Shrewsbury House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Shewsbury House is registered to provide care and support for up to five people. There were five people living at the service at the time of our inspection. We inspected Shrewsbury House on 9 November 2018.

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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

.

Sufficient, skilled staff were deployed to meet people’s needs. Robust recruitment processes were in place to ensure only suitable staff were employed. Staff demonstrated a good understanding of their responsibilities in safeguarding people from potential abuse. Risks to people's safety were identified and control measures implemented to keep people safe. Accidents and incidents were reviewed and action taken to prevent them happening again. Safe medicines processes were in place and staff competence in supporting people in this area was assessed. People lived in a safe environment and staff followed safe infection control procedures. The provider had developed a contingency plan to ensure that people's care would continue to be provided in the event of an emergency.

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 support this practice. People were supported by staff who received continuous training and supervision to support them in their roles. People lived in an environment which was suited to their needs. Where areas of the service had been refurbished, people’s future needs had been considered. The service worked closely with healthcare professionals to ensure that people's healthcare needs were met. People had access to a varied menu and food of their choosing.

People and staff had developed positive, trusting relationships. Staff treated people with kindness and were aware of their preferences. Staff demonstrated a good understanding of people's communication styles. People were treated with dignity and respect and their independence was promoted.

People's care records were personalised and detailed. Regular care plan reviews were completed with people to ensure their support was provided in the way they wanted and continued to meet their needs. People received support to develop plans regarding the support they wanted when approaching the end of their life. There was a range of activities which were planned with each person in accordance with their interests and preferences. There was a complaints policy in place and people told us they would feel comfortable in raising any concerns.

There was a positive culture and shared ethos throughout the service. Systems were in place to monitor the quality of the service provided and ensure continuous development. The service worked proactively with other agencies to share best practice. People and staff had the opportunity to contribute to the running of the service. CQC were notified of all significant events within the service.

Further information is in the detailed findings below.

Shrewsbury House is a large detached house located close to Merstham Village and local facilities. The service is registered to provide support and accommodation for up to five people who have a learning disability. The home is owned and operated by Ashcroft Care Services who operate several other homes in the area.

There was 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 and associated Regulations about how the service is run.

Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.

Staff met with their line manager on a one to one basis to discuss their work. Staff said they felt supported and told us the provider had good management oversight of the home.

People lived in a homely environment and were encouraged to be independent by staff. Staff supported people to keep healthy by providing people with a range of nutritious foods. Everyone was involved in the menu planning and shopping. People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health.

People were supported to participate in arranged activities which were individualised and meaningful for them. We heard people discussed with staff what plans they had for the day.

People had risk assessments in place for identified risks. The registered manager logged any accidents and incidents that occurred and staff responded to these by putting measures in please to mitigate any further accidents or incidents.

Staff had a good understanding of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). Nobody at the service was subject to a DoLS authorisation or had their liberty deprived.

There were a sufficient number of staff on duty to meet people’s needs and support their activities. People and staff interaction was relaxed. It was evident staff knew people well, understood people’s needs and aspirations. Staff were very caring to people and respected people’s privacy and dignity.

Staff had personal development plans and received mandatory training and training specific to people’s needs. This allowed them to carry out their role in an effective and competent way.

The registered manager and staff undertook quality assurance audits to ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were actioned by staff.

If an emergency occurred or the home had to close for a period of time, people’s care would not be interrupted as there were procedures in place.

Appropriate checks, such as a criminal record check, were carried out to help ensure only suitable staff worked in the home. Staff were aware of their responsibilities to safeguard people from abuse and were able to tell us what they would do in such an event and they had access to a whistleblowing policy should they need to use it.

A complaints procedure was available for any concerns. This was available to people and staff supported them to raise any issues or concerns they may have. People were encouraged to feedback their views and ideas into the running of the home.

Our inspection of this service helped answer our five questions. Is the service caring, safe, effective, responsive and well-led.

Below is a summary of what we found based on our observations during our inspection, talking with people who used the service, talking with staff and looking at records.

Is the service caring?

Peoples views and expectations were taken into account in the way the service was provided and delivered in relation to their care.

People told us they were allowed to express their views and make decisions regarding how their care was provided. We saw people were well cared for and staff had a good understanding of individual needs. People had been living in the home for a long period of time and told us their needs were regularly reviewed. They told us they were supported by staff to participate in a wide range of activities. Staff supported them to maintain links with family and friends. We saw staff were proactive in facilitating activities for example arranging holidays, attending football and maintaining contact with friends and family.

Is the service safe?

People told us they felt safe living in the home and said they could relax. They said if they felt worried or unhappy about something they knew who to talk to about this. We saw safeguarding vulnerable adult procedures were in place and staff told us they had undertaken training in adult protection. During discussion with staff they demonstrated to us how they safeguard people they supported. We saw assessments were in place to manage risks associated with finance, managing predictable behaviour, and health care.

Is the service effective?

People's health care needs were discussed with them and we saw how these were managed in health action plans. We saw people visited their GP and we saw a risk management plan in place which was signed to ensure appropriate guidance was followed to maintain their health and wellbeing.

Is the service responsive?

We spoke with staff who told us they felt had the training and support required to undertake their roles. They told us they were always attending training relevant to their roles. We found the service responded to various situations. For example staff said if a person's psychological needs changed the manager would arrange additional training in order that they would be able to understand and manage that person's needs.

Is the service well-led?

We found the service was well managed and people felt confident with the management structure in place. We saw systems were in place to manage the quality of service provision which included regular auditing, provider visits, and feedback surveys. This ensured the service identified shortfalls and made adjustments to continue to improve.

People told us that they liked living in the home and that it had been their home for several years. They told us that staff treated them with respect and that their views were taken into account regarding the daily routines of the home.

People who used the service told us that they had been involved in developing their care plan and that they always attended their care reviews.

We were told that the food was good and that people who used the service were involved in menu planning and food shopping for the home. People also said that they enjoyed eating out.

People told us that they knew how to make a complaint and could tell the staff or other people who supported them if they were unsure about anything or not happy about something.

We were told that people were encouraged to personalise their rooms and people showed us some of the ways they achieved this.

Staff told us that they enjoyed working in the home and felt that they had the training and support necessary to undertake their roles.

There were five people living in the home on the day of our visit. Two of them were out on our arrival undertaking individual activities.

People were very welcoming and told us that they enjoyed living in the home.

They told us that the staff were “the top team” and cared for them very well.

People told us that they were fully involved in their care and treatment and were given the choice about all aspects of their daily living routine.

People told us that they were aware of their care plans and were able to arrange and plan their individual care reviews.

One person told us the staff were kind and caring, and helped to go out to various events and activities.

Another person told us that the staff enabled them to maintain contact with their family overseas.