Priory House provides accommodation and support for up to three people who have a learning disability. The service is located in a residential area and within walking distance to a small town which staff supported people to access. At the time of the inspection there were three people living at the service.

The inspection took place on 12 December 2016 and was unannounced. Prior to this the service was last inspected on 9 January 2014 and was found to be compliant in all areas.

The service had a registered manager in post. However, they were also the service manager for the organisation; therefore the deputy manager took responsibility for the day to day management of the service. 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 were supported by staff who knew how to recognise the signs of abuse and who were confident about how and whom to report any concerns to.

Potential risks to people’s daily lives had been assessed and staff had taken action to manage and minimise these risks. The service had a process in place for recording, monitoring and analysing accidents and incidents and action had been taken to mitigate the risk of reoccurrence. In addition to this the environment was regularly monitored to ensure that people were kept safe from harm.

Staff supported people to take their medicines safely and staff competencies relating to the administration of medicines were regularly checked.

There were sufficient staff available to effectively care for people and keep them safe from harm. Staff supported people to access the wider community and pursue areas of personal interest outside of the home.

The service had a robust recruitment process in place to ensure that staff had the necessary skills and attributes to support people using the service. New members of staff were introduced to the service through a thorough induction programme and were required to complete a probation period to ensure that they had acquired the necessary skills to care for people.

Staff demonstrated that they had the skills and knowledge to meet the needs of people living in the service. The provider supported staff to continue to develop their knowledge through regular training sessions and as the needs of people living in the service changed staff were supported to access training which was appropriate to meet their new needs.

People were supported in line with the legislation of the Mental Capacity Act and no unnecessarily restrictive practices were in place. There were effective systems in place to ensure that people’s medication, money and personal information were kept safe.

Staff supported people to maintain a healthy diet and to access drinks throughout the day. Mealtimes were sociable occasions and were flexible in order to accommodate people’s routines, preferences and commitments. People were encouraged to be as independent as possible and were supported to make choices about what they ate and to prepare and cook their meals.

Staff worked alongside health and social care professionals to meet people's needs and sought specialist advice and support when the need arose.

Staff were kind and respectful when providing care. People sat and chatted and joked with staff members and clearly felt relaxed and comfortable in their presence. Staff demonstrated that they knew people well and delivered care in accordance with their preferences and wishes. Staff were skilled at caring for people who had complex behavioural needs and were consistent in their approach.

People were empowered to express their views and opinions through daily planning meetings, weekly meetings with their support worker and formal resident meetings. Staff used a variety of m

Priory House is a care home providing accommodation and personal care for a maximum of three people with learning disabilities. The existing registered manager for this service informed us that their role was changing to become the locality manager for Priory House and three other services in the area owned by the same provider. An existing manager of other services owned by the provider who knows the people living at Priory House and the staff well is taking over management of the service.

There were two people at home when we visited. Both people told us that they felt safe and that the staff were kind and caring. People’s care records showed that staff were following effective risk management plans to protect people from the risks of harm, or where people’s health and wellbeing was at risk. For example, we saw that detailed crisis behaviour management plans were in place that ensured any behaviour that challenged was dealt with effectively and in a manner that respected people’s dignity and protected their rights.

We found that systems were in place that ensured people who used the service received their medicines safely and in a clear and consistent way.

The service had policies and procedures in place that ensured staff had access to guidance on how to promote people’s privacy, dignity, independence and human rights. We observed that staff adhered to these principles during our inspection, and recognised the diversity, values and rights of the people that used the service.

We saw that people’s preferences and needs were recorded in their care plans and that staff followed the plans in practice. Records showed that people’s health was regularly monitored to identify any changes that needed additional support or intervention. This meant that people received care and support that promoted a good quality of life.

People’s nutrition and hydration needs were assessed and monitored to ensure that they received a balanced and nutritious diet that maintained their health. People told us that they were routinely asked about their choice of meals and that snacks were always available. One person told us “I am able to go into the kitchen and make myself a sandwich when I want one.”

Documents showed that mental capacity assessments and best interests meetings had taken place, when decisions needed to be taken on behalf of someone who was deemed to lack capacity. This showed that the service understood the requirements of the Mental Capacity Act (MCA) 2005 and put them into practice to protect people.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. (The deprivation of liberty safeguards are a code of practice to supplement the main Mental Capacity Act 2005 Code of Practice.) We looked at whether the service applied the DoLS appropriately. These safeguards protect the rights of adults who use services so that if there were any restrictions on their freedom and liberty these would be assessed by professionals who are trained to consider whether the restriction is needed. The manager said that while no applications had needed to be submitted by the service, proper policies and procedures were in place. The registered manager understood when an application should be made, and how to submit one. During our inspection we saw no evidence to suggest that anyone who lived at the service had been deprived of their liberty.

We found that the management and leadership of the service assured that staff delivered high quality care which was centred on the needs of the people who lived at Priory House. Our observation of the interaction between people who used the service and staff, and the records we looked at, confirmed that people’s care was individually led by well trained staff who demonstrated clear values in relation to involvement, compassion, dignity, respect, equality and independence.

We looked at the staff rotas and saw that there were sufficient numbers of staff, available at all times, to meet the needs of the people who used the service.

We saw that systems were in place that enabled open communication between the people that used the service, their relatives, managers and the staff. Residents meetings took place on a regular basis so that people were able to have their say about how the service was run, and talk about things that mattered to them. The minutes of staff meetings showed that staff had the opportunity to discuss issues about the service in an open and transparent way.

We spoke with two people who used the service. They told us that they were happy living in Priory House. One person said, “I get on with everyone and have no complaints." Another person said, “I like it here."

People told us that the staff treated them with respect and kindness. One person said, “They (staff) are caring and help me to do the things I want. They (staff) take me out which I like and are good to me.”

We saw that staff interacted with people in a caring, respectful and professional manner.

We looked at two people's care records and found that they experienced care, treatment and support that met their needs and protected their rights. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We saw that people who used the service were provided with a safe environment to live in.

We looked at staff records and spoke with two members of staff who told us they were being appropriately trained and supervised. We saw that the service provided enough qualified, skilled and experienced staff to meet people's needs

We looked at the way that complaints were recorded and dealt with, and saw that they were handled in line with the provider's policy.

We spoke with three people using the service. They all confirmed that they felt safe and that staff helped them to do the things that they enjoyed. One person told us a great deal about their preferences and thoughts: "Staff always help me. Sometimes I feel angry and, when this happens, staff sometimes help me to take medicine to help me feel better. They always ask first. It does not happen very much." The same person told us about the activities they join in, "I like to go to the pub when it is quiet and I love to buy DVDs. Staff go on the bus with me. Staff are good to me and I trust them."

We found that the service was providing good, person-centred care to people which met their specific individual needs. Staff were competent in their roles and had taken time to familiarise themselves with people's preferences and needs. Medication was well managed and mood controlling drugs were administered in line with a strict protocol and in agreement with people using the service. People were able to make their own choices around daily living tasks and were supported to be involved in the local community.

People with whom we spoke told us that they liked living at Priory House. They told us that the staff understood their needs well and helped them when they were worried or upset. They also told us that they felt safe living at Priory House and always felt that they could speak to the staff about anything.