About the service:

Showell Green Lane is a care home for up to six people who have a learning disability or autism spectrum diagnosis. At the time of the inspection six people were living at the service.

The care service has 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.

People’s experience of using this service:

• People’s experience of using the service was positive. People told us, “I like living here. The staff are nice and kind to me.” People were protected against avoidable harm, abuse, neglect and discrimination. People received their medicines as prescribed.

• Staff had the skills and knowledge to meet people’s needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People’s nutritional needs were met and they received enough to eat and drink to ensure they had a healthy diet. People accessed health care when needed.

• People received care from staff who were kind and caring and knew them well. Staff were patient and empathetic and had built good relationships with people. People's privacy, dignity and independence were respected by staff.

• People's support needs were assessed regularly and planned to ensure they received the assistance they needed. People's support was individualised. People were supported to take part in activities of interest and their preferences, likes and dislikes were known to staff. The provider had a complaint process which people were aware of to share any concerns.

• The provider had systems in place to investigate and monitor accidents and incidents. The registered manager understood their legal requirements within the law to notify us of all incidents of concern, deaths and safeguarding alerts. The registered manager was open and honest and had a development plan in place to drive improvements.

Rating at last inspection:

• At the last inspection the service was rated Good. (Last inspection report published 5 April 2016.)

Why we inspected:

This was a planned comprehensive inspection scheduled to take place in line with the Care Quality Commission (CQC) scheduling guidelines for adult social care services.

Follow up: We will review the service in line with our methodology for ‘Good’ services.

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

This inspection took place on 2 March 2016 and was unannounced. When we last inspected this service in August 2014 we found it compliant with all the regulations we looked at.

Showell Green Road is a residential home which provides support to people who have learning disabilities. The service is registered with the Commission to provide personal care for up to six people and at the time of our inspection there were six people using the service. There was a registered manager at this location. 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 and associated Regulations about how the service is run.

People we spoke with told us they felt safe and were kept safe from the risk of harm by staff who could recognise the signs of abuse. Assessments had been conducted to identify if people were at risk of harm and how this could be reduced.

There were enough staff to meet people’s care needs. Staffing levels were regularly assessed and changed when necessary to meet people’s specific care needs or when a new person started to use the service.

Medication was managed safely. Where people were prescribed medicines to be taken on an “as required” basis there were details in their files about when they should be used. Checks were conducted regularly to ensure people had taken their medication as prescribed.

Staff told us and records confirmed that they received regular training and supervisions with senior staff to maintain their skills and knowledge. People were confident in the abilities of the staff to meet the needs of the people who used the service.

The service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. When necessary the registered manager had made applications to the local safeguarding authority to support people in ways which could restrict their freedom.

Meal times were positive occasions. People were invited to help prepare meals and given a choice of foods staff knew they liked to eat. When necessary the registered manager involved dietary and nutritional specialised to help meet people’s specific needs.

Staff spoke affectionately about the people they supported. Processes were in place which supported people to be involved in developing their care plans and expressing how they wanted their care to be delivered. People felt listened to and had control over the care they received.

People were supported to take part in activities they said they liked and staff responded promptly to people's requests for assistance. The registered manager actively sought the views of the people who used the service and took action to meet their expressed wishes and views.

The deputy manager had taken action when people had voiced their opinions about the service and people were involved in recruiting staff they wanted to be supported by.

People were aware of the provider’s complaints process but felt they could talk openly with staff and that their concerns would be addressed appropriately.

There were processes for monitoring and improving the quality of the care people received. The provider conducted regular audits and we saw that effective action had been taken when it was identified improvements were needed.

The inspection was carried out by one inspector. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, staff who supported them and from records we looked at. We also spoke with a district nurse whose team visited the home twice a day. There were six people using the service at the time of the inspection.

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

Is the service safe?

A person who used the service told us, “I like living here, I like the staff and I feel safe.”

People living in the home had assessments of risks to their health and welfare and these were reviewed at least every six months. We found that people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

People and those acting on their behalf told us staff respected their rights and dignity. Suitable arrangements were in place for obtaining and acting in accordance with people’s consent in relation to their care and support.

Staff recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and action taken to ensure the safety of people.

Systems were in place to make sure that staff learned from events such as accidents, incidents, practice shortfalls, complaints and concerns. This reduced risks to people and helped the service to continually improve.

The home was clean and well maintained. A range of audits had taken place to ensure the safety of the environment.

Is the service effective?

Records showed that people’s health and care needs had been assessed and their support plans were up to date, reflecting their current needs.

Staff had received training to ensure they had the skills to meet people's needs.

The registered manager and senior staff were accessible to staff for advice, guidance and support.

Is the service caring?

People told us they were happy with arrangements for their care and support. One person stated, “I like living here, staff are kind.”

We found staff to be knowledgeable about people’s preferences and lifestyle choices. They were attentive to people, with high levels of engagement. Their interactions with people and their general approach was friendly, cheerful, caring and respectful.

Is the service responsive?

The home had a robust safeguarding procedure. This ensured an appropriate response in accordance with local multi-agency procedures for the protection of people from abuse or risk of abuse.

People and those acting on their behalf had been informed of the procedure for making a complaint or expressing a concern. People could be assured the home had effective systems for investigating and responding to complaints.

Systems were in place for analysing incidents, complaints and safeguarding alerts. These had been taken seriously and appropriate action taken.

Is the service well-led?

The service employed a suitably qualified, experienced registered manager. At the time of the visit they were managing two homes, supported by senior staff in both establishments. They were positive about the training opportunities available to them. Their continuous training and development had enabled them to perform their role and manage the home effectively.

We saw that staff worked in partnership with other professionals, agencies and services, ensuring people received seamless care and support.

The service had a quality assurance system. We saw that identified problems and opportunities to change things for the better had been addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. They said they received good support and guidance from the registered manager. They demonstrated understanding of the home’s ethos and values and commitment to ensuring people received a good quality care and support.

Most people were not able to give us their views on the service because of their complex needs and conditions. We met all six people who lived in the home as they were getting ready to go out for the morning. Each person was alert and engaged with staff comfortably. We briefly spoke with two people and they told us that they liked living at the home.

People had their privacy, dignity and independence respected and their views were sought about day to day living and in relation to their care. We found that staff treated people with warmth and knew them well.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Staff received updated training in safe administration of medication. Where people were able to administer their medication independently, they were given the support to safely do so.

People were supported to be able to eat and drink sufficient amounts to meet their needs. Where people were identified as being at risk of poor nutrition the service made referrals to healthcare specialists. Staff followed advice to support people's welfare and improve their health. There were good stocks of a variety of foods and drinks in the home for people to choose from including fresh vegetables, fruit and salad. Staff received updated training in food hygiene and in good nutrition so they could safely support people's choices around food and drink.

We visited the service on 29 June 2012 and met all five people who were living in the home. Most people were not able to give us their views on the service because of their complex needs and conditions. Two people told us that they liked living at the home. One person said the staff were nice and gave them the help that they needed and there were enough staff to help them.

We used a variety of methods including the Short Observational Framework for Inspection (SOFI) to gauge other people's experience of the service. Care workers and managers treated people with warmth and respect. People, including those with complex needs and conditions appeared comfortable with their care workers, responded to them positively and actively engaged with their environment and their day.

We spoke with a person who used the service. She told us, “Going to Stratford next month”. We asked her how often she goes out, she replied, “Yes sometimes, when I want to “.

We spoke with a person who was using the service. She said, “Lived here for five years, I enjoy it”.

We asked a person who uses the service about staff, she said, “Staff nice”.