in the service had an up to date support plan. The provider had a process for monitoring the quality of the service but had not completed some actions within the set time-scales. The provider had not responded appropriately to a long-standing complaint. Following our previous concerns the provider had taken action to improve the safety of the building.

People using this service have very limited verbal ability. However we observed their non-verbal interactions and behavioural responses and concluded they were happy with the care and support they received. A relative said of their daughter's care - "it's good, I'm very happy with her care. It is easy to access [the service], my daughter is looked after very well." When asked if anything could be better the relative said "nothing at the moment".

We were not able to verbally communicate with people using the service. This was due to fact that they had limited verbal ability. However, we observed their non-verbal interactions and responses and concluded that they were happy with the care and support that was provided to them.

The staff on duty had a good understanding of people’s communication needs and were observed engaging with them in a respectful and sensitive manner. People looked happy and well-cared for.