The inspection took place on 16 January 2019 and it was unannounced. SENSE Tanglewood is a ‘care home’ for people with sensory impairment. 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. On the day of our inspection seven people were using the service.

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.

The care service had not originally 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. However, people were given choices and participation within the local community was encouraged.

At our last inspection on 25 January 2016 we rated the service as good. At this inspection we found the evidence continued to support the rating of good.

People continued to receive a safe service. People were supported to stay safe. Staff knew how to recognise abuse and how to report it. Risks were assessed so that staff knew what action to take to keep people safe. They did this while also promoting people’s independence as much as possible.

There were sufficient numbers of staff, with the required knowledge, skills and experience to support people with their needs. Many people required a one- to- one ratio of staff and this was provided. Recruitment processes were safe and this meant that so far as possible only people of suitable character and experience were employed.

Medicines were managed in a safe way. Staff had received training about this and supported people to take their medicines at the right time and in a safe way.

People continued to receive an effective service. Staff were knowledgeable about the needs of the people they supported. People were supported to make choices around their care and daily lives. Staff had attended training to ensure they were able to provide care based on current practice when assisting people.

People were supported to have the 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 were supported to eat and drink enough and had a balanced diet. Staff understood and met people’s nutritional needs. They supported people in a sensitive way. People had access to the healthcare professionals they required.

People continued to receive a service which was caring. People were treated with kindness and compassion by the staff. Staff knew people well and often went that extra mile to make sure people were as comfortable as possible. People’s social needs as well as their physical and emotional needs were incorporated into the plan of care and used to promote and maintain people’s abilities and independence.

People and their relatives were involved in making decisions and planning their care, and their views were listened to and acted upon. Staff treated people with dignity and respect. People knew how to raise concerns and had confidence that they would be listened to and action would be taken. Feedback provided was used to make improvements to the service.

The service continued to provide responsive care and support. Staff knew how to effectively communicate with people. They had developed innovative ways to meet people’s information and communication needs. This had resulted in improved outcomes for people because they had gained more

The inspection took place on 25 January 2016 and was unannounced. SENSE Tangelwood offers accommodation for up to seven people with learning disabilities or autistic spectrum disorders, physical disabilities and sensory impairment care needs. There were seven people living at the home at the time of our inspection. People had their own rooms and bathrooms. People had the use of a number of comfortable communal areas, including a kitchen and dining area, a lounge, a sensory and leisure room and garden areas.

We had the opportunity to talk with two people who lived at the home on the day of the inspection. We have therefore not used quotes within this report and the examples we have given are brief because we respect people’s right to confidentiality.

A registered manager was in post at the time of our inspection. 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 obtained advice from health professionals and took action so people’s health needs were met. Staff arranged for people to see their GPs and other health professionals when they needed to. Staff supported people to take their medicines so they remained well.

People benefited from living in a home where staff understood their individual needs and preferences. Staff recognised when people’s needs changed and took action so people continued to receive care in the best way for them. Staff knew about the things which were important to people and what things they liked to. People were encouraged to try new things which they might enjoy.

People’s right to make decisions and their freedom was protected. Staff worked with other organisations to make this happen. Staff knew what actions to take, if they had any concerns for people’s safety or well-being and were able to obtain advice from the manager, provider or external organisations if required. Staff were supported through regular supervision, training and meetings.

People had enough to eat and drink. People were encouraged to prepare their own meals where possible. Other people were supported to enjoy a range of food, drinks and snacks by staff so people would remain well.

People enjoyed being with the staff who cared for them. We saw people got on well with the registered manager and caring relationships had been built with the staff. Staff supported people to keep in touch with their families and to do the things they enjoyed doing. Staff knew how to support people so they were able to make choices about how their care was given and people’s levels of independence was taken into account by staff. People were given encouragement and reassurance by staff when people when they wanted this.

People were involved in deciding what care they received and staff encouraged people and their relatives to be involved in their care reviews so they received the care which was right for them. Relatives knew how to raise any complaints they had and were confident staff would take action if this happened.

The registered manager and senior staff team supported care staff to provide safe and compassionate care. There was clear and open communication between the registered manager and staff, so staff knew what was expected of them. Checks were undertaken on the quality of the care provided by the registered manager and provider and actions were taken where developments had been highlighted. The registered manager and provider made sure there was a focus on continuous development of the home.

Seven people lived at the home when we visited. People who lived at Tanglewood had sensory impairments and learning disabilities. People who lived at the home were unable to tell us about their experiences due to their communication difficulties.

We spoke with relatives of two people, who told us they were very happy with care that was being provided. We also spoke with the registered manager, the deputy manager and three other staff members.

We watched staff as they cared for people. They provided care and support that met people’s needs. We found that staff knew about the needs of the people they cared for. We looked at four people’s care records and found that these contained guidance for staff on how to meet people’s needs. We saw that people’s needs had been reviewed regularly. Relatives told us that they had been involved in planning their son's or daughter's care.

Relatives told us that their relations were happy with the food that they had been given and that they had been offered choices. People had been protected from the risk of harm and abuse because staff had received training in how to safeguard vulnerable people. Staff showed us they had a clear understanding of their roles and responsibilities with regard to safeguarding. We looked at records which showed that the provider was regularly monitoring the quality of its service.

During our inspection we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We used SOFI to observe how people were feeling and their engagement with staff. We found that overall people had positive experiences. The support that we saw being given to people who used the service matched what their individual care plan said they needed.

People who used the service appeared calm and relaxed in the environment and overall responded positively to interactions with support workers.

During the lunchtime we used our SOFI tool to help us see what people’s experiences at mealtimes were. We spent 30 minutes watching at lunchtime and found that overall people had positive experiences. We saw that people were eating meals of their choosing and that staff were providing support in a caring and supportive manner. The atmosphere at lunchtime was very relaxed and we saw positive interactions between people who used the service and the staff supporting them throughout lunchtime.

We were told by the registered manager that there were plans to improve arrangements for menu planning to enable more involvement from people who use the service in deciding the meals to have each week. The aim was to include picture menus and to hold a menu planning session each week with people. Work had already started on this project.

Throughout our visit we saw people who used the service moving around the home and spending time in the places they had chosen. People’s rooms were very personalised and we were told that they had been involved in deciding how they would like their rooms to be decorated and furnished.

A schedule of weekly activities had been developed for each person who used the service which reflected their individual preferences. We found that schedules were flexible and people could change their mind if they wanted to.

Daily diaries were kept by support workers in which they recorded all the activities and events relating to each person who used the service. During our visit we saw that people who used the service were aware of their diaries and engaged with staff during their completion. The information that we saw in people’s daily diaries showed that people were making choices about when they got up and when they went to bed each day. This meant that people who used the service were able to make decisions about aspects of daily living and that they were treated with dignity by staff.

Support workers had a good understanding of the individual needs of people who used the service and had received appropriate training to enable them to understand and meet those needs.

The atmosphere within the home was very relaxed and homely and we observed staff supporting people throughout the day in a calm and caring manner. The staff we spoke to had a good understanding of people in their care and their individual needs and preferences.

During our visit we observed people who used the service accessing communal and their own private areas. People appeared comfortable in their surroundings and responded positively to engagement with staff.

People’s rooms were very homely in appearance and they had been able to personalise them with furniture and furnishings of their choosing. At the time of our visit one person was planning to move to a different room. We saw that they had been involved in determining how their room would be decorated and furnished and a picture board had been used to identify and express their wishes.

We saw that some areas of the home were showing signs of wear and tear but there was evidence of ongoing maintenance work and redecoration to address this.

Weekly activity schedules had been planned for each person. We were told schedules were flexible and were adapted to meet the needs and wishes for each person on each particular day.

People were seen going out to do individual activities as determined by their needs and wishes and we saw that activities changed in accordance with peoples preferences at that time. Records showed that people engaged in a range of activities including woodwork, pottery, hydrotherapy, shopping trips, walking trips, trips to the pub, cooking and community involvement. The service had three vehicles which were used for transporting people.

Staff in the home supported people to keep in touch with families and friends. We saw that one person had been able to maintain regular contact with family members by using a web cam.

People’s healthcare needs were identified and staff supported people who used the service to attend medical appointments and accompanied them to hospital if an admission was necessary. Each person who lived at the home was registered with a local doctor and annual health checks were carried out.

The home has a set menu at mealtimes. We were told this was not rigid and alternatives to the main options were always available. People who use the service were encouraged to assist with meal preparation and we saw people actively engaged in cooking during our visit. Snack and drinks were available to people throughout the day.

Everyone living in the home had been offered the opportunity to have annual holidays. Holiday plans were discussed and determined with the person, their family and the staff team.

Staff encouraged people who use the service to be involved in the completion of their care documentation and to reflect on things that had happened to them during the day. Not all of the records we saw were up-to-date and accurate.

At the time of our visit the home had a vacancy for a Care Manager and were recruiting into this position.