This was an unannounced inspection that took place on 24 and 31 October 2017.

The home provides personal care and accommodation for up to six people with learning disabilities. It is located in the Teddington area.

The home had 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 and associated Regulations about how the service is run.

At the last inspection on 2 and 7 September 2015 the home met all the key questions and was rated good in each with an overall good rating.

Relatives spoke on behalf of people with limited verbal communication. People enjoyed living at St John’s and were happy there. They liked how staff provided them with care and support. People were enabled to make their own choices and these included activities with people going to and coming back from them during our visit. The activities they pursued were varied and took place at home and in the community. The home was a safe place to live and work and there was a welcoming, friendly atmosphere. People’s interaction with staff and each other was positive throughout our visit.

The home’s records were up to date and covered all aspects of the care and support people were provided with. People’s care plans were individualised to them and contained comprehensive information that was regularly reviewed. This enabled staff to carry out their duties efficiently and professionally. Staff encouraged people to discuss their health needs with them and people had access to GP’s and other community based health professionals. People were supported to choose healthy and balanced diets that also met their likes, dislikes and preferences, whilst protecting them from nutrition and hydration associated risks. They said they were happy with the choice and quality of meals provided.

People were well supported, familiar with the staff that supported them and staff were fully aware of people’s needs, routines and preferences. Relatives told us that staff worked well as a team and provided them with updated information as required. Staff had appropriate skills and provided care and support in a professional, friendly and supportive way that was focussed on people and their individual needs. The staff were well trained and made themselves accessible to people and their relatives. Staff said they enjoyed working at the home and that the organisation was a good one to work for. They received good training, support and there were opportunities for career advancement.

People said the management team and provider were approachable, responsive, encouraged feedback and consistently monitored and assessed the quality of the service provided.

The health care professional that we contacted was satisfied with the support that the home provided for people.

Our inspection team was made up of an inspector who answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

Is the service safe?

During our visit we saw that staff treated with people with dignity and respect. People told us that they felt safe. Safeguarding procedures were robust, staff were trained in how to invoke them and understood how to safeguard people. Details of areas or circumstances specific to individual people were also recorded in the sample of 3 care plans we looked at.

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

The home had policies and procedures that worked in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Training was provided for relevant staff to understand when an application should be made and how to submit one. No applications had been required for submission. This meant that people was safeguarded as required.

The service was safe, clean and hygienic with well maintained equipment that was regularly serviced. This meant people were not put at unnecessary risk.

People’s care needs were taken into account by the staff rotas when making decisions regarding the required staff numbers, qualifications, skills and experience. This ensured that people’s needs were met.

No staff were currently subject to disciplinary action and policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

There was an advocacy service available should people require it. This meant that people could access additional support. An advocate was present during part of our visit.

The home assessed people’s health and care needs with them and those that wished were involved in contributing to their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans as required. One of the care plans had been signed by a person using the service. People told us "I have enough activities and choose what I want to do" and "I do my own cooking".

The layout of the service enabled people to move around freely and safely.

The visiting policy and visitors' book demonstrated that people were able to see their visitors in private and that visiting times were flexible.

Is the service caring?

We saw that people were supported by kind and attentive staff. The staff were patient and gave encouragement when supporting people. People commented,"Staff are nice and help me when I want it”.

People and their relatives completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with this information.

Is the service responsive?

People regularly completed a range of activities in and outside the home. During our visit people were coming from and going to a number of different activities individually. We were told that they also attend group activities. The home had access to transport, that enabled people to be involved in activities within their local community and further afield.

People knew how to make a complaint if they were unhappy. We looked at how complaints were investigated and saw that they were investigated properly and action was taken as necessary.

Is the service well-led?

We saw that the manager and staff listened to people's needs, opinions and acted upon them. The service worked well with other agencies and services to make sure people received their care in a joined up way. This was demonstrated by the relationship the home had with the local authority commissioning team and community based health services.

Appropriate notifications to the Care Quality Commission were made.

During our visit people told us they chose the type of care, support and activities they wanted and how they were delivered. "I go out a lot".

They liked the staff and way they were treated. "My key worker is nice". "Staff are very pleasant" and "If I have a problem, I talk to staff".

We were also told "My room is okay", "We clean our rooms". "I go to gateway on Thursdays to meet my friends".

People said they liked the house, their bedrooms and enjoyed living there.

They did not tell us if they thought there were enough staff but did tell us they knew how to complain and who to.

They said they were asked what they thought about the service and that staff were very good.

We saw that the staff treated people with dignity and respect and listened to what they had to say.

People were given choices, opportunities to decide what they wanted to do and were supported to do the activities they had chosen.

We also saw that people using the service were living in a safe environment that they enjoyed.

People had their own person centred support plans and key workers.

There were enough competent staff to meet people's needs.

There was a robust, easy to access complaints procedure and a system that investigated complaints thoroughly.

During our visit people using the service said they were involved in choosing the type of care and support they needed and way it was provided. They liked the staff, how they were treated, felt safe and enjoyed living at the home. One person using the service said "I enjoy living here". Someone else said "We go out together and on our own" and "I draw and do writing in the evening and sometimes wash the floor when it is my turn". We were also told "I do my own laundry and some cooking", "We are going to a pantomime at the church and there is a party afterwards". Someone else said "I'm not going to the pantomime, I don't like them". One person told us "I'm going to away for Christmas".

They did not tell us about the support staff received from the manager and organisation or about the quality assurance system. They did tell us they were asked what they thought about the service they and that staff were very good. One person told us "the staff are okay, I like the staff".

We saw that the staff treated people with dignity and respect and listened to what they had to say. They gave them choices and opportunities to decide what they wanted to do and supported them to do the activities they had chosen. We also saw that people using the service were living in a safe environment that they enjoyed. Everyone had their own person centred support plans that were part of the quality assurance system. Staff were also well supported to do their jobs effectively.

We carried out this review to look at the way people were supported with managing their medicines because we identified some concerns about this when we visited in October 2011.

During this visit we spoke with three of the people who live at the home. When we visited in October 2011 people told us that they liked living at the home. They showed us their bedrooms and communal areas and told us how they had personalised these. They said that the staff helped them to shop, prepare food, stay healthy and to do fun things.

People who live at the home told us that they liked living there. They showed us their bedrooms and communal areas and told us how they had personalised these. They said that the staff helped them to shop, prepare food, stay healthy and to do fun things.

This was an unannounced inspection and took place on 2 and 7 September 2015.

The home provides personal care and accommodation for up to six people with learning disabilities. It is located in the Teddington area.

The home had 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 and associated Regulations about how the service is run.

In May 2014, our inspection found that the service met the regulations we inspected against. At this inspection the home met the regulations.

People and their relatives told us they were happy living at the home and with the way that staff provided care and support. People made their own choices including activities and the home was a safe place to live. During our visit there was a welcoming, friendly atmosphere and people came and went doing activities and interacting positively with each other and staff. The activities they pursued were varied and took place at home and in the community.

The home’s and people’s records were kept up to date, covered all aspects of the care and support people received, their choices, activities and safety. People’s care plans were fully completed and the information contained was regularly reviewed. This supported staff to perform their duties efficiently and professionally. People were encouraged to discuss their health needs with staff and had access to GP’s and other community based health professionals, as required. People were supported to choose healthy and balanced diets that also met their likes, dislikes and preferences. This enabled them to be protected from nutrition and hydration associated risks. They said they were happy with the choice and quality of meals they ate.

People knew who the staff that supported them were and the staff knew them, their and their preferences. They were well supported and they liked the way their care was delivered. Relatives also said staff worked well as a team and provided them with updated information. Staff had appropriate skills and provided care and support in a professional, friendly and supportive way that was focussed on people as individuals. The staff were well trained and accessible to people using the service and their relatives. Staff said they enjoyed working at the home and that the organisation was a good one to work for. They received good training, support and there were opportunities for career advancement.

People said the management team and provider were approachable, responsive, encouraged feedback from people and consistently monitored and assessed the quality of the service provided.