The inspection took place on the 8 and 9 October 2018. It was an unannounced visit to the service. This was a comprehensive inspection to review the rating and improvements within the service.

22 Bierton Road 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 service accommodates eight people in one adapted building. At the time of our inspection there were eight people living in the home. The service is registered to support people with a range of needs such as learning disabilities, autism, mental health, physical disabilities and drug and alcohol misuse.

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen, as set out in the Registering the Right Support CQC policy.

The service had 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 2008 and associated Regulations about how the service is run.

At the previous inspection the service was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well-led to at least good. At this inspection we found improvements had been made to meet the relevant regulations. As a result, the service was providing safe, effective, caring, responsive care in a service that was well-led.

People and their relatives were happy with the care provided. They felt people were safe and were appropriately supported. They had positive relationships with staff and felt people were treated like family members. They described the service as “home from home.” Professionals were happy with the way the home was managed. They felt communication with them was good and people’s needs were met.

People were safeguarded from abuse. Risks to them were identified and managed. Accident and incidents were responded to and appropriate action taken.

People’s medicine was safely managed. They had care plans in place which provided guidance to staff on the support they required. Their health and nutritional needs were identified and met. They had access to day centres and leisure activities.

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. People’s communication needs were identified and met. Staff worked to the principles of the Mental Capacity Act (MCA) 2005 to further safeguard people.

People were provided with equipment to promote their safety. Equipment such as moving and handling and fire safety equipment was suitably maintained and serviced. The home was homely and a refurbishment plan was in place. The provider was considering what changes were required to the environment to enable them to meet people’s changing needs.

Staff were suitably recruited, inducted, trained and supported in their roles. The service had a consistent staff team who knew people well. They had positive relationships with people and were kind and caring in their engagement with them. The required staffing levels were maintained. However, some staff were not working to the organisation's guidance on extra hours. This was addressed and systems put in place to m

This inspection took place on 11 and 12 September 2017. It was an unannounced visit to the service.

We previously inspected the service on 17 and 19 August 2015. The service was meeting the requirements of the regulations at that time and was rated as good. This inspection was a comprehensive inspection to review the rating.

22 Bierton Road is a care home which provides accommodation and personal care for up to eight people with a learning disability. At the time of our inspection there were seven people living in the home.

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. The home had a manager in post who was in the process of applying to the Commission to be registered.

People and their relatives were happy with the care provided. They felt people got safe care.

Systems were in place to safeguard people. However accident and incident reports were not reviewed. This meant incidents were not investigated, risks not managed and appropriate referrals were not made to promote people’s safety. In addition notifications relating to those incidences were not made to the Commission either.

Improvements were required to medicine management. Risks to people were identified but not all risks were managed in line with the guidance in people’s care plans. People’s records were not up to date, suitably maintained and kept secure.

The provider had systems in place to audit the service. These audits were not effective in identifying the issues we found.

People had care plans in place. They were organised and provided guidance on how people were to be supported. People’s health and nutritional needs were met. They had access to regular reviews of their care with professionals. Professionals were positive about the relationships they had with the home.

People had access to activities and were provided with the information and support to make a complaint.

Systems were in place to ensure staff were suitably recruited. Sufficient staff were provided. The home had an established staff team. They were inducted, trained, supported and supervised. They were clear about their roles and responsibilities and felt suitably skilled to do their job.

Staff had a good knowledge of the people they supported. They were kind, caring and supportive. They promoted people’s privacy and encouraged them to make day to day decisions and choices about their care.

Appropriate Deprivation Of Liberty Safeguards (DoLS) applications were made to the local supervisory body for people who had restrictions imposed on them.

Systems were in place to get feedback on the service provided. People had access to monthly resident meetings and families were invited to give feedback as part of annual reviews and surveys.

Staff, relatives and professionals were happy with the way the home was run and managed. Management were accessible and receptive to feedback. They were proactive in addressing issues to improve the service.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The people we met were happy and said they felt well looked after, people were relaxed and told us they enjoyed living at the home. These people also told us that they regularly went out on shopping trips, out to the cinema and attended a variety of local social clubs of their choice. We looked at a range of people’s weekly activity plans and we noted that a broad range of weekday, evenings and weekend activities were promoted. We spoke with one person who told us, “I am independent and I go out when I want. I mainly like going to the gateway club but I have lots of friends here at the home too.”

We spoke with three care staff who told us that they supported people to be as independent as possible and supported them to work towards and achieve personal leisure activities or social goals. We looked at four care files that demonstrated the personalised approach in place to support the staff’s comments. We observed that the manager operated a model of good practice by offering staff regular supervision and access to a framework of training and support that enabled them to provide a high quality of care.

We observed staff treating people with respect and were able to see that there was a good relationship between staff and people who used the service. We observed staff assessing people’s needs and ensuring that care was provided in line with individual care plans. We were able to see that people were comfortable and that there was adequate numbers of staff available to provide the individualised support needed.

The people we talked with seemed settled living at Bierton Road. They had lived there together for many years. One person told us they hoped they would be able to live more independently in the future. People had established routines which suited them. Those included trips out, shopping, going out to cafes or pubs in Aylesbury, and to a weekly social club. Some people went to college to attend a daily life skills course. Over the Christmas period people had been to a number of social events and on the day of our visit people were going to a pantomime in the evening. We saw that staff were available to provide support to people when it was needed. People were comfortable and safe in the service.

Staff treated people with respect and had a good relationship with them. We found people’s needs were assessed and their care was provided in line with their care plan. The environment was suitable for people using the service at the time of this inspection. People were protected against the risk of abuse. Staff were supported in providing care and support to people. The organisation responded appropriately to complaints.

People told us that they were happy living in the home. They told us that the staff were good and that they were treated well.

One person invited us to view their room. They told us that they liked their room and liked living in the home. The person had personalised the room to their own taste. The decor reflected this and this room was quite distinct from other areas of the home.

Reach Bierton Road provides accommodation and support for up to eight adults with learning disabilities within the Aylesbury area. At the time of our inspection, seven people were living at the home.

Reach Bierton Road has 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.

People were supported by staff who knew their needs, likes and dislikes well. Most staff had been employed at the service for a significant period of time which had a positive impact on how people were supported. Staff were able to explain people’s needs and how they supported people to be independent and to promote people to make life choices.

People were protected from harm by staff who were inducted, trained and supervised within the service. Staff knew how to respond to allegations of abuse, and how to protect people from potential risks. Medicines were managed well within the service.

People’s health and social needs were met in a way which promoted best outcomes for people, for example, the use of health professionals such as doctors, speech and language therapists and social workers.

People were supported by staff to access the community in ways they wanted, for example, on the days of our inspection, people were supported to go on holiday to a seaside resort and people who did not go on holiday, were supported to visit the local shops and a wildlife park. People were also assisted to access cookery courses and college courses if they wished.

People appeared happy and settled within the service. The service had a calm environment and people appeared relaxed and at ease. Relatives we spoke with told us “I have no complaints, X has never been happier in her life, X loves it here” and “X seems very happy there.”