We inspected the service on 18 December 2017. The inspection was announced. SENSE- 25 Horsegate is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

SENSE- 25 Horsegate is registered to provide accommodation and personal care for five people who have a learning disability and/or sensory adaptive needs. There were five people living in the service at the time of our inspection visit. All of the people had special communication needs and principally expressed themselves using sign assisted language, vocal tones and gestures. The 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 was run by a charitably body who was the registered provider. There was a registered manager in post. 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. In this report when we speak about both the charitable body and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 11 November 2015 the service was rated, ‘Good’.

At this inspection we rated the service as, ‘Good’.

People were safeguarded from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. This included times when people became distressed and needed help to keep themselves and others around them safe. Most of the necessary arrangements had been made to manage medicines safely and there were enough staff on duty to provide people with the individual assistance they needed. Also, background checks had been completed before new care staff had been appointed. Furthermore, there were suitable arrangements to prevent and control infection and lessons had been learnt when things had gone wrong.

Care was delivered in a way that promoted positive outcomes for people and care staff had the knowledge and skills they needed to provide support in line with legislation and guidance. People received the individual assistance they needed to enjoy their meals and they were helped to eat and drink enough to maintain a balanced diet. In addition, suitable steps had been taken to ensure that people received coordinated and person-centred care when they used or moved between different services. People had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. Furthermore. the accommodation was designed, adapted and decorated to meet people’s needs and expectations.

People were supported to have maximum choice and control of their lives. In addition, the registered persons had taken the necessary steps to ensure that people only received lawful care that was the least restrictive possible.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. In addition, confidential information was kept private.

People received personalised care that was responsive to their needs including their need to have information presented

This was an announced inspection carried out on 11 November 2015.

SENSE – 25 Horsegate can provide accommodation and care for five people who have a learning disability and who have reduced hearing and vision. There were five people living in the service at the time of our inspection. All of the people living in the service had special communication needs and used a combination of words, signs and gestures to express themselves.

There was 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.

Staff knew how to respond to any concerns that might arise so that people were kept safe from harm. People were helped to promote their wellbeing, steps had been taken to reduce the risk of accidents and medicines were safely managed. There were enough staff on duty and background checks had been completed before new staff were appointed.

Staff had received training and guidance and they knew how to care for people in the right way including how to respond to people who had special communication needs. People had received all of the healthcare assistance they needed.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered manager had worked with the relevant local authorities to ensure that people only received lawful care that respected their rights.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, respected confidential information and promoted people’s dignity.

People had received all of the care they needed including people who could become distressed. People had been consulted about the care they wanted to receive and staff supported people in imaginative ways to celebrate their individuality. Staff had supported people to pursue a wide range of interests and hobbies and there was a system for resolving complaints.

Regular quality checks had been completed and people and their relatives had been consulted about the development of the service. Staff were supported to speak out if they had any concerns because the service was run in an open and inclusive way. People had benefited from staff acting upon good practice guidance.

When we visited 25 Horsegate we found five people used the service. We spoke with the registered manager, the deputy manager,one care staff and a district nurse. Due to their health conditions or complex needs, people were not able to share their views about the care that they received. We observed their experiences to support our inspection.

We looked at two care records, four staff files, the provider's policies and quality assurance records.

We found people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

We found staff had an understanding of the needs of people who used the service. 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.

We found the provider worked well with other services to ensure the health and wellbeing of the people who used the service.

We found there was an effective recruitment process in place to ensure that staff had the skills to meet people's needs.

The provider monitored the risks of providing the service and had made improvements where needed.

Sense – 25 Horsegate provided care for five deaf blind people. On the day we visited all of the people who lived at the home were present. However they were unable to communicate with us so we spent time observing their care, speaking to staff and reviewing their records to see what it was like to live at the home.

We saw there were good relationships between the care workers and people living at the home. Care workers were patient and supported people to take time to make choices. Care workers were aware of challenging behaviour triggers and worked to ensure incidents of challenging behaviour were kept to a minimum.

Records showed the provider worked collaboratively with the local safeguarding team to keep people safe.

The downstairs communal areas of the home were clean and nicely decorated. However, people’s bedrooms did not always reflect their individuality and the extension of the banister in bare wood was not appropriate.

Records showed many of the staff had not completed refresher training in areas such as first aid, food hygiene and manual handling.

One person told us, "I like it here. I have my own chair".

Two people told us they liked being there with the staff, who helped them the way they wanted. One person said that it was best to keep away from another person living there.

People indicated that they felt safe with the staff.

We observed staff communicating with and guiding people. All interactions and contacts were respectful.

Staff told us that they always checked if people were satisfied with their personal care at the time they were supporting them. There were no house meetings as people were not willing and able to communicate within a group situation.