This inspection took place on 31 May 2017 and was unannounced. The service provides accommodation and personal care for up to four adults with a learning disability. At the time of our visit there were four people living at the service.

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 2008 and associated Regulations about how the service is run. The registered manager was also the registered manager for a sister home two doors away and as such ran both services very similarly aside from recognising and promoting the individuals who lived in each of the two homes.

We last inspected the service in January 2015. At that time we found no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 or the Health and Social Care Act 2008 (Registration) Regulations 2009. The service was rated as Good in all five key lines of enquiry and received an overall rating of Good.

At this inspection we found the service remained Good in three of the key lines of enquiry and they had improved to an Outstanding rating in Caring and Well Led. Overall the rating has changed to Outstanding

St Mary’s was part of a small organisation which also included an additional small care home accommodating 10 people in total and, a domiciliary care agency providing care and support to people in their own homes. The ethos, vision and values were provider led and, as such, applied across all three services. This included; following current best practice, innovation, plans for the future and continuous striving to be the best. It was evident that the provider and registered managers worked together effectively. However each service was additionally recognised for its individuality. They had a healthy, respectful, working relationship which encouraged each service to strive to provide the best possible care independently, based on their own merits. Two of the providers other services had received an overall outstanding rating following inspections by CQC in November 2016.

Following those inspections the provider and registered manager had continued to improve the quality of the services they provided despite having achieved outstanding status. They continued to put people who used their services at the forefront of this.

The registered manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, action plans were in place about how to manage these, monitor and review them. Medicines were managed safely and staff followed the services policy and procedures.

People were supported by the services recruitment policy and practices to help ensure that staff were suitable. The registered manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.

People moved into the service when a full assessment had been completed and the registered manager was sure they could fully meet a person’s needs. People’s needs were assessed, monitored and evaluated. This ensured information and care records were up to date and reflected the support people wanted and required.

Staff had the knowledge and skills they needed to carry out their roles effectively. They were supported by the provider and the registered manager at all times. People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions Mental Capacity Act (MCA) 2005 best interest decisions had been made. The Deprivation of Liberty safeguards (DoLS) were understood by staff and, appropriately implemented to

This inspection took place on 11 January 2015 and was unannounced. The previous inspection was carried out 5 June 2013 and there had been no breaches of legal requirements at that time.

St Mary’s Residential Care Home is registered to provide accommodation and personal care for up to a maximum of four people. The service provides care and support to people with learning disabilities who are supported to as independent as possible.

A registered manager was in post at the time of inspection. 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.

At the time of our inspection one person was in hospital and one person had gone out for the day. One person who was at home was able to tell us how they felt about living in the home. They told us they felt safe and that staff looked after them in ways that made them feel safe. Staff interactions were viewed during our inspection and were sensitive and in line with people’s assessed needs. People looked comfortable in the presence of staff and were seen engaging with staff in a relaxed manner while eating their mid-day meal.

Staff received training to help them understand their obligations under the Mental Capacity Act 2005 and how it had an impact on their work. Staff we spoke with confirmed they had a good understanding. Within people’s support plans we found the service had acted in accordance with legal requirements when decisions had been made when people lacked capacity to make that decision themselves.

Staff had attended Deprivation of Liberty Safeguards training (DoLS). This is legislation to protect people who lack mental capacity and need to have their freedom restricted to keep them safe. One person in the home was subject to a DoLS authorisation. All documentation was appropriately completed that safeguarded the person’s human rights.

We found the provider had systems in place that safeguarded people. Staff received safeguarding adults training and had a good understanding of the process and who to report concerns to.

Staffing levels were sufficient to meet the needs of people living in the home. This was confirmed by people we spoke with and staff. One person was able to go out for the day with a member of staff on the day of the inspection.

The provider had ensured that staff had the knowledge and skills they needed to carry out their roles effectively to ensure people who used the service were safe. Training undertaken ensured their knowledge was current and in accordance with current guidance and staff we spoke with were knowledgeable of people’s needs.

Processes were in place for the safe storage and administration of people’s medicines and we found medicines were given as prescribed by people’s GP. A policy was in place that included the ordering and safe disposal of medicines. Recording charts also showed people received their medicines on time.

People were supported to attend external medical appointments that ensured the safe management of their long term health conditions.

People’s care records demonstrated their involvement in their support planning and decision making processes. Some people had signed their documentation to show this involvement. Pictures were used to enable people to understand what was being asked of them where they needed help with communication.

People received regular reviews of their care needs to ensure that staff had up to date information about how to meet people’s needs. and the support plans continued to effectively meet the person’s needs.

Staff meetings and registered manager meetings took place with the operations manager on a regular basis. Minutes were taken and any actions required were recorded.

Quality and safety in the home was monitored to support the registered manager in identifying any issues of concern. Meetings were held with people and their relatives to ensure that they could express their views and opinions about the service they received and raise any concerns.

There were systems in place to obtain the views of people who used the service and their relatives. People, their relatives and external professionals were also given a yearly satisfaction survey to complete. This was provided in a format to meet people’s individual communication needs that lived in the home.

Two people were living in the home at the time of our visit and one person was staying for respite care. We met with all three people living in the home throughout our visit and spoke with one at length. They told us that they enjoyed taking part in the inspection and we were made to feel welcome.

It was a positive visit and the atmosphere was warm, happy and relaxed. People were confident in their surroundings and with each other. Staff had supported them for many years and they were dedicated and caring. It was evident through observation and in discussions that they enjoyed working in the home and they knew people well.

There were 3 people living in the home at the time of this inspection. We were able to meet with one person who lived there. One person was in hospital and the other person had gone out for the day.

The registered manager was absent on the day of our visit. A newly appointed manager had been recruited and was going to apply to be the new registered manager. They had completed induction and assisted us throughout our visit. We also spent time talking with three other staff members.

The provider had recently transferred St Mary's to another location and people had moved into an extensively redecorated and refurbished new home. Staff told us about the positive effect the move had on people and how settled they were in their new surroundings.

There was a happy, relaxed atmosphere in the home. We saw staff interact in a caring way and the person at home responded to this. Staff were confident and knowledgeable about people's past social and medical history and what care and support they required.

Their passion, knowledge and enthusiasm of the service and the people in their care was evident. Staff morale was positive and they were 'proud' of the service they provided as a team so that the quality and safety of people was maintained.