About the service: Sense – 55 Shipdham Road provides care and support to people with learning disabilities. At the time of the inspection it was providing support to five people who used the regulated service. This service provides care and support to people living in “supported living” settings so that they can live in their own home as independently as possible.

People’s experience of using this service:

• The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

• People were protected from abuse, neglect and discrimination.

• Individual risks to people were assessed and managed to keep people safe while promoting their independence.

• There were enough suitably qualified staff to meet people’s needs.

• Medicines systems were organised, and people were receiving their medicines when they should.

• Incidents and accidents were reviewed, and lessons learned to keep people safe in the future.

• People’s needs were holistically assessed.

• Staff were skilled and knowledgeable and had the training they needed to carry out their roles.

• The service worked with other agencies to ensure that people received the healthcare they needed to live healthier lives and improve their independence and wellbeing.

• 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.

• People and relatives told us that the staff were kind and caring and knew people well.

• People were supported to express their views and to be involved in decisions about their care.

• The service was responsive to people’s needs in a way that helped them to develop skills and become more independent.

• The service recognised that in the future they may need to care for people at the end of their life and had a strategy to put systems in place to support this.

• The service was well led. People, relatives and staff all gave positive feedback about the management of the service.

• The registered manager valued and supported staff and was committed to high-quality, person-centred care and support.

• There was an ethos of continuous learning to develop the service and improve care. People, relatives and staff were all involved in this process.

Rating at last inspection: At the last inspection the service was rated good. (Report published 14 October 2016)

Why we inspected: This was a scheduled planned inspection based on the previous rating.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated good.

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

The inspection took place on 14 September 2016 and was an announced inspection. This meant that we gave the service notice of our arrival so that we could meet with people who lived there.

The service is registered to provide personal care and there were six people living in a shared house, and accessing the service at the time of this inspection. The service provided care and support to people with a sensory impairment and physical and learning disabilities.

There was a registered manager for this service, who was available every day. 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.

People’s relatives told us that people were safe using the service. Staff were trained in adult safeguarding procedures and knew what to do if they considered someone was at risk of harm, or if they needed to report concerns.

There were systems in place to identify risks and protect people from harm. Risk assessments were in place and carried out by staff that were competent to do so. Risk assessments recorded what action staff should take if someone was at risk and referrals were made to appropriate health care professionals to minimise risk going forward.

There were sufficient staff to keep people safe and meet their needs, and the registered manager had followed safe recruitment procedures. Staff were competent with medicines management and could explain the processes that were followed. Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005. The registered manager understood that there should be processes in place for ensuring decisions were made in people’s best interests. Staff sought consent from people and recorded this.

Staff were caring, knew people well, and supported people in a dignified and respectful way. Staff maintained people’s privacy. Relatives felt that staff were understanding of people’s needs and had positive working relationships with people.

Care provided was individualised according to each person’s needs and preferences. People and their relatives were involved in assessment and reviews of their needs. Staff had knowledge of changing needs and supported people to make positive changes to their care plans.

People and staff knew how to raise concerns and these were dealt with appropriately. The views of people, relatives, health and social care professionals were sought as part of the quality assurance process. Quality assurance systems were in place to regularly review the quality of the service that was provided.

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service caring?

Our observations showed us that people living in the service were treated with respect at all times. Staff knew the routines that people had chosen and were aware of their care and support needs. We saw staff supporting people in a caring and considerate manner.

Is the service responsive?

We saw that people's individual social and physical needs were being met. People were encouraged to decide what they wanted to do on the day of our inspection.We saw that staff allowed time for the individual to fully understand their choices and the options offered to them. Where people who lived in the service were not able to verbally respond, staff continued to include them in conversations throughout the day.

Is the service safe?

Records showed us that risk assessments were completed for any activities inside and outside of the service. All assessments included an evaluation for the level of risk that was presented plus any actions to be taken to reduce or eliminate such risks. Lawful requirements under the Mental Capacity Act 2005 were recognised and staff expressed a thorough knowledge of matters relating to the Deprivation of Liberty Safeguards (DoLs).

Is the service effective?

We saw positive interaction between members of staff and people who lived in the service. People were relaxed and looked happy, particularly when staff were talking and explaining what was happening around them. Rooms were designed specifically to meet the needs of people who lived in the service. The mobility and daily routines of people were supported with new equipment that had been installed. The bedrooms we saw reflected the personality of the person and staff told us that the colour scheme and soft furnishings were the choice of the individual themselves.

Is the service well led?

Staff explained that they undertook regular training and we saw a list of dates that showed us that training was updated regularly. People were therefore supported by a staff team who knew how to provide support in a safe and appropriate way. Quality assurance systems were in place and regular quality audits were completed for all areas of the service. We saw records that clearly documented the observations that had been made and when any improvements were to be completed.

We did not speak directly to people during this inspection. People using the service have complex needs and were unable to express their views clearly verbally. We listened to some interaction between staff and people using the service. This showed staff made efforts to communicate with people. We saw one person responding to a staff member by smiling. The standards we were following up allowed us to gather information by looking at records and speaking to staff rather than observing care.

The manager was aware of the importance of reporting any allegations of abuse promptly to the safeguarding team. She had undertaken some work with the staff team to ensure they were aware of expected conduct and the values the provider expected them to uphold.

We found that there had been improvements in the supervision and appraisal of staff so that they were supported to deliver care to people safely. However, some staff had still not received supervision. We also found that some staff had not received updates when their training had expired. This included some staff who had not received moving and handling training, which had been due for renewal more than two and a half years before our inspection. However, people were supported by a consistent, experienced and stable staff team.

We found that action had been taken to ensure people were not at risk of inappropriate care arising from inaccurate or conflicting records. This was because care plans had been reviewed and updated to ensure information was consistent and up to date.

We used a number of different methods to help us understand the experiences of people using the service. This was because the people using the service had complex needs which meant they were not able to tell us their experiences. We spent time observing what was going on for people and how staff responded to them.

Our observations showed that staff supported people at their own pace, taking time to encourage them with activities and offering choices. One person showed some signs of agitation but staff responded quickly and quietly, giving the person time and space to calm down while ensuring they remained safe. The incident was soon over.

People had also been out during the day and two people confirmed they had a good time.

People with whom we spoke stated they had enjoyed recent days out and also a trip to an exhibition where some people had taken part.

One comment made to us was ‘I am happy here’ and when asked about the trip out for the day we were told ‘I enjoyed it but am tired now’.

Another person was smiling and wanted to tell us ‘I am happy today and had a good time in the sun’.