The Cottage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It provides accommodation for people living with a learning disability. The home can accommodate up to ten people. At the time of our inspection there were nine people living in the home. The Cottage is part of a larger site called Heath Farm, which consists of five other homes and an activity resource centre.

At the time of our inspection 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. In this report when we speak about both the company we refer to them as being, ‘the registered persons’.

At the last inspection the service was rated, ‘Good’. At the present inspection the service remained ‘Good’. At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. However, improvements were required in the 'well led' domain. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Suitable quality checks were being completed. However, these were ineffective. The refurbishment plan was behind schedule and previously identified issues had not been resolved. Where issues were identified it was not clear when issues would be resolved as dates for completion were not always in place.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. Background checks had been completed before new staff had been appointed.

Medicines were managed and administered safely. There were arrangements to prevent and control infections.

Where people were unable to make decisions, arrangements had been made to ensure decisions were made in people's best interests.

Staff had been supported to deliver care in line with current best practice guidance. People were helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have maximum choice and control of their lives and to maintain their independence. Staff supported them in the least restrictive ways possible and the policies and systems in the service supported this practice. People received person-centred care.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. Where appropriate people had access to lay advocates. Confidential information was stored securely.

Despite the service having significant vacant hours there was enough staff on duty at the time of inspection. Recruitment was ongoing and appropriate employment checks were in place.

Information was provided to people in an accessible manner. People had been supported to access activities and community facilities. The registered manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to in order to improve the quality of care.

There was a positive culture in the service that was focused upon achieving good outcomes for peo

We inspected The Cottage on 24 September 2015. The inspection was unannounced. The last inspection took place on 12 August 2014 during which we found the provider had met all of the outcomes we inspected.

The Cottage provides personal care and support to people who live with complex needs related to the autism spectrum, and learning disabilities. The service can accommodate up to 10 people and there were 10 people living there when we visited.

The Cottage is part of a larger site called Heath Farm, which consists of five other homes, an activity resource centre and a main administrative office. It is located within the Scopwick area of Lincolnshire.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are 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. At the time of the inspection 10 people who lived in The Cottage had their freedom restricted and the provider had acted in accordance with the Mental Capacity Act, 2005 DoLS.

People were supported to make decisions and choices for themselves wherever they were able to. Where this was not possible staff used the correct legal safeguards to ensure people’s rights were protected. People were encouraged to share their views and opinions wherever they were able to, although the registered manager and provider’s representative recognised that the current formats for gathering people’s views and assisting them to make complaints could be improved.

People were safe living within The Cottage. Identified risks to their safety and well-being were planned for and well managed. Staff knew how to identify and report any concerns for people’s safety and welfare and they were trained to manage medicines safely and appropriately.

People received individualised care and support from staff who were recruited, trained and supported appropriately. Vacancies within the staff team were effectively managed to ensure people received the support that was planned for them. People had good access to health care and their nutritional needs were fully supported to enable them to lead a healthy lifestyle.

People were treated with respect by staff who displayed a caring and warm approach to supporting them. They were able to maintain and develop their personal skills and were supported to enjoy a varied social life. Their privacy and dignity was maintained by staff who demonstrated a detailed understanding of each persons preferred lifestyle and needs. People’s private spaces within the home were personalised to their tastes and needs.

Systems were in place to maintain and improve the quality of the services provided for people. The registered manager and the provider’s representative ensured services were provided in line with good practice guidance and up to date approaches to care.

Our inspection team on this occasion was made up of one inspector. We considered our evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who use the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

Regular checks were undertaken to ensure the environment was safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care home. One application had been submitted, proper policies and procedures were in place.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly. Therefore people were not put at unnecessary risk.

The registered manager ensured safety checks were completed for staff prior to their commencement of employment.

Staffing levels were adjusted as people's needs changed and the staff liaised with the commissioners of services.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Relatives and people who used the service told us staff discussed people's needs with them. Relatives told us they had attended best interest meetings to review changes in family members needs.

People's needs were taken into account with signage and the layout of the service enabling people to move around without difficulty and safely.

People told us they could express their views at group meetings, meetings on a one to one basis and by completing surveys.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People commented, "I like it here" and "Staff are nice." One relative told us, "I know my family member is happy here as they run in to greet staff after a weekend away."

People who used the service, their relatives, friends and other professionals involved with the service attended meeting throughout the year. Where shortfalls or concerns were raised these were addressed. People told us they felt their opinions were valued.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People received their prescribed medicines.

Is the service responsive?

People who used the service and relatives told us they could speak with staff each day and share their concerns. They told us staff acted quickly. Relatives told us they could speak with staff about their family member's needs, when that person could not make decisions for themselves.

Is the service well-led?

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

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed.. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

We were not able to talk with people in detail about their experience of living at the home due to their complex communication needs. We therefore used a number of different ways to help us understand their experiences. For example, we spent time observing the care people received and talking to staff and managers who looked after people. We also looked at a range of records kept in the home.

We saw people were comfortable and relaxed in the company of staff. Some people indicated by sign language that they were happy living in the home and liked the staff.

Staff provided support to people in a respectful and professional way. They followed care plans at all times and demonstrated a detailed knowledge of people’s needs, likes and dislikes. We saw they received the right training to do their job.

Staff made sure people had a good diet and were generally protected from the risk of infections. They did this by following the right guidance and involving other professionals in planning and delivering care.

We found some areas of the building could pose an infection control risk. However, the provider showed us they had already identified these issues and had clear and timely plans in place to manage the risks.

We used a number of different ways to help us understand the experiences of people who used the service. This was because some people had complex needs which meant that they were not able to tell us about their experiences.

We saw that people who lived in the home received individualised care and support, from staff that were knowledgeable about their needs, wishes and preferences.

Staff clearly understood each person’s way of communicating their needs and wishes. They supported them to make choices and decisions about their lifestyles wherever they could do so.

We were unable to gain people’s views about the services they received, so we used other methods such as observing how they were supported, we looked at their care records, and we spoke to staff.

We saw that staff supported them in a respectful and dignified way, and that they followed the care that was set out in people’s plans.

We saw that people were given support to make choices and decisions for themselves wherever they could do so.