About the service:

Shaftsbury House was a large 10-bed care home. It was registered for the support of up to 10 people. Eight people were using the service. This is larger than current best practice guidance. However. the design of the building fitted into the residential area.

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence and inclusion. Peoples support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People using the service benefited from an outstanding responsive service. The service was exceptional in placing people at the heart of the service. We saw how staff and management were supportive and went the extra mile to care right for people and were passionate about providing person-centred care to people when needed.

People's needs, and wishes were met by staff who knew them well. We saw and were told of many examples of staff going the extra mile to help and support people they cared for. For example, we were told about how the service had supported a person with very complex needs to plan a holiday to visit family. The service told us this action "had a massive effect on the person's positivity and mental 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’s healthcare needs were being met and medicines were being managed safely.

People were protected against avoidable harm, abuse, neglect and discrimination. The care they received was safe.

Care plans were up to date and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate identified risks.

People received personalised care and support specific to their needs and preferences. People's likes, preferences and dislikes were assessed. Care packages met people's desired

expectations.

People were enabled to follow a variety of interests and activities. Ideas and events were initiated by people based upon their interests.

Staff were being recruited safely and there were enough staff to take care of people. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their ongoing development needs.

There was a complaints procedure in place and people knew how to complain.

Everyone spoke highly of the registered manager who they said was approachable and supportive. The provider had effective systems in place to monitor the quality of care provided and where issues were identified, they acted to make improvements.

Rating at last inspection:

At the last inspection the service was rated Good, the report was published October 2016.

Why we inspected:

This was a planned comprehensive inspection based on the rating at the last 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

Shaftsbury House is registered to provide personal care and accommodation for 10 people over the age of 18 who have a learning disability; this includes two beds which are reserved for short term respite care. The service is situated close to local amenities and public transport routes. There are communal rooms available for people to use on the ground floor with access out to a large enclosed garden with seating. There is a small car park and further on-street car parking nearby.

The service had 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.

We undertook this unannounced inspection on the 18 August 2016. At the time of the inspection there were 10 people using the service at Shaftsbury House. At the last inspection on 20 August 2013, the registered provider was compliant with all areas assessed.

People told us that they felt safe living at Shaftsbury House. We found that staff had a good knowledge of how to keep people safe from harm and that there were enough staff to meet people’s needs. Staff had been employed following appropriate recruitment and selection processes.

Risk assessments were completed to guide staff in how to minimise risks and potential harm. Staff took steps to minimise risks to people’s wellbeing without taking away people’s rights to make decisions.

We found people who used the service received their medicines as prescribed. Staff managed medicines well and ensured they were obtained, stored, administered to people and disposed of appropriately.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health professionals based in the community.

Positive interactions were observed between staff and the people they cared for. People’s privacy and dignity was respected and staff supported people to be independent and to make their own choices. When people were assessed by staff as not having the capacity to make their own decisions, meetings were held with relevant others to discuss options and make decisions in the person’s best interest.

Staff had access to induction, training, supervision and appraisal which supported them to feel skilled and confident when providing care to people.

People were encouraged to follow their interests and participate in activities.

A complaints policy was in place and we saw when complaints were received they were responded to in line with the policy.

A quality assurance system was in place that consisted of audits, checks and feedback from people who used the service. When shortfalls were identified action was taken to improve the service as required. The registered manager was a constant presence within the service and understood the requirement to report notifiable incidents to the Care Quality Commission.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People told us, “I get asked what I want to do" and “I do things I like to do.” People said they would not do anything they did not want to. Staff had received training in the Mental Capacity Act (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and policies were in place in relation to consent and capacity.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. A relative of a person who lived at the home told us, “We think our [family member] is settled, there’s some lovely staff. We wouldn’t keep [family member] there if we weren’t happy with the home.”

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. The home had an appropriate recruitment procedure in place to ensure staff would be suitable for the role.

There was an effective complaints system available and comments and complaints people made were responded to appropriately.

People told us they were happy with the care and support they received and felt the home was a friendly and safe place to live. We saw they were offered choice and staff respected their privacy and dignity while encouraging them to be as independent as possible. One person told us, “I like it here, staff are very helpful.”

People had access to a variety of social and educational activities both in the home and in the community. One person told us, “I like working in the garden and growing vegetables.”

A safe system was in place for the handling, storage and administration of medications. One person we spoke with told us they could be responsible for their own medicines if they wanted to, but said they preferred staff to do this for them.

Staff were well supported by the management team. This included undertaking essential and specific training to meet the needs of the people they supported, and attending meetings.

People said they felt confident taking any concerns to the manager or any of the staff. They told us they were asked their opinion about how the home was run at meetings and when they completed questionnaires.