About the service: Tanners is a residential care home that provides personal care for up to seven older people with learning disabilities, autism and physical disabilities. At the time of the inspection six people lived at the home.

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.

What life is like for people using this service:

The property was clean, comfortable with plenty of room for people to live. People indicated to us they felt safe and happy at the home with gestures and smiles. There were safeguarding systems and processes in place that sought to protect people from harm. Staff knew the signs of abuse and what to do if they suspected it. There were sufficient staff in place, all of whom had passed safe recruitment procedures to ensure they were suitable for their role. There were systems to monitor people's safety and promote their health and wellbeing, these included risk assessments and care plans. The provider ensured that when things went wrong, incidents and accidents were recorded and lessons were learned.

People's needs were assessed in detail before moving into the home so the provider knew whether they could meet a person's needs. Staff were sufficiently skilled and experienced to fulfil their roles. They received training and were supported through supervision and appraisal. People were prompted to eat and drink healthily and could choose what foods they wanted to eat. 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.

People were treated kindly and compassionately by staff. People were supported to express their views and make decisions about the care and treatment they received. Staff respected people's privacy and dignity and supported them to be as independent as possible.

People received personalised care because their support needs and preferences were detailed in their care plans. People were supported to lead meaningful and fulfilled lives through activities of their choice. The provider had a complaints policy and process in place; people told us they would feel comfortable raising complaints. There were no people at the end of their life, but the provider worked with people to establish their wishes at such a time, so that they could support people if their health changed.

People and staff thought highly of the registered manager. Staff knew their roles and understood what was expected of them. The area manager and deputy manager understood their responsibilities in the absence of the registered manager, to ensure people received a safe, high quality service. People and staff were engaged in the service and their opinions were sought. There were quality assurance systems in place to assist the provider to monitor and improve its care and treatment of people. The service had built local community links to benefit the lives of people using the service.

This service met characteristics of Good in all areas; More information is in the 'Detailed Findings' below.

Rating at last inspection: Good. The last report for Tanners was published in June 2016.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

Follow up: We will continue to monitor the service to ensure it meets its regulatory requirements

We undertook an unannounced inspection of Tanners on 10 May 2016. We spoke with people’s relatives and professionals by telephone and email on 16 and 17 May 2016. During our inspection in August 2014, we had found that the service did not have sufficient numbers of staff to support people safely. We found that improvements had been made during this inspection”.

The service provides accommodation and personal care for up to seven people with mental health and learning disability support needs. On the day of our inspection, there were six people using the service and one person was in hospital.

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 staff had undertaken risk assessments which were regularly reviewed to minimise potential harm to people using the service. Medicines were administered safely by staff who had received training.

There were appropriate numbers of staff employed to meet people’s needs and provide a safe and effective service. Where there were staff shortages, agency staff were deployed. Staff were aware of people’s rights and choices, and provided people with person centred care.

The provider had a robust recruitment process in place which ensured that staff were qualified and suitable to work in the home. Staff had undertaken appropriate training and had received regular supervision and annual appraisals, which enabled them to meet people’s needs. Staff were well supported to deliver a good service and felt supported by the manager.

People were supported to make decisions for themselves and encouraged to be as independent as possible. People, their relatives and/or other professionals were involved in planning the support people required. Staff were aware of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLs).

People were supported to eat and drink well and to access healthcare services. Staff were quick to act on people’s changing needs and were responsive to people who required support.

The provider had effective systems in place to monitor the quality of the service they provided. The provider engaged with people and their relative were asked their opinion about the service

During our inspection we spoke with three people who used the service, five support staff, three relatives, one external health professional and the manager. We considered all the evidence we had gathered under the outcomes we inspected.

This is a summary of what we found:

Is the service safe?

People told us they felt safe. Safeguarding vulnerable adults from abuse procedures were robust and staff understood how to safeguard people they cared for. Systems were in place to make sure that managers and staff learnt from events such as accidents, incidents, complaints and whistleblowing investigations. This reduced the risks to people and helped the service to continually improve.

The service had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put into place to ensure that people's human rights are protected should their liberty be restricted in any way. Staff had been trained to understand when an application should be made and knew how to submit one.

Staff knew about risk management plans and showed us examples where they had followed them. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

Staff were sufficiently qualified, skilled and experienced to meet the needs of the people who used the service. We looked at staff rotas which showed us that there was not an appropriate level of staffing in place. Policies and procedures were in place to make sure that unsafe working practice was identified and people were protected.

Is the service effective?

People’s health and care needs were assessed with them. Specialist dietary, personal care and psychological needs had been identified in care plans where required. People told us that they had been involved in writing their care plans and that they reflected their current needs.

Is the service caring?

People were treated with respect and dignity by the staff. People were supported by kind and attentive staff. We saw that support workers showed patience and gave encouragement when supporting people. People we spoke with told us, “I really like the staff and we get to do some fun things like going to watch football."

People who used the service, their relatives, friends and other professionals involved with the service completed a yearly satisfaction survey. People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People knew how to raise a concern or complain if they were unhappy.

The service worked well with other agencies and services to make sure people received care in a joined up way.

People completed a range of activities in and outside of the service regularly.

Is the service well-led?

The service had a quality assurance system in place. Records seen by us showed that identified shortfalls were addressed promptly. We were therefore assured that the provider had taken steps to continually improve the service.

Staff told us they were clear about their roles and responsibilities and staff demonstrated a good understanding of the ethos of the service.

During our inspection, we met three people using the service. Not all the people we met were able to answer questions about the service because of their learning disability. However, their gestures, sounds and facial expressions indicated that they were happy and content with the staff and the care provided.

One person who was able to communicate verbally told us that they were going out to the local restaurant for lunch. We were told that two members of staff would be accompanying them.

We observed that staff interacted well with people, and understood each person's ways of communicating. The staff present had knowledge of people's preferences, and provided assistance appropriately.

We found that staff had managed medication administration appropriately. We noted that the premises had been well maintained, and people lived in a comfortable and clean environment.

During our site visit, we met five people using the service. They were not able to communicate verbally with us due to their learning disability. However, people's facial expressions, sounds and gestures indicated that they were happy and satisfied with the care and service provided.

One of the people had just returned from the local shops, accompanied by a member of staff. The person was unable to communicate with us verbally, but their facial expression showed that they had had a good time shopping.

We observed that staff were gentle in their approach, and interacted well with people. Staff showed that they understood each person's ways of communicating, had knowledge of their preferences, and had provided assistance appropriately.

During our site visit, we found that the premises and the surrounding grounds were well maintained, and provided a comfortable environment for people to live in.

During our visit, we spoke with five members of staff and looked at the care plans and records for four people. The people in the home were not able to engage in conversation so we observed how staff interacted with them. Not all staff interactions we observed were positive or for long periods, people did not have meaningful stimulation or interactions with staff. People's dignity and privacy was not always respected.

People's views and wishes about their care and support needs were not actively sought and recorded on their care plans and the home did not carry out mental capacity assessments for significant decisions about people's care.

People's care and support plans did not give staff clear guidance on people's needs and not all risk assessments had been completed. There were gaps in some records, for example, social activities. Not all care plans and records had been reviewed on a regular basis.

People's medications had been administered in accordance with their prescription from the GP.

There was not enough skilled staff on duty to ensure that people's needs were being met as there gaps in members of staff’s training to effectively meet people’s needs.

The provider did not have an effective system to regularly assess and monitor the quality of service that people receive as regular audits of the service and quality assurance surveys had not been completed.