The inspection took place on 7 August and was unannounced. The inspection continued on 8 August 2018 and was again announced.

Two Wells 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.

Two Wells is registered to provide accommodation for persons who require nursing or personal care. It is registered for up to four people with learning disabilities or autistic spectrum disorder. At the time of our inspection there were four people living in the home.

The home was a two storey detached property which had a kitchen and open plan dining and living area with a conservatory and utility area. There was one bedroom on the ground floor with a staff office/ sleep in room opposite the kitchen and three further bedrooms on the first floor.

The care service had been developed and designed in line with the values that underpinned 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 could live as ordinary a life as any citizen.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had not had a registered manager in post since January 2018. 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 manager had completed their pre-registration checks and had submitted their registered manager’s application to The Care Quality Commission.

People were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. When people were at risk of seizures or choking, staff understood the actions needed to minimise avoidable harm. The service was responsive when things went wrong and reviewed practices in a timely manner. Medicines were administered and managed safely by trained staff.

People had been involved in assessments of their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People had their eating and drinking needs and preferences understood and met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. 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 and their families described the staff as caring, kind and friendly and the atmosphere of the home as relaxed and engaging. People were supported to express their views about their care using their preferred method of communication and were actively supported to have control of their day to day lives. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs, their life histories and t

This inspection took place on 12 March 2016 and was unannounced. The inspection continued on 13 March and was announced.

The service is registered to provide personal care with accommodation for up to four people with learning disabilities. A person proudly showed us around their home. The service had an open plan living and dining room with a conservatory which led into an enclosed rear patio and garden area. There was one en-suite bedroom on the ground floor and a staff sleep-in room come office opposite the kitchen. There were a further three bedrooms on the first floor and a shared bathroom.

The service has a registered manager in place. 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 was safe because innovative and creative systems were in place for people to identify risks and feedback to staff what support they needed. People used visual templates to convey and communicate their support needs.

There were emergency evacuation plans in place for each person. These plans detailed how people should be supported in the event of a fire. There was a standard evacuation plan placed by the front door and a pictorial version for each of the people.

There were sufficient staff in place to provide the care and support people required. Employment checks were carried out so that appropriate staff were recruited who had the skills and knowledge required to fulfil the role. Staff were able to tell us how they would recognise signs of abuse and who they would report concerns to.

Medicines were stored and recorded appropriately. Regular audits were carried out and people were supported appropriately to manage their own medicines safely.

Staff were knowledgeable of people’s needs and received regular training which related to their roles and responsibilities. The organisation provided all new staff with a staff handbook during their induction period. This covered key topics such as attendance, benefits, policy summaries and code of practice. Staff received regular supervision and appraisals.

Staff had a good understanding of the principles of the Mental Capacity Act 2005 and demonstrated positive person centred approaches around obtaining consent from people. People’s capacity was assessed and best interest decisions recorded when appropriate.

People were supported using creative, accessible person centred tools to plan menus, learn about healthy eating, cooking and food shopping. A person told us, “I like food here; I cook tonight, fish and chips. I like chicken casserole. I take part in menu planning meetings and food shopping”.

People were supported to maintain good health through regular healthcare appointments. Records we reviewed showed that people had attended annual health checks including visits to their GP. and dentists. A health care professional told us, “Staff attend health checks with people and use approaches that promoted their independence”.

People were supported by staff who understood personalised care and practice. Staff were kind, empathic and had developed positive relationships with them which aided them to understand people’s individual needs.

The service was responsive to people’s changing needs and worked closely with people to review these to ensure they were at the heart of what support they received. People set their own goals and were supported to achieve these. The registered manager told us on several occasions that it was all about the people.

Complaints, concerns and suggestions were used in a positive way to review and develop the service. These were well managed and seen as a means of understanding how to improve people’s experiences.

The registered manager promoted an open, transparent

People received care that met their needs and promoted their well-being. People had care plans which told staff about the support they required and how to manage risks to their safety. People were supported to see their doctor and other health care professionals about their health needs. People who lived in the home told us that staff gave them the help they needed while enabling them to do things for themselves.

People's independence in their home and community was encouraged. People were supported to cook and clean for themselves. They were also supported to go to work and do activities of their choice. One person told us, "I like this place. I make drinks by myself. I make my own lunch. Staff listen to what I want."

People's medicines were managed safely. People received support with their medicines where they needed it. Where people could take their medicines themselves, they were supported to do this in a safe way. This helped ensure that people took their medicines as prescribed.

There were enough staff, with the right skills, knowledge and experience to support people who lived in the home. People told us that there was always a member of staff around when they needed them. They told us that staff knew how to help them. Staff told us that they received training, for example in emergency first aid and epilepsy, so that they had the knowledge and skills to meet people's needs.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were generally maintained. Records about people's personal care were stored securely.

During our visit, two of the people living at the home were attending a workshop and two people were at the service. One person told us about their experiences at the home. They said they were happy with the care and support they received and they were positive about the manager and staff team. The manager and one staff member were present during our inspection.

There was a calm and supportive atmosphere in the home and people appeared happy and relaxed as they went about their daily routines.

Each person living at the home had their own individual plan of care that included information about their personal, social and emotional needs and wishes. In order to meet the individual needs of each person, staff at the home worked with a variety of healthcare professionals including learning disability teams. We were shown that advocates and specialist consultants were used where appropriate.

People were protected from risk of abuse or harm because safeguarding policies and procedures were in place and staff knew how and when to use them should the need occur.

We saw that there was an experienced and caring staff team and that staff were well supported and trained appropriately. People were positive about the manager and staff and said they were kind and supportive.

Quality assurance audits were undertaken regularly to ensure that the home was kept under review and that families and professionals involved in people's care were kept up to date.

People told us that they were involved in decision making and their consent was obtained about how and when they received care. The people living in the home said that they are able to choose how they spend their time and are supported to access a range of activities. People told us that they are able to maintain contact with family and friends and develop significant relationships.

People said that they are involved in care planning and the plans are in a format that they understand.

People are protected from abuse by the training given to staff and adherence to correct procedures.

People living in the home receive their medication as prescribed and in a safe manner. They are supported to self medicate when able.

People are supported by adequate numbers of staff that are safely recruited, trained and competent to do their job.

The inspection took place on 6 and 10 November 2014. We announced the inspection the day before. This was because Two Wells is a small care home and we wanted to make sure that people would be available to talk with us.

Two Wells provides accommodation and personal care for up to four people with a learning disability. It is a detached house which is situated in a semi-rural village. People who live in the home have their own bedroom and there are shared areas including a lounge, dining room, kitchen, bathroom and gardens. At the time of our inspection, four people were living in the home.

Two Wells was last inspected in December 2013. No concerns were identified at that inspection.

The home had a registered manager. 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.

There were procedures in place to keep people safe. Staff knew how to report any concerns about people’s welfare. We found that, where a concern had arisen, staff had taken appropriate action to report this in line with local safeguarding procedures. However, the registered manager had not notified the Care Quality Commission about the incident as they are required to do by law.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Improvements were needed in relation to the implementation of DoLS to ensure decisions to deprive people of their liberty in the care home were made in people’s best interests.

People received the care they needed. Staff responded to changes in people’s needs and involved health care professionals when necessary. Risks to people’s welfare were assessed to help them be safe in their home and community. This helped ensure people could lead full and active lives.

People had caring and supportive relationships with staff. They told us that staff knew them well and listened to them. People were able to make choices about how they spent their time and make decisions about the running of their home. We observed that staff did things with people, rather than for people, to promote their independence. This helped ensure that people’s rights were respected.

There were arrangements in place to store and administer people’s medicines. Where people wanted to take their medicines by themselves, we found they were able to do this. Checks were carried out on medicines to make sure they were being given safely.

Staffing was arranged to meet people’s needs. Staff worked flexibly and received training and supervision to help ensure they understood people’s needs and their responsibilities. People told us there were enough staff to give them the support they needed.

People, and their relatives, told us they felt able to raise any concerns and felt confident the registered manager would listen to them. There was a clear management structure which meant that staff knew where to seek advice and support. The provider carried out checks on the quality and safety of the home to ensure that standards were maintained.