We carried out an unannounced comprehensive inspection of this service on 5 October 2016.

The home is registered to provide accommodation and personal care for adults who require care and have a learning disability. A maximum of six people can live at the home. There were five people living at home on the day of the inspection. There was 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 felt safe in the home and were supported in a safe way. Staff told us about how they kept people safe from the risk of potential abuse. During our inspection staff were available for people and were able to support them by offering guidance or care. People received their medicines as prescribed and at the correct time. They also felt that if they needed extra pain relief or other medicines these were provided. People were supported by an individual member of staff in the day time and where extra staff were needed to support them this had been provided.

People told us staff knew what care they needed. Staff felt confident that they were trained in how to look after the needs of people who lived at the home. All staff we spoke with felt supported by the registered manager and were able to discuss their role or training needs. People had been involved in the planning of their care and relative’s views had been considered in any decision making where appropriate.

People told us they enjoyed the food and that it was well prepared by them or with staff support. People had access to healthcare professionals that provided treatment, advice and guidance to support their health needs.

People told us and we saw that their privacy and dignity were respected and staff were kind to them. People received supported to have their choices and decisions respected and staff were considerate of promoting their privacy and dignity. Staff anticipated people’s care needs and attended to people in a gentle and unhurried way. Staff developed positive, respectful relationships with people and were kind and caring in their approach.

Staff knew the care needs of people who felt involved in their care and treatment. Staff were clear about the levels and expected care needs of people at the home. People we spoke with happily raised any concerns or complaints with the management team.

People were involved in their home and the registered manager regularly checked that people and their family members were happy with their home and care. The management team were approachable and visible within the home which people liked.

On the day of our inspection six people were living at the home. People we spoke with were unable to tell us their views about their experience in any detail. This was due to their learning disability. People we met appeared happy in the home. One person said, “I love to live here”. During the inspection we sampled people’s care records and spoke with staff. They helped us to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

People were treated with respect and dignity by the staff. Care plans identified people’s needs and were reviewed regularly. Staff demonstrated a good understanding of people’s needs. People were given choices and supported to make decisions themselves. Risk assessments were in place and control measures identified. However, recent incidents within the home presented an increased risk to people. The registered manager felt the likelihood of harm was low. A new risk assessment was to be completed. This ensured that people’s needs were met and risks to people were managed in order to keep people safe.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff received training in the Mental Capacity Act and Deprivation of Liberty safeguards. This meant that systems were in place to safeguard people as required.

People were protected against the risks associated with medication because the provider had appropriate arrangements in place to manage medicines. Only staff that had been trained administered medication.

New staff underwent an induction and shadowed other staff. Staff received mandatory training and were required to have either a level two or three in health and social care. Staff that did not already have this qualification were supported to achieve this. Specific training in sexualised behaviour was being planned to enable staff to support people’s needs. This meant that people received care and support from staff who had the skills and knowledge to meet their needs and keep them safe.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints and concerns. Multi-disciplinary meetings took place in order to reduce incidents. This helped to reduce the risks to people and helped the service to continually improve.

Is the service effective?

People experienced care, and support that met their needs. People were encouraged to remain as independent as possible and to participate in a range of activities and outings Records showed people and their relatives were invited to participate in care reviews. The service agreed to consider the use of advocacy for people when relatives were not fully involved. This meant that people’s needs were met.

People were able to move around the home freely. Communication aids such symbols and pictures were available throughout the home. This enabled people to communicate their needs and staff to offer choices. Regular audits and checks took place. Issues identified were acted on. This meant the service had effective systems in place to identify improvements and continually meet people’s needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that support workers showed patience and gave encouragement when supporting people. We saw people responded positively to staff. One person told us, “I like the staff”.

People’s preferences, likes, dislikes and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People were involved in their day to day care and were supported to maintain relationships that were important to them. We saw that people were supported to identify future activities and their diversity and individuality were promoted and respected.

Is the service responsive?

We saw staff that responded quickly to meet people’s needs and ensured people’s safety was maintained. For example, we saw staff were observant to people’s communication through their behaviour. This meant staff could respond appropriately and in a timely manner. We saw that people were supported to express their views and these were acted on. One person asked to see their care plan and was issued a copy. People had the opportunity to engage in activities both in the home and within the community.

A complaints procedure was in place. Staff told us that they would support people to raise a concern or make a complaint. No complaints had recently been received.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff felt supported in their roles and felt their views were listened too.

The service had a quality assurance system. Regular audits were undertaken and identified issues were acted on. A new questionnaire had been developed for people who used the service. This meant the quality of the service was continually improving.

None of the people we met were able to express their views about the service they received in any detail. However, everyone we met appeared happy in the home. People were comfortable with the staff and their surroundings.

One person was happy to talk to us about what they were doing. They told us they liked cooking.

We saw staff treating people with respect and in a friendly supportive way. Staff made an effort to understand people and acted in ways that supported their independence as far as possible.

Care plans were very person centred and contained lots of information to help staff provide good consistent care.

All the staff had received training about the safeguarding of vulnerable adults. The manager had openly reported potential safeguarding incidents to the local authority and had cooperated fully with their investigations.

We found that there had been significant improvements at the home since our last visit.

We found that the new manager had introduced suitable arrangements to obtain and act in accordance with the consent of people using the service. The new procedures had been reinforced with additional staff training on mental capacity issues.

We also found that staff training had considerably improved. We saw that staff had received a wide range of training since our last visit. Staff we spoke with told us that training opportunities had improved and that they felt better supported by the management.

None of the people we met were able to express their views about the service in any detail. However, everyone we met appeared happy in the home. People were comfortable with the staff and their surroundings.

One person was happy to show us the craft work they were doing. They also showed us their bedroom and pointed out things they liked.

We saw staff treating people with respect and in a friendly supportive way. We found that staff made an effort to understand people and acted in ways that supported their independence as far as possible.

We found that the provider had not carried out proper assessments of people’s individual capacity to make decisions. The provider did not, therefore, have suitable arrangements in place to obtain and act in accordance with the consent of people.

We saw that staff received regular supervision and annual appraisals. However, we found that not all the staff had received all the appropriate training they needed to deliver care and support effectively.