62 Wright Street is a domestic property located close to Horwich town centre and has good access to local shops and public transport. It is part of a larger organisation, The Royal Mencap Society. The service is registered to provide accommodation and personal care for up to four people with a learning disability / autistic spectrum disorder. On the day of the inspection three people were living at the home.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This was an unannounced inspection which was carried out on the 15 February 2018.

At our previous inspection on 18 November 2015 we found that people were receiving high quality care which was responsive to people's individual needs. At this inspection, we found that these standards had been maintained and improved further. People received an outstanding level of care. Skilled and extremely caring staff supported people in an exceptionally person centred way. Staff embraced people's diversity and this was reflected in the care plans we saw.

The registered manager was based at 62 Wright Street five days per week. There was an assistant service manager on site five days per week who worked flexibly in response to the needs of the service. There was a manager available by telephone at all times.

We observed excellent relationships between people and observed the senior management team and staff interacting with people in a caring, good humoured and friendly manner. Management and staff demonstrated exceptional insight and understanding of people's personal preferences and needs. People appeared happy and relaxed and we overheard much laughter and observed meaningful interactions during our visit.

People’s confidence and ability to be as independent as possible had grown since living at 62 Wright Street. Risks were managed effectively and people clearly felt safe meeting new challenges with the support of the staff. There were enough staff on duty so that they could take part in the activities they wished and be supported in meeting their individual needs. People had access to activities that were important and relevant to them, both inside and outside their home. They were protected from social isolation because of the exceptional support and exhaustive range of opportunities offered by staff.

There were systems and processes in place to protect people from harm. They had their medicines administered safely. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. People's needs were assessed before and when they moved into the home and on an ongoing basis to reflect changes in their needs. Clear and well thought out arrangements were in place for people moving into the service which helped to significantly reduce possible anxiety about this change.

The service had fostered positive working relationships with health and social care professionals which led to joint working to expand people's communication skills and identify new ways for people to access health care.

A robust system for staff recruitment, induction and training was in place. This enabled the staff to support people effectively and safely.

The home was clean, tidy and remarkably homely in character. There were systems in place to prevent the spread of infection. Staff were trained in infection control.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

The managers and staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguard

The unannounced inspection took place on 18 November 2015. The last inspection took place on 06 August 2014 and the service was found to be meeting all the regulations inspected at that time.

62 Wright Street is a domestic property providing support and accommodation for up to 4 people with a learning disability. The home is situated close to Horwich town centre and has good access to local shops and public transport. There is a small front garden and back garden, mainly paved. Parking is available on the front street. The home also has its own vehicle.

There was a registered manager at the service. 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 robust recruitment procedure in place, to help ensure staff employed were suitable to work with vulnerable adults. There were sufficient staff at the home to meet the needs of the people who used the service.

There were safeguarding adults and whistle blowing policies in place. Staff demonstrated an understanding of safeguarding issues and were confident to follow the local procedures.

Appropriate risk assessments were in place and accidents and incidents were recorded and followed up appropriately.

Infection control procedures were followed at the home. There was a medicines policy in place, medication systems were fit for purpose and all staff had undertaken medication training.

There was a robust induction programme in place, which included mandatory training and shadowing of an experienced member of staff. Training and development for staff was on-going and supervisions were regularly undertaken.

Care records included relevant health and personal information and were reviewed and updated regularly. People’s individual nutritional needs were met and monitoring was carried out by the service when required.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

People we spoke with told us staff were caring and kind and we observed friendly, respectful and relaxed interactions throughout the day. Staff endeavoured to work in an anti-discriminatory manner.

Information was clear and comprehensive and people who used the service were involved in all aspects of their care delivery as far as they were able.

Some staff had undertaken accredited training in end of life care and people who had previously lived at the home had been able to remain there and be cared for in familiar surroundings at the end of their lives.

Documentation was person-centred and included people’s individual preferences, likes, dislikes, choices and interests. People were encouraged to pursue their hobbies and interests and there were a number of activities on offer both inside and outside the home.

There was a relevant complaints procedure in place but there had been no recent complaints. The home had received a number of compliments from both relatives and professionals.

Staff and professionals described the management team as approachable and said they felt listened to. The service undertook a number of audits and checks, results of which were monitored and analysed, issues identified and actions put in place.

Supervisions and staff meetings took place regularly. The registered manager attended local professional partnership meetings.

During this inspection the Inspector gathered evidence to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

During the inspection we looked at care and welfare, cooperating with other providers, staffing, quality assurance and complaints.

This is a summary of what we found, using evidence obtained via observations, speaking with staff, speaking with relatives of people who used the service and looking at records:

Is the service caring?

We observed staff administering care and support with kindness and patience. People were given choices and gentle encouragement with daily living tasks and staff took the time to understand people’s non-verbal communication methods and techniques.

We spoke with the relatives of two people who used the service. One person said, “Staff are always pleasant. They listen when I tell them something is wrong and don’t dismiss it. You seldom get a team that is open to discussion. My X’s abilities fluctuate and staff need to manage these changes. I feel they always do their best”. Another relative told us, “They care for X brilliantly and do things with him that I couldn’t possibly do”.

Is the service responsive?

People’s support plans and health action plans were personalised and individual. Their particular preferences, backgrounds, interests and pastimes were documented. Each person who used the service was treated as an individual and the support given and activities undertaken were tailored to their specific personalities, needs and wishes.

People who used the service, and their relatives, were involved in all aspects of their care planning, delivery and discussions with other agencies and professionals.

Reviews of support plans and risk assessments were undertaken on a monthly basis, or responsively to changing needs. Other agencies and services, such as Speech and Language Therapy (SALT) and Physiotherapy were accessed as and when needed by each person.

People’s decision making abilities were taken into consideration in line with the Mental Capacity Act (2005) (MCA) to help ensure decisions were made in the person’s best interests.

Complaints and concerns were responded to appropriately.

Is the service safe?

There were appropriate risk assessments in place in the care records and guidance was available for staff to follow. Risk assessments were regularly reviewed and updated with changes appropriately recorded.

Health and safety equipment was regularly checked and serviced and emergency procedures were in place.

There were adequate numbers of staff on duty to ensure people were cared for safely. Staff training was on-going to help ensure their knowledge and skills were up to date.

Is the service effective?

We observed staff making efforts to ensure people were comfortable and content in the home. We saw people respond to staff in a positive way. We spoke with three staff members who demonstrated a good understanding of their roles and responsibilities.

We saw comments from other agencies and professionals which indicated their satisfaction in the effectiveness of the service.

Is the service well-led?

There was a manager in place who was appropriately registered with the Care Quality Commission.

The service worked well with other agencies and services to make sure people received their care in a joined up way. There was evidence of appropriate information sharing with other professionals.

We saw up to date records of a significant number of checks and audits which were undertaken. The results of these were analysed and any shortfalls addressed, to help quality assure the service delivery.

Staff told us they were given good guidance and support in their roles. They said they felt confident to speak with the manager if they had any issues to raise.

We visited Royal Mencap, 62 Wright Street on 13 August 2013. At the time of our visit there were three people living at the home and one vacancy.

Capacity was considered and consent sought verbally for all interventions. Efforts were made to ensure that the people could communicate their wishes to the best of their abilities.

We saw that care was delivered competently and respectfully. We looked at all three care plans, which contained a range of health and personal information. Support plans were individualised and personal preferences taken into consideration.

We spoke with a relative of one person who used the service. They said “They treat X very, very well, they always give respect, I can’t fault them with that.” They went on to say “If there is a problem they don’t always tell me... I have spoken to the manager about this.” They told us that they were always invited to reviews to put their point of view forward and discuss any concerns.

Support plans included nutritional, dietary and hydration needs and clear guidelines for staff to follow. Weight charts were completed and professionals involved as appropriate.

The service had robust recruitment and induction procedures and training and staff development were on-going.

There were quality assurance systems in place to facilitate continual monitoring and improvement of the service. Efforts were made to ensure that the people who used the service and their representatives were able to raise any concerns.

Communication with people who use the service was limited due to the nature of their disability. However we did observe that peoples’ facial expressions and their body language appeared at ease when approached by staff.

In March 2012 relatives were asked to complete a satisfaction questionnaire. Comments were positive and included, “This is an excellent service” and “Excellent support is given to relatives”.