About the service: 35 Hawthorn Road provides accommodation and personal care for up to six people. People who use the service live with disabilities that affect their hearing and vision and other sensory disabilities.

People’s experience of using this service: Safe care and treatment was not always provided. Safe medication processes were not in place with regards to the management of some aspects of people’s medicines. There was also no evidence that any checks on people’s medication were undertaken to ensure people’s medicines had been administered correctly. We also found that the management of the service overall was not consistent, this was also commented on by relatives and staff.

We observed support being delivered within the home and saw that people were comfortable in the presence of staff. This indicated that positive relationships had developed between people receiving support and care staff

The registered provider had a complaints policy in place and people were given information on how to make a complaint about the service should they wish to do so. Safeguarding and whistleblowing procedures were also in place for staff to follow. Staff spoken with were knowledgeable about safeguarding procedures and how to raise any concerns they had.

Staff were recruited safely and received regular supervision and the correct level of training to do their job.

People received the support they needed to eat and drink and maintain a healthy and balanced diet.

Consent to care and treatment were sought in line with the principles of the Mental Capacity Act 2005. People told us staff always asked for their consent before providing support. People’s chosen advocates was identified in their care plans should people need support to make a decision about their care.

Care plans and risk assessments reflected people's needs, and held person-centred information. Care files had been reviewed regularly and people were involved in these reviews.

People who lived in the home had multiple sensory disabilities, the provider had strategies in place to ensure communication was effective and that people were given the opportunity to make their own choices about their lives.

Rating at last inspection: The service was last inspected 28 January 2016. At the last inspection this service was rated as Good. At this inspection it was rated Requires Improvement

Why we inspected: This was a planned comprehensive inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 28 January 2016 and was unannounced. The service was last inspected in November 2013 and was meeting all the regulations. SENSE- 35 Hawthorn Road provides accommodation for a maximum of five adults with learning disabilities, physical disabilities and sensory impairments. People living in the home were unable to verbally tell us about the care they received but did communicate with us through other forms of non-verbal communication. We observed how care was provided to people and whether people appeared happy living at the home.

The home is required to have a registered manager. 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.

We saw that people were safe by observing care and through speaking with staff and relatives. Staff had a good knowledge of safeguarding practice and how to apply this knowledge to their role of supporting people at the service. We saw that there were sufficient staff available to provide care safely. Medicines were managed safely and people received the level of support as detailed in their care plan.

People were supported to make choices and we saw that consent was gained from people before staff assisted them. Staff that we spoke with understood how to support people in line with the Mental Capacity Act (2005). Some people living at the home had authorisations in place to deprive them of their liberty. Staff were not aware of these authorisations. However, people were supported in the least restrictive way.

Through our observations we saw that staff knew people well and understood people’s different methods of communication. Relatives informed us that they thought the staff were caring and that their family member was happy living at the home. People appeared relaxed and comfortable whilst interacting with staff.

Care had been planned around each person’s individual needs. Staff were able to describe how people preferred to be supported and told us how they worked with people to find out what they liked and didn’t like. We observed staff responding appropriately to people’s requests. There were systems in place to review people’s care at different intervals to ensure that people were happy with the care they were receiving. People were given opportunities to partake in activities based on their interests.

Staff told us they had received sufficient training to carry out their role effectively and we saw there were processes in place to plan training to ensure staff kept up to date with best practice. Staff felt involved in the running of the service and had opportunity to feedback to the management of the home through supervisions and staff meetings.

We saw that people were encouraged to maintain their independence and that where needed equipment had been purchased to achieve this.

People were supported to eat healthily and we saw that people’s preferences for food had been incorporated into menu planning. Each person had access to regular planned healthcare and staff had been informed of the level of support people needed.

Relatives informed us that they were happy with how the service was managed. Monitoring systems were in place to measure and maintain the quality of the service provided to people. The registered manager had ideas of how he wanted to improve the service by introducing interactive technology to aid people’s communication.

The five people that lived at 35 Hawthorn Road were unable to verbally communicate with us. We observed how staff supported these five people and spoke to two of the people's relatives and an advocate. All of the people we spoke with were happy about the care provided. Amongst their comments were: "The care is fantastic (person's name) has learnt a lot and progressed well," "Staff are great, they care and it shows. Staff here stay" and "Yes, I would speak to the manager (about concerns) he always responds, he is never too busy and he is always 'straight' with us."

We observed that staff supported people safely and in a caring way and that support was given in the way described in the individual's care plan and / or risk assessment. This ensured that the care given met the person's needs and was effective. Staff showed knowledge about people’s preferences, care needs and risks to them. Staff showed they were able to respond appropriately when needed.

People were given nutritious food and supported to have appropriate drinks.

There were sufficient staff on duty to ensure that people had access to activities and staff could work with people individually at times. Staff we spoke with confirmed that they had appropriate training and support to meet the needs of the people they were caring for.

We had received no complaints about the home in the last year.

Risks to people’s health and wellbeing were identified and audited with plans made to minimise risks to people using the service.

People living in the home were unable to tell us about the care they received. We observed how people were cared for to understand people's experience of care. One of the ways we did this was by undertaking a short observational framework for inspection (SOFI). We also walked around the home and spoke with two care staff, the registered manager and two relatives.

Care staff supported people in a sensitive way using differing methods of communication to ensure that people understood what was going to happen. People were supported to experience a range of activities and to undertake some day to day tasks. People appeared well cared for having their personal care needs met in an environment that supported them.

Two people told us they were contacted should care staff be concerned about their relative. They told us the home was: "Fabulous," and "Brilliant."

Systems were in place to ensure that risks to people's safety and well being had been identified and risks minimised. Permanent care staff were generally appropriately trained and supported. However, the responsibility for bank staff needed to more explicit to ensure that they received training and supervision.

There were five people living at Hawthorn Road at the time of our visit on 2 March 2012. Two people were away on holiday. The people living in the home were unable to tell us about the service they received. To understand people’s experience of care we watched the way care workers responded to people living in the home. We saw that care workers responded to people kindly and in an unhurried way.

We saw that people had been assisted to dress in ways that showed their individuality.

We spoke to two care workers on duty during our visit. The care workers knew the needs of the people they were caring for.

We spoke to the relatives of two people living in the home. One relative said “X is really well looked after. They are really happy there. They come to see me regularly.”

The other relative said “It’s (the home) excellent, can’t fault them. Everyone’s kind, willing and helpful. Y seems very happy there. Y shows us their bedroom”.

People were helped to use local community services by going shopping, horse riding, swimming and going out for meals.