This was an unannounced inspection that took place on 30 August 2017.

The home provides personal care and support for up to six adults with learning disabilities and the service is managed by United Response. The home is in Whitton, Middlesex.

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 and associated Regulations about how the service is run.

In May 2015, the home met all the key questions and was rated good in each with an overall good rating.

As people had limited verbal communication relatives spoke on their behalf. We also based our findings on observation of the care provided and people’s responses to it. Relatives told us the home provided a good service, its staff were friendly, hospitable and well-trained and people enjoyed living at Kneller Road. Staff supported people to choose and engage in the activities they wished. These were group and individual. The activities took place at home, in the local community and there were also trips out. The home was well maintained, had recently been redecorated and there was new furniture in the communal area. People’s rooms decorated in the way they wanted them. The home provided a safe environment for people to live and work in. The home’s atmosphere was warm, comfortable and inclusive.

The home had records that were comprehensive and kept up to date. These included care plans and risk assessments that contained clearly recorded, fully completed, and regularly reviewed information that enabled staff to perform their duties and people to live safely.

Staff were equipped with appropriate skills and training and provided person centred care. They supported people in a professional, friendly and caring way. The staff were very knowledgeable about the people they worked with and the field they worked in. They had access to good support and career prospects.

During our visit people were enabled and supported by staff to enjoy themselves and this was made visible by smiling faces. Staff knew when people were experiencing anxiety or discomfort and took appropriate measures to make them comfortable and calm.

Relatives said staff informed them of any changes to people’s care including health needs. Staff supported people to access community based health professionals. People were protected from nutrition and hydration associated risks with balanced diets that also met their likes, dislikes and preferences. Relatives said people had good choices of meals and were encouraged to try new things.

Relatives told us the management team were approachable, responsive and encouraged feedback from people. There were processes to consistently monitor and assess the quality of the service provided.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Our inspection team was made up of an inspector who answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

Is the service safe?

We saw that staff treated people with dignity and respect during our visit and the home had a friendly, relaxed and inclusive atmosphere. People said and we saw that they enjoyed living at the home, the staff were very supportive and people were safe living there. One person said "Staff are nice". We saw that the safeguarding procedures were robust, the training staff received was appropriate and they understood how to safeguard people individually and as a group. Any areas or circumstances of concern identified regarding individual people was recorded in the sample of two care plans we looked at.

The organisation had systems that ensured the manager and staff learnt from accidents and incidents, listened to people's concerns, complaints, whistleblowing and investigations. This reduced risks to people and helped the service to improve.

The home had policies and procedures that adhered to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Training was provided for relevant staff to understand when an application should be made and how to submit one. People living at the home had recently been re-assessed under (DoLS) and appropriate applications made and approved. This meant that people and their rights were safeguarded.

We walked around the building, garden and saw that the home was safe, clean and hygienic with well-maintained equipment that was regularly serviced. This meant people were not put at unnecessary risk.

People’s individual care and support needs were taken into account by the manager when making decisions regarding the required numbers of staff on each shift, that included skills, experience and qualifications. This was reflected in the staff rota and ensured that people’s needs were met.

No staff were currently subject to disciplinary action and policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

The home assessed people’s health and care support needs with them and they were supported to contribute as much as they wished to their care plans. Any specialist care and support required such as diet, mobility or equipment needs were identified in people's person care plans. A sample of two care plans we saw indicated that people had been involved in the care planning process.

The layout of the service enabled people to move around freely, safely and there was suitable equipment to support them to achieve this.

The visiting policy and visitors' book demonstrated that people were able to see their visitors in private and that visiting times were flexible.

Is the service caring?

We saw that people were supported by kind, professional and supportive staff. The staff were patient and encouraged people to give their opinions. People said, "I've been shopping” and "I go to rugby at Twickenham stadium".

People and their relatives completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed by the manager and organisation.

The care plans we saw recorded people’s preferences, interests, aspirations, diversity and demonstrated that care and support was provided in accordance with this information.

Is the service responsive?

During our visit people told us about the various activities they were engaged in. They participated in these either individually or as a group depending on the nature of the activities and their interest in them. The home had access to transport, that enabled people to be involved in activities within their local community and further afield.

Is the service well-led?

We saw that the manager and staff listened to people's needs, opinions and acted upon them. The service worked well with other agencies and services to make sure people received seamless support. This was demonstrated by the relationship the home had with community based health services.

Appropriate notifications were made to the Care Quality Commission.

During our inspection we met three people who lived at 131 Kneller Road. We were not able to speak with people who used the service because they had a number of complex needs, meaning that it was difficult for people to tell us about their experiences. We spoke with relatives of two people living at the home and they told us "The staff are very good and keep us informed of changes". Another relative told us "We get invited to special events at the home".

We asked staff to describe how they sought consent from people at the home. One staff member told us "It's important that there is effective understanding between staff and people living at the home".

During our inspection we viewed two support plans, two health action plans and records relating to people's assessed needs. The support plans were individualised and included details about the care, support and treatments people required. We checked the Medicine Administration Records (MAR) charts of all of the people living at 131 Kneller Road and these were complete.

We looked at recent records relating to the recruitment of staff, which demonstrated that policies and procedures had been followed when recruiting and employing staff.

We looked at the Complaints policy which covered accessible information, how to complain and descriptions and definitions between complaints, comments and concerns, which meant that information was available to help support people if they wanted to raise any issues.

We spoke briefly with three people living at United Response, 131 Kneller Road. Not everyone we spoke with was able to tell us about their experiences and some people's responses did not relate to the standards we were inspecting. We met four staff and spoke with the manager of the home.

We visited the home on the 29th August 2012 and found that the home was not meeting two of the regulations. Some parts of the home required maintenance and we found that some parts of the home were not as clean as other areas in the home. We returned to the home on the 5th December to check on whether the home had taken action to address these points. The registered manager informed us that all outstanding actions and work had been completed and that the home had benefitted from two new radiators, new automated hand soap dispensers and paper hand drying towels housed in their own dispensing units. We also saw that outstanding maintenance work had been completed and that areas across the home were clean, tidy and well maintained.

We haven’t been able to speak with all people using the service because some of the people using the service had complex needs which meant that they were not all able to tell us their experiences.

We spoke with one person using the service and one relative of another person living at 131 Kneller Road. The relative explained how staff supported people and cared for those living at the home. “The staff are very good and I can discuss matters with them and be involved in what happens.” “The staff are very helpful and do their best for people living at Kneller Road, they understand what people like and dislike and know them well.”

The manager was on annual leave on the day of the inspection. We spoke with four staff and asked them questions about the home and how they understood and met people’s needs. They told us that they were key workers to each of the people living at Kneller Road and provided support, advocacy and care.

Staff provided information and explanations about the care, wellbeing and support that people received and described their role in helping people to fulfil their goals and contribute to their aspirations.

We met all the people who live at 131 Kneller Road. Although the majority of people cannot communicate verbally, they appeared relaxed and happy. The staff supported them in a kind and caring way. Some of the people who live at the home told us that they were happy and well cared for. They told us that they did the things they wanted to and that the staff helped them with this.

This was an unannounced inspection that took place on 22 and 26 May 2015.

The home provides personal care and support for up to six adults who have a learning disability and is run by United Response.

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 and associated Regulations about how the service is run.

In June 2014, our inspection found that the home met the regulations we inspected against. At this inspection the home met the regulations.

People who use the service and their relatives told us a good service was provided by the home, its staff and they enjoyed the environment they lived in. People were supported to choose and engage in the activities they wanted to do by staff. The activities were both individual, group and provided people with the opportunity to develop relationships within the local community as well as at home. The home was well maintained, furnished, clean and provided a safe environment for people to live and work in. The home’s atmosphere was warm, comfortable and enabling.

The records were comprehensive and kept up to date. This included care plans and risk assessments that contained clearly recorded, fully completed, and regularly reviewed information that enabled staff to perform their duties and people to live in a safe environment.

The staff had appropriate skills, training and were focussed on providing individualised care and support in a professional, friendly and supportive way. Those we spoke with were very knowledgeable about the people they worked with and the field they worked in. They had access to good training, support and career advancement. During our visit people were enabled and supported by staff to enjoy themselves, in a safe way and there was a lot of smiling and laughter.

Relatives told us they were kept informed of any changes in people’s care and support including health needs. People were protected from nutrition and hydration associated risks with balanced diets that also met their likes, dislikes and preferences. Relatives were positive about the choice and quality of food available. Staff also supported people to access community based health professionals, as required. During our visit staff knew when people were experiencing discomfort or anxiety and took appropriate action to make them comfortable and less anxious, in a calming way. Relatives also said the management team at the home were approachable, responsive and encouraged feedback from people. There were processes to consistently monitor and assess the quality of the service provided.