The Old Coach House is a care home for up to five people who have a learning disability and sensory impairment. At the time of our inspection five people were living at this home.

At the last inspection in September 2015 the service was rated Good.

At this inspection we judged the service provided remained Good.

Why the service is rated Good.

People received the support they required to live a full and active life while maintaining their safety and well-being. There were sufficient staff to meet people’s needs and the registered provider had robust recruitment checks to ensure new staff were suitable to work in adult social care.

People’s risks had been assessed and staff knew what action to take to keep people safe. People received their medicines as prescribed.

Staff had received training and support to ensure they were aware of people’s needs and how to meet them. People received the help they required to maintain good health, to attend health appointments and have enough to eat and drink.

People were supported, as far as possible to have choice and staff supported people in the least restrictive ways possible. When restrictions on people’s liberty were necessary the registered manager had ensured the correct applications had been made to protect each person’s legal rights.

People were supported by staff who were kind and caring and who treated them with dignity and respect. Staff knew people well and supported people to maintain their independence. A range of activities and opportunities were provided each day that were tailored to each person’s needs and preferences. People had been supported to maintain links with people that were important to them.

We received consistent feedback that the home was well run, and that the registered manager was supportive and approachable.

The registered manager and registered provider had a wide range of checks and audits in place that ensured the on-going safety and quality of the service.

We last inspected The Old Coach House in May 2014. At that inspection we found the provider was meeting all the regulations.

The home provides accommodation and support for up to five people who have a sensory impairment and have an additional learning disability. There were five people living at the home when we inspected but one person was away on holiday.

The home is required to have 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post.

We found that people were safe. Our observations and feedback from staff and relatives who visited the home confirmed this. We reviewed the systems for the management of medicines and found that people received their medicines safely. During the inspection we saw there was always enough staff to provide care safely.

We observed a friendly and relaxed atmosphere in the home throughout the time of our inspection and we observed and heard staff working with people in a way that was kind and compassionate. We brought to the attention of the registered manager three isolated incidents where we had observed care practice that needed improvement. This included one member of staff assisting a person to the dining table without first having checked if the person needed support with their personal care.

Relatives we spoke with told us that the care people received was good. They said staff were kind and caring. Staff used differing forms of communication with people such as objects or hand under hand signs to tell them what was going to happen next in their day. We also saw that staff observed people for non-verbal communication so that they could meet their needs. Staff had received training about the needs of deaf blind people and used the knowledge to communicate and support people to make choices in their day-to-day their life.

The service was meeting the requirements of the Mental Capacity Act 2005 Code of Practice but some staff were not confident about the requirements of the Deprivation of Liberty Safeguards.

Staff told us they had received appropriate training and were knowledgeable about the needs of people who lived in the home. Our observations showed they anticipated people’s needs as they knew them well. People’s needs had been assessed and care plans developed to inform staff how to support people in the way they preferred.

People’s nutritional and dietary needs had been assessed and people were supported to eat and drink sufficient amounts to maintain good health. People told us they had access to a variety of food and drinks. People were supported to stay healthy and were supported to have access to a wide range of health care professionals.

Management systems were well established to monitor and learn from incidents and concerns. The manager and provider undertook checks and had systems in place to maintain the quality of the service the home was providing.

The inspection was undertaken by one inspector. We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with relatives of all of the people living at the home, with staff and from looking at records.

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

Is the service safe?

People had been protected from the risk of harm and abuse because staff had received training in how to safeguard vulnerable people.

We checked people's care plans and found that these were detailed. Risks were identified to ensure that people had the care provided safely and risks to them were minimised. Staff we spoke with were aware of the care that people needed to keep them safe.

Recruitment practice was safe and thorough. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were informed that policies and procedures were in place and the manager demonstrated a good level of awareness of this area.

Is the service effective?

People’s relatives told us that they were happy with the care that was provided and that people’s needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well.

Care plans contained information and guidance about people's specific conditions to enable care staff to meet the individual needs of the people who used the service. People's preferences, interests, aspirations and diverse needs had been recorded in people's care plans and people were supported as much as possible with these interests.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. One person’s relative told us, “Staff are very caring.”

We saw that care plans contained essential information about people's health

assessments from other professionals. This ensured staff had access to information about people's needs and could provide the most appropriate care.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes. People had access to a range of activities and had been supported to maintain relationships with their friends and relatives.

Is the service responsive?

The provider had a complaints policy which showed people how to make a complaint if they were unhappy. Relatives told us that felt able to raise any concerns. One relative told us, “I have a good relationship with all of the staff and feel able to talk to any of them.”

Each person who lived there had an annual review to discuss their individual needs and goals, and whether they were happy with the home and the care and support they were receiving. Relatives told us that they had the opportunity to feedback about the quality of the service at people's annual review meetings.

Is the service well-led?

Staff and relatives of people living in the home told us that the manager was accessible and took account of their comments.

The service had a quality assurance system and records showed that identified problems and opportunities to change things for the better were usually addressed.

We saw that there were regular meetings with staff to discuss quality issues and this helped to ensure that people received a good quality service at all times.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We observed staff interaction with the people who used the service, spoke with staff and with three relatives on the telephone.

All of the relatives we spoke with told us that they were satisfied with the care provided at the home. One relative told us, ‘’Sense is the best organisation he has lived at.’’ Another relative told us, ‘’I have always been happy with the care from Sense.’’

We found that people had lots of positive interaction from staff .We saw that staff were kind, respectful and unhurried. We observed that staff confirmed people's consent for their day to day care. We saw how staff communicated with people through a variety of means and gained their co-operation before proceeding to offer care.

Medicines were kept securely and administered safely. Improvements were made to guidance for ordering new supplies of medication following our visit.

Staff told us that they were well supported and felt they had been provided with the appropriate training in order to do their job effectively.

Relatives told us that they had the opportunity to give feedback about the service at people’s annual review meetings. One relative told us, ‘’Any concerns I have raised have been responded to and action taken.’’

People who lived at the home were not able to tell us their views due to their learning

disability and communication needs. To help us to understand the experiences people had we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. We found that people who lived at the home had good interactions from care staff and that people were in a positive mood for most of our observation.

We spoke with relatives of all people who lived at the home. They all confirmed they were satisfied with the care provided. One relative told us ‘’Excellent care at the home.’’ They told us they felt able to raise any concerns they had directly with staff at the home.

We saw that staff were respectful to the people living in the home. Staff engaged with people to help them take part in activities. They offered them choices of what they wanted to do and people looked happy. Staff understood the importance of respecting people's choices and personal preferences. One relative told us ‘’Staff are very aware of her needs and that she knows her own mind.’’