Rainscombe Bungalow is a residential home which provides care and accommodation for up to six adults with learning disabilities, autistic spectrum disorders and behaviours that may challenge others. On the day of our inspection six people were receiving support. Some people were able to express themselves verbally using one or two words; others used body language to communicate their needs.

This inspection took place on 20 September 2016 and was unannounced.

The home was run by a registered manager and they were present throughout our inspection. ‘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.

The provider did not have a robust process that had ensured people finances were managed appropriately which is subject to investigation.

People and their relatives gave positive feedback about the service they or their family member received. People were very happy.

People said that they felt safe and they appeared happy and at ease in the presence of staff. One person said; “The staff look after me here.” People benefited from a safe service where staff understood their safeguarding responsibilities. Staff had received training in safeguarding adults and were able to tell us about the different types of abuse and signs a person may show if they were being harmed. Staff knew the procedures to follow to raise an alert should they have any concerns or suspect abuse may have occurred.

Risks to people’s personal safety had been assessed and plans were in place to minimise these risks. People who experienced conditions such as epilepsy had protocols in place for staff to ensure they remained safe during times of seizure activity.

People received their medicines as they were prescribed and when they needed them. Processes were in place in relation to the correct storage, disposal and auditing of people’s medicines.

Care was provided to people by a sufficient number of staff who were appropriately trained and deployed. People did not have to wait to be assisted.

Staff recruitment processes were robust and helped ensure the provider only employed suitable staff to care for people.

Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe. The premises provided were safe to use for their intended purpose.

People and their families had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. Staff ensured people had access to healthcare professionals when needed.

People said that they consented to the care they received. The home was meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People said that they were involved in making decisions about their care as much as they wanted to be. However we noted that all documentation was typed similarly and not personalise to meet each person’s needs.

Staff had the specialist training they needed in order to keep up to date with care for people. Staff demonstrated best practice in their approach to the care, treatment and support people received.

People were provided with a choice of meals each day and where they wanted to eat, for example go out for lunch or have lunch at home. Facilities were available for staff to make or offer people snacks at any time during the day or night. Specialist diets to meet medical or religious or cultural needs were provided where necessary.

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. We observed so

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions:

Is the service Safe? Effective? Caring? Responsive? and Well-led?

Below is a summary of what we found. The summary describes what relatives of people who used the service and members of staff told us, what we observed and what we learnt from the records we looked at. We talked with two of the staff, a deputy manager and the registered manager. Records we looked at included three care records, staff training records, management audits and the service’s quality assurance documentation. Following the inspection we spoke by telephone with relatives of two people who lived at the home. This was because opportunities for our meaningful engagement with people who lived at the home were limited.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

All staff were up to date with training about safeguarding vulnerable people. Staff we spoke with had a clear understanding of what constituted abuse and how to refer any concerns as safeguarding or whistle blowing issues.

Care plans recognised the benefits of supporting people to take risks in life experiences in and out of the home, and assessed how risks were to be managed to support them to do so. Risk assessments routinely considered issues of vulnerability to various forms of potential abuse. Risk management strategies covered how to keep people safe, for example by one-to-one staff support in the community and appointee arrangements for overseeing access to and use of money.

Is the service effective?

Staff and management were proactive in researching leisure and learning opportunities in the community. The service had two vehicles for community access. People went out daily for rides, walks and use of cinemas and eateries.

Care and support plans showed people’s diagnoses and reasons for being placed in the home. Care plans included a health action plan. Staff we spoke with said the care plans underpinned the care and support people received. They had time to read them and knew how to access information. They received a handover of updating information, together with delegated responsibilities, each time they started work. Records showed evidence of close liaison with external care managers and health professionals. The home used body maps to show clearly where any mark or injury was observed, but these were not being used to track progress of treatment.

Two people with relatives who lived at the home told us they were informed about care plan reviews, invited to take part and informed of outcomes. Both said their respective relatives’ had shown improved physical and emotional wellbeing as a result of living at the home. They said staff kept them informed about, and asked their opinions on, any health changes, including changes to medicines.

Some people who lived at Rainscombe Bungalow had histories of presenting behaviours that other people could find challenging. We found behaviour management planning was based on maximising people’s opportunities to express themselves positively, and to have choice and individual support in how they lived their daily lives. A letter from a person’s relative said after admission to the home, the person’s “challenging behaviours were quickly diverted…staff are confident, experienced and relaxed with (them)”.

Is the service caring?

We saw gentle, caring interactions between staff and the people who liveding atin the home. Staff gave explanations of choices available to people and allowed time for responses. Two staff we spoken with expressed a strong view that their role was to support people to feel at home and to live the life of their choice. They told us there were always enough staff to meet people’s needs. A person’s relative told us the staff demonstrated respect for people’s dignity by being attentive to their appearance and cleanliness. Daily records showed people experienced individual support to engage in identified preferred routines and activities

Is the service responsive?

Staff were supported in delivering care by an organised training programme, which included autism awareness. All but one of the staff had achieved relevant qualifications. Staff received monthly individual supervision every month. Records demonstrated a consistent approach that supported staff in identifying and meeting the needs of people living in the home.

There was evidence of effective liaison between the home and outside health and social care services. Care records showed specialist advice and care directions were incorporated into care plans and were followed by staff. External care management reviews gave the service feedback and discussion about the quality of care and support it provided for people living there. Where a person’s relative had raised a query through the annual quality survey, this had been investigated and followed by further communication from both the home and the provider.

An annual survey of people living in the home, their relatives and the staff provided information the provider used to inform developmental planning for the service. Relatives we spoke with said staff and management were very responsive to comments and requests.

Is the service well-led?

The provider was well known to staff and relatives of people who lived at the home.

The quality of environment for people in the home received ongoing attention. We saw shortfalls were quickly referred to the provider’s maintenance department for repair or replacement. There were daily schedules and checks for ensuring all areas of the home were cleaned to a good standard.

Monthly staff meetings covered care and operational issues. Staff we spoke with said they felt management listened to their views and kept them well informed of developments and plans. They felt a strong identity as a team working together.

The provider has produced a statement of purpose and service user guide which contains information about the service and the support that would be provided regarding the care and treatment of the people who used the service.

We saw that everyone receiving a care package from the service had an assessment of their needs undertaken before a care agreement was offered. This was to ensure that people's assessed needs could be met and that the service had the staff with the relevant skills and qualifications to meet these needs.

We looked at five care plans for people who used the service. Care plans were based on the needs assessment that had been undertaken prior to admission. People who used the service had limited capacity so were not generally involved in the care planning process.

We saw the service had adult protection policies and procedures in place known as safeguarding. These demonstrated how the provider identified potential abuse and prevented abuse from happening for the people who used the service.

There were sufficient numbers of bathrooms and toilets for people to use. We found that some of these had been adapted to provide assistance for people that had been assessed with mobility needs.

The provider had an established quality assurance (QA) programme in place. We looked at the provider’s QA system and found that there was a range of monitoring processes in place that enabled the provider to respond to issues of quality and risk.

Some of the people who were living at Rainscombe Bungalow have communication difficulties therefore they were unable to tell us about their experiences of using the service. We were able to speak with one person who used the service. This person told us that they were happy living at Rainscombe Bungalow.

We observed that staff spoke to people in a friendly and respectful way. We found that people were involved in making decisions and their right to respect, dignity and privacy was respected.

We observed that staff had a good understanding of people’s needs and their means of communication and they had a good knowledge of their needs and preferences.

We found that people were supported by sufficient numbers of staff. Staff told us that they received a lot of training. Staff were visible throughout this inspection and they provided people with good levels of support and they spent time engaging and interacting with them. A person who used the service said that there was always enough staff to support them.

Staff told us they receive regular supervision and an annual appraisal. One member of staff told us that they received regular supervision. They continued to state that the "supervision and support" had got "considerably better" since the provider had reorganised the management of the service. Another member of staff told us that they felt fully supported and valued by the manager and the organisation.

People who live at Rainscombe Bungalow have multiple complex needs.

We were not able to ask them about their levels of satisfaction with the outcome areas reviewed.

We were able to observe that people using services, appeared relaxed and at ease in their surroundings.

We saw good interactions between staff and people who use the service.

We observed that staff were attentive to those at home and they demonstrated a good understanding of their communication styles or body language.

Some of the people using services were out on the day of our visit. Records showed them to be taking part in planned day care activities.

Staff were seen to offer support and guidance in a sensitive, knowledgeable and caring manner.