Rouse is a residential care home for up to three people who have learning disabilities or an autistic spectrum disorder. At the time of the inspection there were two people living at the 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained Good.

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The care service has 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.

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.

The service had a safe, friendly and homely atmosphere. The service benefited from a well-established stable staff team who know the people living there extremely well. This had allowed them to develop professional effective and caring relationships with people..

People were supported to be as independent as possible and the service continued to work with people to develop their independence further. This was done in the service and on regular activities in the community.

People were supported in a person centred way. It is clear the staff valued the people living at Rouse and treated them as individuals. They allowed them to make decisions about their care and support. It was also clear that the staff thought of Rouse as the people’s home and not just their work place.

The service supported people to access health services effectively. Not only when they were ill but also in a preventative manner. For example, people attended their GP on an annual basis for 'well woman' and 'well man' checks which screen for particular diseases and check their general health. This is important as the people living in Rouse have communication difficulties and would not be able to say if anything was wrong.

The people living in Rouse were encouraged to develop and maintain relationships with other people living in the community and their relatives.

This inspection took place on 15 April 2016 and was unannounced.

The service is registered to provide accommodation and support for up to three people with a learning disability or autistic spectrum condition. At the time of the inspection there were two people living in the home with complex care needs. People had limited or no verbal communication skills due to speech or language difficulties associated with their learning disabilities. People were able to carry out most of their own personal care with prompting and occasional support from staff. However, people needed staff support to go out into the community to keep them safe from avoidable harm or abuse.

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.

The registered manager told us the service philosophy was “Working towards independence and stretching people within their capabilities. We want to support people to maintain a happy and balanced life and to introduce new experiences as much as we can”.

There was a friendly family atmosphere in the home and everyone got on well together. All of the interactions we observed between people and staff were caring and supportive. It was clear the registered manager and staff were very fond of the people who lived in the home and wanted the best for them.

People were encouraged to be as independent as possible and had choice and control over their daily routines to the extent they were able to express their preferences. Staff respected and acted on the choices people made. The service knew how to protect people’s rights if they lacked the mental capacity to make certain important decisions about their care and welfare.

People were supported to visit relatives, access the community and participate in a wide range of social and leisure activities of their choice on a regular basis.

The service employed a small close knit team of staff who were knowledgeable about people’s individual needs and preferences. There were sufficient numbers of staff to meet people’s needs and to keep them safe. Staff received training and supervision to ensure they had the knowledge and skills to provide the care and support needed.

Systems were in place to ensure people received their medicines safely. Checks were carried out to ensure the correct medicines were administered to the right people at the right time.

People’s relatives and the staff told us the registered manager and the provider’s Director were accessible and approachable. They said they would speak with the registered manager whenever they needed help or advice.

The provider had an effective quality assurance system which ensured the service maintained good standards of care and promoted continuing improvements.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

Systems were in place to protect people from abuse and avoidable harm. Individual and environmental risk assessments were carried out and plans were in place to protect people’s health and welfare.

Staff knew how to protect people from abuse. They knew about the different forms of abuse, how to recognise the signs of abuse and how to report any concerns. Staff said they received training in safeguarding of vulnerable adults and they were aware of the provider’s policies and procedures on safeguarding and whistleblowing. We observed people were happy and at ease with the staff and with the other people who lived in the home.

The manager said the provider always carried out relevant employment and criminal record checks when new staff were recruited. New staff underwent a comprehensive induction programme which included safeguarding training. These steps helped protect people from the risk of abuse.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager said they had not needed to submit any DoLS applications but the provider had procedures in place if an application was needed in the future.

Is the service effective?

Staff we observed on the day of our inspection were competent and effective in supporting the people who lived in the home. Staff received training in subjects relevant to their role and they were well supported by other colleagues and by the management. This ensured they had the knowledge, skills and experience to meet the needs of the people they supported.

A small regular team of staff supported the people in the home. This helped ensure staff knew people’s preferences, needs and behaviours well. People were supported to live their lives in a way that suited their personal needs and preferences. This helped promote effective care outcomes and a good quality of life for the people who lived in the home.

Is the service caring?

Staff treated each individual with dignity and respect. They spoke to people in a friendly and caring manner and were sensitive and discreet when carrying out personal care.

People who lived in the home had very limited verbal communication skills. However, staff members knew each individual’s needs and were able to communicate with them in both verbal and non-verbal ways. People were able to make daily living choices with prompting and support from the staff. People were given space to spend time on their own but staff were on hand whenever needed.

Is the service responsive?

The service was responsive to people's needs. People's needs were assessed and their care was planned and delivered in line with their individual requirements. People’s care plans were comprehensive and contained detailed information about each individual’s support needs and personal preferences.

Staff spoken with had a clear understanding of each person’s support needs and how they should be met. Each person had a designated key worker responsible for monthly care plan reviews. These reviews ensured the care plan was current and remained appropriate to the individual’s needs.

Is the service well led?

The previous manager of the home had left and a new manager had been appointed recently from within the service. The new manager had applied to become a registered manager with CQC and the application process was nearing completion.

The new manager was based at the home and provided ‘hands-on’ care as an integral member of a small team of care staff. During our conversations it was clear the manager had a good understanding of the needs and preferences of each person in the home. We observed they had a good rapport with each of the individuals in the home and with the other care staff.

Staff we spoke with said they respected and liked working with the new manager. They said all of the provider’s management team were very approachable and a senior person was always available if they needed advice or support.

The provider had effective systems in place to monitor and manage the service. This included obtaining feedback about the service from the individuals, their families and professionals involved with their care. Effective systems were also in place to identify, assess and manage risks to the health, safety and welfare of people.

People who lived in the home had the capacity to make most of their own daily living choices although they needed prompting and support from staff. We observed staff asked for people’s consent before providing care and support. Staff offered people choices throughout the day, including choice of drinks, food, leisure or other social activities.

From our observations and limited conversations with the people who lived in the home they appeared happy and content. People were calm and relaxed with each other and with staff. This indicated they were content with the care provided. We could see from care plans that support and advice was also obtained from other health and social care professionals when needed.

We found the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. The provider had health and safety policies and procedures. These outlined the protective measures in place and what to do in the event of an emergency.

We spoke with the home manager about the provider’s recruitment practices and looked at the staff files. The provider had followed appropriate recruitment procedures which meant that risks to people who used the service were minimised.

We found that people’s personal records, staff records and other records relevant to the management of the services were accurate and fit for purpose. This helped protect people from the risks of unsafe or inappropriate care.

We met with the two people living in the home at the time of inspection. The people were limited in their abilities to communicate verbally therefore we observed the care that was provided to help us understand their experience. We also spoke to one person's relative over the telephone to get their views.

We observed people moving freely around the downstairs area, sitting quietly and being involved in activities. Staff intervened effectively when people became agitated to settle them. Staff took people out into the community on two occasions. There was one member of staff allocated to each person during the day. A relative told us "it's the best situation in regards to staffing possible".

Care plans were detailed and included individualised risk assessments. We saw evidence that medicines were managed safely and medications reviewed. We observed care being delivered which reflected the needs of the person as outlined in the care plan demonstrating that care was personalised to meet each person's needs. We saw evidence that complaints were handled appropriately with due care to people's needs.

We observed people not being consistently offered choices and consent was not always sought before an action was taken. People had to ask staff for the key to their bedroom doors in order for them to access their bedrooms. There was no formal risk assessment in place to evidence the need for this and other, potentially less restrictive, methods had not been tried.

We met with the two people who currently lived in the home and they looked happy and well cared for. The people who lived in the home were limited in their abilities to communicate verbally therefore we observed the care that was provided to help us understand their experience. We also spoke with staff and had a conversation with one person’s parent who was visiting on the day of our inspection. The parent told us they were pleased with the care and support provided and said, “The care is very good”.

Although the people who lived in the home had difficulties communicating verbally they were able to express their daily choices in other ways. Staff also had regular contact with people’s families which helped provide further information about people’s preferences.

We observed that people were free to move around the communal areas of the home as they wished. Each person had their own individualised bedroom to suit their needs and preferences. We were told that staff supported people to plan their weekly menu choices and to do their food shopping. People were supported to engage with the local community in various ways. This included regular walks around the village, visits to a local farm, picnics, car journeys, swimming, discos and visits to their family homes. Within the home people were supported with a range of activities including toys and games, activities in the garden, listening to music, watching television, and stimulation from sensory lighting.

Staff were attentive, patient and friendly with the people who lived in the home and were aware of the most appropriate communication methods for each individual.

People looked at ease and were happy in the presence of the care staff and with the other people who lived in the home. One person’s parent told us they did not have any concerns about the way their relative was treated and said, “I feel they are perfectly safe here”.