The Firs is a ‘care home’. People in care homes received accommodation and nursing or personal cars as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Firs accommodates eight people in one adapted building. 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 included choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the last inspection, the service was rated Good. At this inspection we found the service remained good.

There was a new manager in post who was in the process of being registered by the commission. They were supported by the provider who supported them on a day-to-day basis. 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.

People were safe because staff supported them to understand how to keep safe and staff knew how to manage risk effectively. There were sufficient numbers of care staff on shift with the correct skills and knowledge to keep people safe. There were appropriate arrangements in place for medicines to be stored and administered safely.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 and 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. Management and staff understood their responsibility in this area. Staff were committed to ensuring all decisions were made in people’s best interest.

Staff had good relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected at all times. People and their relatives were involved in making decisions about their care and support.

Care plans were individual and contained information about how people preferred to communicate and their ability to make decisions.

People were encouraged to take part in activities that they enjoyed, and were supported to keep in contact with family members. When needed, they were supported to see health professionals and referrals were put through to ensure they had the appropriate care and treatment.

Relatives and staff were complimentary about the management of the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service.

The management team had systems in place to monitor the quality and safety of the service provided.

The inspection took place on 31 July 2015 and was unannounced.

The Firs provides accommodation and personal care for up to nine people who live with a learning disability or autistic spectrum disorder. The service does not provide nursing care. At the time of our inspection there were eight people using the service.

A registered manager was in post at the service. 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.

People were safe because staff understood their responsibilities in managing risk and identifying abuse. People received safe care that met their assessed needs.

There were enough staff who had been recruited safely and who had the skills and knowledge to provide care and support in ways that people preferred.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider was following the MCA code of practice.

People’s health needs were managed appropriately with input from relevant health care professionals. Staff supported people to have sufficient food and drink that met their individual needs.

People were treated with kindness and respect by staff who knew them well.

People were supported to maintain relationships with friends and family so that they were not socially isolated.

There was an open culture and the registered manager encouraged and supported staff to provide care that was centred on the individual.

The provider had systems in place to check the quality of the service and take the views and concerns of people and their relatives into account to make improvements to the service.

Many of the people living at The Firs had complex needs and were unable or chose not to speak with us. We gathered evidence of people’s experiences of the service by observing how they spent their time and we noted how they interacted with other people living in the home and with staff.

We saw that people had individual ways of communicating and were able to make members of staff aware of their needs and preferences.

An advocate who had completed a survey as part of the home’s own quality assurance process said: “There is a very welcoming and friendly environment” and a healthcare professional said: “Staff are always very helpful and friendly.”

We noted that the environment at The Firs was spacious, with sufficient communal areas to meet the needs of people living there. We saw that people were comfortable in their surroundings.

We found that staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the specific needs of the people using the service. We saw that staff treated people with respect.

The Firs was well managed and the registered manager had put robust systems and processes in place to ensure people received a good service that took into account their needs and preferences.

We used a number of different methods to help us understand the experiences of people using the service. The people living at The Firs had complex needs which meant some of them were not able to tell us their experiences. Many people shared their views through gestures, facial expressions and body language, we spoke generally with some people and we observed how people interacted with one another and with members of staff.

We saw that people smiled and appeared relaxed and comfortable with staff and other people living in the home.

Relatives were complimentary about the service provided at The Firs; they made positive comments about the staff, the standard of care and the activities that people enjoyed. Comments about staff included, “The staff are excellent”, “The staff are very inspired and helpful”, “They are very attentive of [my relative’s] needs” and “I find the staff caring and have a rapport with the residents.”