We carried out this announced inspection on 9 and 11 October 2017. The provider was given notice of this inspection as it provides a service for people who may be out during the day. At our last inspection on 7 September 2015 we rated this service “Good”. At this inspection we found the service remained “Good”.

34-35 Huddleston Close is a small care home run by the Royal Mencap Society for up to four adults with learning disabilities. It consists of a three bedroom house with a shared lounge, kitchen and garden. Upstairs is a self-contained flat where one person lives with support. There were three people living in the service.

The service had a registered manager, who had been in post since May 2014. 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.

Since our last inspection, there had been some changes in people’s needs and the risks they faced through reduced mobility, health conditions and behaviour which may challenge. The provider continued to assess these risks and informed staff to carry out risk management plans to address these in a way which promoted people’s independence and positive risk taking. There had been changes to the building to address these, such as the use of sensor systems and high visibility tiling and flooring and there were measures such as streaming devices, objects of reference and sensory profiles in order to provide an environment which met people’s needs. There were support plans in place to manage people’s long term health conditions and to address behaviour which may challenge.

Staff continued to receive effective training and supervision to meet people’s needs, which was overseen by an effective system which also prompted managers to carry out observations of people’s practice. There had been one new member of staff recruited, and there were systems of safer recruitment and appropriate inductions for new staff and agency staff. Staffing levels remained suitable to meet people’s needs, and the provider was in the process of recruiting volunteers to support people to access the community.

There were detailed communication profiles in place to enable staff to better understand the needs of people who were non-verbal, which had continued to develop since the last inspection. Where there were concerns about people’s safety, these had been reported and investigated in line with safeguarding procedures and there was evidence of the provider learning from these and addressing poor practice. There had been improvements made to medicines procedures in response to a medicines error and an external audit, and staff were supported to learn from these, with medicines safely managed by staff who had been trained and observed as competent to do so. There were suitable checks of the safety of the environment and measures in place to ensure a safe evacuation in the event of an emergency.

Staff were encouraged to reflect on their practice and there was an open, listening culture from managers. There were systems such as daily shift reviews and recording of positive interactions to promote a culture of routinely learning from people’s experiences. Managers maintained systems to ensure that tasks were planned and carried out promptly and carried out innovative systems of audit which took a person centred approach to meeting people’s needs and promoting good health and inclusion.

We inspected this service on 7 September 2015. This inspection was unannounced. At our previous inspection on 3 January 2014 we found that the service was meeting the regulations that we inspected.

34-35 Huddleston Close is a care home registered to provide care, support and accommodation for up to four adults with a learning disability. The service is provided by MENCAP. There are three bedrooms in the main house, and upstairs is a self-contained flat where one person lives with support from the staff team. At the time we visited, there were three people living in the service.

The service had a registered manager, who had been in post since May 2014. 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 premises were safe, with regular health and safety checks including fire drills carried out. The service had detailed risk assessments in place to manage risks for the people who lived there, and where people were deprived of their liberty for their own safety, the service had taken appropriate steps to inform the local authority and to reduce these restrictions wherever possible.

We found detailed care plans were in place, and reviewed regularly in order to ensure that people received the right support as their needs changed. The service had procedures in place to ensure that incidents and near-misses were recorded and reviewed, and in response to these had made changes in order to reduce the risks to people who lived there.

Two of the people who lived at the service were unable to communicate verbally, and we saw that the service was using communication tools such as pictures in order to enable people to make choices about their daily lives. Staffing levels ensured that people were able to be supported to carry out activities of their own choice by being supported individually in line with their assessed needs. People’s rights were respected and staff were friendly and respectful.

The registered manager was based on site, and people we spoke to told us he encouraged a culture which was open and inclusive. Staff training was regularly reviewed and made available to staff, and there were systems in place to ensure that essential training was attended regularly by staff. The registered manager encouraged feedback from staff about what they had learnt and how the service could be improved as a result of this training.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (2005) (MCA) and DoLS, and to report upon our findings. DoLS are in place to protect people where they do not have the capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. Staff understood when a DoLS application should be made and how to submit one.

We used a number of different methods to help us understand the experiences of people using the service, because most of the people using the service had complex needs which meant that they were un able to tell us their experiences. We gathered evidence of people’s experiences of the service by reviewing communication that the service had with these people’s advocates and other care professionals.

We were able to speak with one person who was using the service. This person said “I’m alright, I am going out soon” and also said “I like going to my shop” (they were referring to a local shop they like to visit regularly). We observed how staff worked with people and remained aware of their needs. We saw that staff were knowledgeable about the way each person made their wishes known and they responded to what people wanted.

The three people who were using the service each had a personal care plan. We looked at two people’s care plans. The care plans covered personal, physical, social cultural and emotional support needs. We saw that care plans were regularly updated and reviewed.

One of the staff we spoke with had started working at the service on the day of our visit. This person told us that they had previously worked on the temporary staff bank and had received training in safeguarding vulnerable adults from abuse and had been told by the manager that they would be attending an update as a part of their induction.

We used a number of different methods to help us understand the experiences of people using the service, because most of the people using the service had complex needs which meant that not everyone was able to tell us their experiences. We gathered evidence of people’s experiences of the service by reviewing communication that the service had with people’s advocates and other care professionals. We found that the service made regular contact with advocates and others to share information about people’s needs, as well as asking for feedback about how people had been cared for.

We were able to speak with one person who was using the service. This person told us they “like the manager” and also said “I talk to people when I want to.” This person also told us about staff that “they do things for me” and they cook with staff in their own flat but sometimes eat with other people next door.

Two of the three people who use this service are not able to hold spoken conversations. One of these people were present during our visit and we observed how staff were interacting with them. The third person did speak with us but only wanted to have a brief chat. Any specific comments that this person made are included in this report.