The inspection took place on 15 December 2016 and was announced.

The Palms is registered to provide accommodation and personal care for up to seven people who have a learning disability or autistic spectrum disorder.

There was a registered manager in post at the time of our 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

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. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. Four people living at the service had been assessed to have their freedom lawfully restricted under a DoLS authorisation and were waiting on the DoLS authorisation to be issued.

Staff undertook appropriate risk assessments for all aspects of a person’s care to keep them safe from harm inside and outside of the service. Care plans were developed to support people’s individual needs. Staff knew what action to take and who to report to if they were concerned about the safety and welfare of the people in their care. People received their prescribed medicine safely from staff that were competent to do so. The registered provider ensured that there were always sufficient numbers of staff on duty to keep people safe.

People were supported to have a healthy and nutritious diet and hot and cold drinks and snacks were available throughout the day. People had their healthcare needs identified and were able to access healthcare professionals such as their GP and dentist. Staff knew how to access specialist professional help when needed. People had insight into their health needs and could tell us about the things treatment and care that made them feel better.

People were at the centre of the caring process and staff acknowledged them as unique individuals. Relatives told us that staff were kind and caring and we saw examples of outstanding care practice. People were always treated with dignity and respect. People were cared for by staff that were supported to undertake training to improve their knowledge and advance their skills to enable them to perform their roles and responsibilities effectively.

People were supported to have an active life and were encouraged to take part in hobbies and interests of their choice. Relatives commented that their loved ones were well looked after and their wellbeing had improved since moving into the service.

People where able were supported to make decisions about their care and treatment and maintain their independence. People had access to information in an easy read format about how to make a complaint. Relatives told us that they could approach staff with concerns and knew how to make a formal complaint to the provider.

The registered provider had robust systems in place to monitor the quality of the service and make improvements. Staff had access to professional development, supervision and feedback on their performance. People, their relatives and staff found the registered manager approachable.

During our inspection we met and spent time with three young adults who received a service. Our direct communication was limited by people’s experience of learning disability and autism. We spoke with two relatives, two support workers and the registered manager.

Relatives told us they were happy with the service provided. One relative complimented staff’s commitment and ability to communicate and understand the needs and wishes of their relative stating, “They get on their wavelength.” Another told us their relative was “Happy to be there and stay there”

We saw care was planned on the basis of assessments of individual care needs for people which reflected the wishes and aspirations of people who used the service. We observed that care was delivered by care staff with warmth and in a way that protected people’s privacy and confidentiality.

People told us that they knew how to raise concerns and complaints. One relative told us “They listen to xxx and they listen to us”

We saw that medicines were managed and administered safely. Staff told us that they felt supported to deliver effective care by good management, peer support and training opportunities.

We noted that care records were well written and organised and the secure storage of these records protected people’s privacy and confidentiality.

On the day we visited four people were living in the home and we spoke with all of them, two members of staff and a visiting health care professional.

People in the home said they were treated with dignity and respect and supported to be as independent as possible. They said they had access to all the leisure activities they wanted although one person told us they wanted to go to church. The operations manager said she would arrange this for them.

People told us they liked living in the home, they felt safe and staff were kind and friendly and knew what they were doing. They also said they could get access to a doctor or other health professional if they needed to.

People also said they knew what to do if they wanted to complain about anything and felt sure something would be done about it.

People told us they were asked for their opinions about the home. We saw evidence that the quality of care in the home was monitored.