Symonds House is a home with nursing providing accommodation and care for 20 adults with physical disabilities. At the time of the inspection there were 19 people living at Symonds house.

At the last inspection the service was rated good.

At this inspection we found the service remained good.

People told us they felt safe living at Symonds House. Risk assessments were in place to ensure people’s safety.

People told us there were enough staff to provide them with support when they needed it.

Staff had received appropriate training, support and development to carry out their role effectively.

People received appropriate support to maintain healthy nutrition and hydration.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). 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.

We observed people were treated with kindness by staff who respected their privacy and upheld their dignity.

People were given the opportunity to feed back on the service and their views were acted on. The registered manager promoted an open, transparent and inclusive culture within the service. People and staff had their views sought and felt listened to

People received personalised care that met their individual needs. People were given appropriate support and encouragement to access meaningful activities and follow their individual interests.

People told us they knew how to complain and were confident they would be listened to if they wished to make a complaint.

There were quality assurance system in place and shortfalls identified were promptly acted on to improve the service.

Further information is in the detailed findings below.

During our inspection of Symonds House on 25 June 2013, we saw evidence that staff had made every effort to identify and act on the wishes of people who lived there. One person told us, “They [staff] listen to us. We talk about what I need but I make the final decision. I have the final say.”

Care records we looked at showed that people’s needs and preferences had been thoroughly assessed, documented and reviewed. A healthcare professional said, “They [people who used the home] have individually tailored care assessments and treatment plans. The level of care provided is excellent and meets people’s needs.”

We saw that people were provided with a good choice of food and drink in a way that both encouraged and promoted a healthy balanced diet. We also saw that people were given appropriate levels of support where necessary to help them eat and drink.

The premises were safe, suitable and fit for purpose. Adequate emergency procedures were in place and the safety equipment we saw had been regularly checked and well maintained.

We saw that a complaints policy and procedure had been put in place and that people’s comments, feedback and suggestions had been regularly sought. Everyone we spoke with during our inspection told us they knew how to make a complaint but had never had any reason to do so.

Some of the people who used the service had complex needs which meant they were not able to tell us about their experiences. We used a number of different methods to help us to understand their experiences. We spent time directly observing care or listening to everyday interactions to help us to determine what it was like for people who lived in the home. These indicated that people were relaxed and comfortable and found their experience at the home to be positive.

Some people were able to communicate verbally with us. One person said, “This should be the benchmark for these kind of services.” Another person said, “I go out as much as I want to, my relative took me to Duxford and the cinema.”

People’s needs were carefully assessed and their care and treatment was discussed with them and delivered within their individual care plan.

People told us that they felt safe with staff and trusted them. Staff understood how to protect people from abuse and had been trained in safeguarding. Staff had been well trained for their roles and were adequately supervised. They could progress their own learning and development needs with the support of their manager.

The provider operated a comprehensive quality assurance system. People who used the service were asked about their views and these were taken into account in the running of the service.

The inspection took place on 21 and 26 August 2015 and was unannounced. At our last inspection on 27 August 2014, the service was found to be meeting the required standards in the areas we looked at. Symonds House provides accommodation with nursing care for up to 20 adults who live with physical disabilities. At the time of our inspection 19 people lived at the home.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

The CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that people’s freedoms had not been restricted and so DoLS authorities were not required.

People told us that they felt safe, happy and well looked after at the home. Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally. Safe and effective recruitment practices were followed to ensure that all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe. Trained staff helped people to take their medicines safely and at the right time. Identified and potential risks to people’s health and well-being were reviewed and managed effectively.

Relatives and healthcare professionals were positive about the skills, experience and abilities of staff who worked at the home. They received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff made considerable efforts to ascertain people’s wishes and obtain their consent before providing personal care and support, which they did in a kind and compassionate way. Information about local advocacy services was available to help people and their family’s access independent advice or guidance.

Staff had developed positive and caring relationships with the people they cared for and clearly knew them very well. People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community. They felt that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded and investigated thoroughly with learning outcomes used to make improvements where necessary.

Relatives, staff and professional stakeholders very were complimentary about the manager, deputy manager and how the home was run and operated. Appropriate steps were taken to monitor the quality of services provided, reduce potential risks and drive improvement.