This was an unannounced inspection which took place on 29 November 2017.

Tova is a care home without nursing which is registered to provide a service for up to eight people with learning disabilities and associated physical disabilities. Some people had other associated difficulties such as being on the autistic spectrum. There were seven people living in the service on the day of the visit. All accommodation is provided on a ground level building which is located on a village style development together with other homes located nearby.

At the last inspection in October 2015 the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good:

There is a registered manager running 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.

The service remained safe. People’s safety was contributed to by staff who had been trained in safeguarding vulnerable adults and health and safety policies and procedures. Staff understood how to protect people and who to alert if they had any concerns. General risks and risks related to the needs of individual people were identified and appropriate action was taken to reduce them.

There were enough staff on duty at all times to meet people’s diverse, individual needs safely. The service had a stable staff team. When recruit new staff were recruited they had systems in place to ensure, that as far as possible, staff recruited were safe and suitable to work with people. People were given their medicines safely, at the right times and in the right amounts by trained and competent staff.

The service remained effective. Staff were well-trained and able to meet people’s health and well-being needs. They were able to respond effectively to people’s current and changing needs. The service sought advice from and worked with health and other professionals to ensure they met people’s needs.

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 practise.

The service continued to be caring and responsive. The dedicated, attentive and knowledgeable staff team provided care with kindness and respect. Individualised care planning ensured people’s equality and diversity was respected. People were provided with a wide variety of activities, according to their needs, abilities, health and preferences.

The registered manager was highly regarded and respected. The very good quality of care the service provided continued to be assessed, reviewed and improved, as necessary.

Tova is set in the grounds of Ravenswood village. Ravenswood was set up in 1953 to provide education and accommodation for people with learning disabilities. People living at Ravenswood come from many different backgrounds with the Jewish culture being at the centre of Ravenswood’s ethos. Tova offers care and accommodation for up to eight people with learning disabilities and physical disabilities. At the time of our inspection there were six people living in the home.

The inspection took place on 17 October 2015. This was announced inspection. As we were visiting the service on a Saturday we rang the day before the inspection to ensure that there would be someone at home on the day of our visit.

A registered manager was employed by 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.

We observed staff interacting with people in a kind and friendly manner, involving people in choices around their daily living. Staff sought permission before providing care and support and ensured people knew what was going to happen at all times.

Staff monitored people’s physical and emotional wellbeing and ensured support was in place to meet their changing needs. Where necessary, staff contacted health and social care professionals for guidance and support.

Staff had received training in how to recognise and report abuse. All staff were clear about how to report any concerns they had. Staff we spoke with were confident that any concerns raised would be fully investigated to ensure people were protected.

People had access to food and drink throughout the day and were supported to maintain a healthy diet.

Staff told us they felt supported. Staff received training to enable them to meet people’s needs.

There were enough staff deployed to fully meet people’s health and social care needs. The registered manager and provider had systems in place to ensure safe recruitment practices were followed.

The registered manager and the provider had systems in place to monitor the quality of the service provided. The legal requirements on the service, such as protecting people’s liberty, were understood and met by the management team and staff. People’s rights were therefore recognised, respected and promoted.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

At the time of our inspection six people were living at Tova. Although we spoke with people who use the service, they did not use verbal communication, and so were unable to inform us verbally of their opinions of the care they received. We observed their support and interaction with staff, and used this information to inform us about their care experience. As part of this inspection we also spoke with two people’s relatives, the registered manager, a deputy manager and three care workers. We reviewed records relating to the management of the service, including three people’s care plans and daily care records.

Tova is one of a group of residential homes providing care and support to people within a village environment known as Ravenswood Village. It was run primarily for those of Jewish faith, but people and staff did not have to be Jewish to live or work there. People were supported to practice their faith, and the village celebrated Jewish rituals and festivals. People had the choice of whether they wished to attend the synagogue or follow Jewish rituals.

Below is a summary of what we found. The summary describes what people using the service, their relatives, the staff and our observations told us, and the records we looked at.

Is the service caring?

One relative told us “The care in Tova is excellent”. Another relative told us “I am overwhelmed with the fantastic care X receives”. One deputy manager told us “We are all comfortable with each other, and chat together, staff and residents”. Care workers we spoke with often referred to the service as “Our family”.

We saw staff involved people in chat and activities in the service, and recorded people’s reactions to meals and activities. This helped them to assess people’s enjoyment or otherwise, and alter meals and activities according to people’s preferences.

Staff were respectful when supporting people, and took care to promote their dignity. They assisted people in accordance with their care plans, but encouraged people to be as independent as possible, through choice and supported tasks and activities.

Is the service responsive?

We observed that the service was responsive to changes in people’s needs or wishes. Staff understood people’s gestures, facial expressions and vocalisations. This helped them to understand when people were happy, anxious or in pain. Staff responded promptly if they thought people were not satisfied with their care, or if their health or wellbeing had been compromised.

Care plans documented people’s care needs and wishes. We saw that care plans had been updated when people’s needs or wishes had changed. For example, if medication was altered by the GP, staff documented any changes to the person’s mood or behaviour, and addressed issues identified with the support of health professionals. This meant staff responded quickly to promote people’s health and wellbeing.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We spoke with the registered manager who demonstrated that they were aware of the recent case law in relation to DoLs, and were reviewing whether applications for people were required with this in mind.

Is the service safe?

One relative told us “I couldn’t want better care for X”. They stated they believed their loved one was in safe hands. Staff understood each person’s health and support needs, and communicated effectively to ensure changes had been documented and were known by all staff.

Staff had been trained to support people safely, and we observed they followed guidance provided by health professionals, such as the speech and language therapist. This meant that risks had been identified and assessed. Measures were in place to reduce the risk of harm to people and others.

Staffing levels were sufficient to meet people’s needs and wishes. We saw that people’s dependency needs had been assessed, and there were sufficient staff on duty to meet these.

Equipment was maintained and serviced in accordance with the manufacturer’s guidance. Care workers had been trained to use the equipment provided, and were competent in its use. This meant that people had been protected from potential risks caused by poorly maintained equipment or its inappropriate use.

Is the service effective?

We found the service was effective. They sought feedback from people and relatives, and acted on the information received. For example, we saw meals and activities had been planned in accordance with people’s known preferences, but had been changed in response to their reactions if they indicated displeasure.

The provider had systems in place to assess and monitor the quality of the service provided. They identified, assessed and managed risks to the health, safety and welfare of people who use the service and others. Reviews and audits of documents, internal checks, equipment servicing and staff learning ensured people were supported safely.

Is the service well led?

We found the service was well-led. Relatives and staff spoke positively about the registered manager. Staff told us they felt supported, and understood the provider’s policies and health professionals’ guidance. They said they had appropriate training and support to understand their roles and responsibilities.

We saw the provider’s guidance, policies and procedures were available on line and where appropriate had been displayed in the service. This meant that staff had access to protocols to promote the safety and wellbeing of the people they supported.

We were unable to gain verbal feedback about the quality of services provided from the people who live at the home as they had limited verbal skills. However, we spent time observing how staff were interacting with people who live there. We saw staff were patient and courteous when dealing with people. They offered appropriate choices in relation to everyday life. We saw and heard staff treating people with dignity and respect, addressing people in friendly manner which respected people as unique individuals. Staff provided personal care to people in a discrete and sensitive manner.

We spoke with two people's relatives about the quality of care provided by the home. One person told us the care was "excellent, it couldn't be better". A second person told us they felt the home should liaise more closely with families and felt that at times staff did not communicate with relatives effectively.

We saw the service had systems in place to monitor their own compliance with the regulations. A robust complaint and quality assurance system was in place which sought peoples views about the quality of the service provided.

Peoples consent to care and treatment was appropriately sought before care and treatment were provided. People experienced safe and appropriate care that was effectively documented.

Staff were skilled, trained and knowledgeable and understood the need to safeguard people from abuse and exploitation.

People who lived in Tova had complex needs which meant they were unable to communicate their views to us on the day of our visit. However, we used a number of different methods to help us understand the experiences of people that used the service.

We observed interactions between people who lived and worked at the home and have

included our observations in this report.

We spoke with two relatives of people who lived at the home. Both confirmed they felt the home was providing a good quality service. One person said "it’s a good home"; "staff always do their best". Another said, "staff are approachable and kind".