About the service:

2 William Street is one of a number of small care homes provided by the organisation in and around the Chippenham area for four people with learning disabilities. At the time of the inspection there were three people accommodated.

People’s experience of using this service:

• There were a range of quality audits undertaken by the area manager and registered managers from other locations. However, internal audits were not consistent with all the findings from the inspection.

• People told us senior managers were approachable. Staff told us the team worked well together. The team was stable and long standing. They said the registered manager was approachable but there was a lack of management presence.

• People were not able to recall that support plans were in place to meet their need. Where people had attended the review meeting their names were included in the minutes. The recently introduced support plan format ensured staff identified future learning and goals. However, how to achieve outcomes identified were not made clear in the care plans. Some care plans were conflicting and lacked detail about how staff were to meet people’s identified needs.

• Risks were not clearly identified and detailed in care plans. Information gained about people that had identified risk was not used appropriately in the care planning. For example, risk assessments needed clarity on how they were to be reviewed.

• People told us the day to day decisions they made and who helped them with more difficult decisions. Staff were knowledgeable about the principles of Mental Capacity Act 2005 in relation to daily living decisions.

• Mental capacity assessments were not in place for all specific decisions. Where mental capacity assessments were in place, there was no evidence to show how the person was supported to make specific decisions. Best interest decisions were made before assessments of capacity were undertaken. Where relatives had power to make decisions, documentation about this was not checked.

• There were areas of the home that would benefit from better cleaning routines. Cleaning schedules were not in place.

• There were systems to support staff with developing their skills and discuss performance. Staff said one to one supervision with their line manager was “sporadic ” but the training matrix provided showed one to one supervision had occurred at the set intervals. Staff told us more specific training was needed to create an insight into how best to care for people with particular conditions.

• Medicine systems were managed safely. Medicine administration records (MAR) charts were signed to show medicines administered. Where medicines were not administered codes were used to detail the reasons. A record of medicines no longer required was maintained and signed by the pharmacist to evidence receipt of the medicines for disposal. However, the protocol for one person needed to be reviewed to reduce confusion on when to administer remedies and pain relief. We recommend that you seek guidance on how to develop PRN protocols for people that have over the counter medicines.

• The views of people, friends and families as well as professionals were gathered. People gave positive feedback about the service.

• People told us they felt safe with the staff. The staff we spoke with knew the types of abuse and to report their concerns.

• People told us the staff responded to their request for support and assistance. We saw adequate numbers of staff available to support people.

• People participated in menu planning and food preparation. People’s dietary requirements were catered for.

• People had access to healthcare services as required. The hospital passports were up to date.

• People we spoke told us they were able to maintain relationships with relatives and friends. We saw some good interactions between people and staff. .

• Activities were taking place. People arranged their daily activi

This inspection took place on 10 October 2015 and was unannounced. The last inspection took place on 15 May 2014 and no breaches of legal requirements were found at this time.

The home provides care and accommodation for up to four people with a learning disability. At the time of our inspection there were three people living in the home. There was a registered manager in place at the home. 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 registered manager told us they were about to embark on long term leave. However the organisation had arranged for a temporary manager to oversee the running of the home in the registered manager absence.

People in the home were supported by safe numbers of staff who were able to meet their needs, and people’s rights were protected in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People’s capacity was considered in decisions being made about their care and support and best interest decisions were made when necessary. Staffing levels were flexible to accommodate the needs of people and the activities they chose to do in their local community.

People were supported by staff who were kind and caring in their approach and were treated with dignity and respect. This was confirmed by speaking with people and the observations we made during our inspection.

Staff were trained in medicines management. Safe procedures and a policy was in place to guide staff to manage people’s medicines safely. Medicines that we checked matched the records that were kept.

People received effective care and were supported to access medical support when they experienced a change in their health needs. Referrals were made to external professionals as required.

People’s nutritional needs were met and people were supported to make choices and cook their own meals if they wished to, with staff support as required.

Staff felt positive about the training and support they received. They felt the training they received enabled them to fulfil their roles effectively.

People’s care and support plans were reflective of people’s needs and contained risk assessments that ensured the least restrictive options were considered. Support plans clearly identified people were given choices in their daily lives.

A detailed system was in place to monitoring the quality of the service that people received. This included a system to manage people’s complaints.

People’s feedback was sought on a regular basis to gain their views on the service they received.

The registered manager understood their legal responsibilities in relation to their role. This included reporting to CQC when they were going to be absent from the service for longer than 28 days.

One inspector visited the home and 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?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

Care plans instructed staff how to meet people’s needs in a way which minimised risk for the individual. People's diversity, values and human rights were respected. People were treated with respect and dignity by the staff.

Safeguarding procedures were robust and staff had a clear understanding of their responsibilities with regard to protecting the people in their care. There had been no safeguarding referrals made in 2013 or 2014. People told us they felt safe and told us: ‘‘we wouldn’t put up with being pushed around.’’

Mental Capacity Act assessments were included, as appropriate in all plans of care. Staff understood mental capacity, consent, choice and deprivation of liberties safeguards (DoLS). The home had not made any Deprivation of Liberty Safeguards referrals in 2013 or 2014. We saw that people had best interests meetings and advocates were involved in particular decision-making processes, as appropriate.

People were helped to take their medication, safely.

The home made sure it had a recruitment process which minimised the risk of employing staff who were not suitable or safe to work with vulnerable people.

Systems were in place to make sure that managers and staff continually monitored the quality of care offered to people. Health and safety was taken seriously by the home and all the appropriate safety checks had been completed. This reduced the risks to people and helped the service to continually improve.

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Is the service effective?

People were involved in their care planning and knew what actions would be taken to support them to meet their aims and objectives for the year ahead. One person described how they had been supported to participate more in community activities.

Three of the four people who lived in the home told us: ‘‘we are very happy living here.’’ ‘‘It’s a lovely home.’’

People’s health and care needs were assessed with them, and/or their relatives, as appropriate. They were involved in developing their plans of care if they chose to be. Care plans were detailed, they clearly identified people’s health and well-being needs and how they should be met.

Is the service caring?

People were supported by knowledgeable kind and patient staff. We saw that care staff interacted positively with people who used the service. We saw that they were sensitive to people’s moods and needs and approached them in a respectful and appropriate manner.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. Peoples’ individual interests were identified and used to enhance peoples’ lifestyle.

Is the service responsive?

People completed a range of activities in and outside the service regularly. Each person had an individual weekly activities plan, which met their current needs.

The home had made changes and improvements as a result of ideas and discussions with people who live in the home and their relatives.

People knew how to make a complaint if they were unhappy. Two people told us they knew who to complain to and were sure that the manager would: ‘‘quickly put things right.’’ The home had not recorded any complaints during the last 12 months.

Is the service well-led?

The service had a robust quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was being maintained or improved.

Staff told us that they had the support of a manager and could get assistance from ‘head office’, as necessary. We saw that the home had a stable staff group who had worked in the home for a number of years.

When we arrived at 2 William Street the house was calm as people were preparing to go out. We spoke with each of the people. One person told us they liked going to the pub and to cafes. Another person told us they had a good relationship with the staff who supported them and each person we spoke with told us they “get on well with staff”.

People had choices and were supported in making decisions. Arrangements were in place should they not have the capacity to make a choice. The home provided people with a safe and comfortable environment where they shared responsibilities for cooking and cleaning with support from staff. Staffing levels met people’s needs and enabled them to have one to one support. Records were kept that recorded the support people were given and provided guidance to staff on how to respond to people’s needs. People were given information about how to complain and the support they would receive in this area. People were happy living in the home and did not express any concerns. The home had not received any complaints.

The guide for people who used services gave information about staff including their qualifications and experience. It was in pictorial and written format and explained what people could expect. The guide also contained information about making a complaint.

One of the people we spoke with said that they liked living at 2 William Street and enjoyed their life. They said they got to do the things they enjoyed. People told us how they discussed and chose what to have at mealtimes. One of the people we spoke with told us they would speak with staff if there was anything troubling them.

One person was assessed as needing a specialist bed with rails at the sides. This was risk assessed to ensure it was in the person’s best interests.

One member of staff we spoke with told us they “love working here”. They had worked at the home for 22 years and spoke about the “longevity of relationships”. They told us they “couldn’t have better support”. Another staff member referred to the organisation as “approachable and person centred for staff”. They said they felt supported by the team and the registered manager.

We were told that the annual quality assurance survey was about to be sent to all people who used the service and their relatives and others such as people’s social workers and health professionals. We saw that this had been produced in two formats including an easy read version with pictures.

We spoke with two people who were living at 2 William Street. They told us that it was a “nice place to live”. They said that they were involved in decisions about their care and would speak to staff if they were unhappy about anything. People spoke about choices available to them including those related to food and opportunities. They told us that their friends and relatives were made to feel welcome and that they got on well with others living in the house.

We spoke with a relative of one person's relative. They said that the person had been with the organisation and it’s predecessor for 25 years and they thought that the service was “brilliant”. They said that as well as caring well for their relative, the service “had been like a friend” to them.