SENSE 35 and 37 Britannia Road, provides accommodation and support for up to four people with learning disabilities and hearing loss. Service users use some British Sign Language (BSL) and staff are all able to sign. Some staff used BSL as their first language. At the time of our inspection there were two people living at the service. People lived in their own flats within the building.

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. 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.

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.

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.

Why the service is rated Good.

People using the service were safe. There were sufficient staff to meet people’s needs and to support them in taking part in the activities they wanted to do. Restraint was occasionally used to manage behaviour that challenged. However this was used as a last resort and staff were trained in using safe techniques.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. When people lacked capacity, decisions were made in their best interests. Staff were well supported with training and supervision to help them carry out their roles effectively.

The service was caring. Staff were kind and caring in their approach and people were calm and confident in their presence. People and their relatives were able to be involved in care planning and reviews.

People took part in a range of activities with the support of staff. These were well planned to ensure they were safe and enjoyable. There was a complaints procedure in place for people to raise their concerns and this was available in a format suited to their needs. People were actively encouraged to raise any concerns at review meetings.

The service was well led. There was a registered manager in post supported by a deputy and senior. Team meetings were held to aid communication with the staff team and pass on important information about the service. There were systems in place to monitor the safety and quality of the service provided.

Further information is in the detailed findings below

The inspection was announced. We gave the registered manager 24 hours notice of our visit because we needed to ensure those people being supported and key staff were available. SENSE – 35 and 37 Britannia Road is registered to provide accommodation and personal care for up to four people. The service is for people who are deafblind and a number of the staff team were also deaf. At the time of our inspection there were two people in residence.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider. They were available on the day of our inspection.

Both the registered manager and the support workers were aware of their responsibilities to protect people from coming to harm. They knew how to raise and report any concerns they had about people’s safety and welfare. All staff received safeguarding adult training. There were safe recruitment procedures in place to ensure that unsuitable workers could not be employed by the service.

Risks to people’s health and welfare were well managed. The presence of any risk was not seen as a reason to not do an activity as the service had a positive approach to risk. Medicines were well managed and support workers were competent to support people with their medicines.

People received the level of care and support that met their specific needs and staffing levels were arranged accordingly. People were supported to make decisions about their day to day life and were assessed for the ability to make more complex decisions. The registered manager was familiar with the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). This is legislation to ensure people were not deprived of their liberty when they could not give consent. Both people in residence at the time of the inspection were subject to authorised DoLS restrictions to maintain their safety.

There was an induction training programme in place for new support workers and this was in line with the Care Certificate, introduced in April 2015. The Care Certificate is a set of standards that social care and health workers must work to in their daily working life. The staff team were well trained and were all able to communicate in British Sign Language.

People were provided with the meals and drinks they liked. Any preferences and dislikes of food were taken in to account but support workers ensured they had a good nutritional diet. Staff ensured safe guidelines were followed where there was a risk of choking whilst eating. Arrangements were made for people to see their GP and other health or social care professionals as and when they needed to.

The staff team had good relationships with the people they looked after and their families. They supported people to maintain contact with their family. The staff team were kind, caring and friendly and interacted well with people. People were encouraged to express their views and opinions, were listened to and involved in making decisions about their care and support.

The service was well led and the registered manager had been in post for many years. They provided good leadership and management for the staff team. There were robust arrangements in place to assess, monitor and improve the quality of the service using a quality framework of audits. There was a service development plan in place in order to drive forward any improvements needed.

We met two of the three people living in the home who appeared happy and pleased to see we were taking an interest in their environment. We also spoke with the registered manager and deputy manager.

When we visited the home in November 2013 we had concerns about the safety of the premises and about the quality monitoring of the service. After that inspection we asked the provider to send us a plan detailing how they were going to respond to our concerns about environmental damage and fire safety.

We received an action plan showing that items had been prioritised and that those considered to be the most urgent had been addressed.

During this inspection we saw that progress had been made. Improvements had been made to the environment although missing cupboard doors had not been replaced. We saw evidence to show that there had been less incidents involving environmental damage over a three month period suggesting that it was people's choice to not have cupboard doors.

Broken emergency door closures were replaced but we were told they were removed again during incidents by some people who lived in the home. Whilst there was a contract for their replacement we felt this could be improved.

The fire safety risk assessment had been reviewed and individual risk assessments were in place for the people who lived in the home. We found there was better attention to fire safety through instruction of staff and monitoring of systems.

People were not all able to verbally tell us their experiences. We spent a short period of time with two people. The other person was not available. One person used a ‘thumbs up’ sign to indicate that they were alright and used the same gesture again to indicate that the staff were treating them‘ok’. Another person nodded to us to indicate that they were alright.

We found people were involved in their care and they were encouraged to maintain their independence. People's care was planned and delivered according to the assessments completed and were reviewed regularly. Appropriate risks were generally considered to ensure people stayed safe.

The environment for people was clean, however, it was unsafe and not well-maintained and had the potential to put people at risk of harm.

The provider made sure that thorough recruitment checks were made on all staff before they were employed.

There were methods in place to assess and monitor the quality of the service, however, the systems in place to manage fire safety risks were not effective and placed people at risk of harm.

Because of their learning disabilities, or communication skills people were unable to evaluate and discuss their care in depth with us, people's views were valued. A staff member assisted us by using British Sign Language (BSL) to ask one of the people living at Britannia Road if they were happy, if they had any concerns or complaints to make and to also ask them what the staff who supported them were like. The person using the service gave a ‘thumbs up’ sign and shook their head. They used British Sign language to respond to our question and the staff member told us that the persons response was that they had no complaints, they were happy and the staff were “good”.

People were encouraged and made day to day decisions about their life. For more complex decisions and where people did not have the capacity to consent, the provider had acted in accordance with legal requirements.

The premises had been refurbished and now provided each person accommodated their own flat, allowing for individuals privacy and independence to be promoted and respected.

People were supported to raise any concerns they may have about their care or the services being provided at 35-37 Britannia Road.

The manager was extremely knowledgeable about the practical and emotional support needs of the people in their care. We saw that staff were friendly and professional when supporting an individual at the home.

In view of the communication difficulties of people who use the service, we relied on

observations between the staff and people who use the service in order to understand their views of the service. We saw staff talking with people who use the service using speech and sign language about their day to day activities and choices for the day ahead.

We spoke to a relative of one of the people living at the home, they told us that they were extremely happy with the care their relative received, they told us that they had noticed a marked improvement in their relative’s behaviour, that they were calmer and less anxious. They told us that they thought the reasons for this change were due to staff support and knowledge as well as a change in medication.

We observed staff offering people choices about how and where they wanted to spend their time, and what food and drinks they wanted.

We spoke with two staff during our visit. Staff were very motivated, caring and positive about working in the home and praised the teamwork and supportive atmosphere