The inspection took place on 1 October 2018 and was unannounced. 9 Blunt Street is a care home that provides accommodation with personal care and is registered to accommodate four people. It provides a service to younger adults with a learning disability and complex needs.

The accommodation at 9 Blunt Street consists of a lounge, a sensory room, a kitchen with dining facilities and four personalised bedrooms. The service has a vehicle people can use and there are good links to public transport and local community facilities. At the time of our inspection four people were using the service.

9 Blunt Street 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. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection in November 2016, 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 ongoing 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 remained safe. People were protected from the risks of abuse because staff understood where harm may be caused and took action when people were at risk. Where staff were concerned about their safety they knew who to speak with. People were supported to take risks at home and when out and encouraged to be independent and learn new life skills. Risks were assessed and reviewed to keep people safe and protect them from avoidable harm.

People kept their medicines in the bedroom and were helped to understand what their medicines were for. Staff knew why people needed medicines and when these should be taken. Staffing were organised flexibly to enable people to be involved with activities and to do the things they enjoyed.

People still had good effective outcomes and had access to food and drink that they liked. People’s health and wellbeing needs were monitored and they were supported to organise and attend health appointments as required.

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 support this practice. People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. Staff sought people’s consent before they provided care and they were helped to make decisions which were in their best interests. Where people’s liberty was restricted, this had been done lawfully to safeguard them.

People received personalised care and staff were confident that they assisted people in the way they wanted. Staff knew people’s likes and dislikes and care records reflected how people wanted to be supported and how care was provided. Staff respected people’s privacy and dignity, encouraged people with making choices, and promoted independence. People could have an advocate to help them to make important decisions.

The service remained caring and people were treated with kindness, compassion and respect and staff promoted people’s independence. The staff had developed good relationships with people and helped them to maintain relationships with their families and friends. Staff recognised where people may be unhappy and expressed dissatisfaction. Relatives knew how to complain about their care and concerns were responded to.

The provider and registered manag

This unannounced inspection took place on 19 January 2016. The service was last inspected on 4 November 2013 when all standards were met and no concerns were identified.

9 Blunt Street is a detached house in a small village development. The service offers personal and social care to four people with a severe learning disability with associated conditions that include autism, sensory and physical disability and behaviour that may challenge others.

The service had a registered manager. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

People were kept safe because staff understood their responsibilities should they suspect abuse was taking place and knew how to report any concerns they had. Potential risks to people’s safety had been assessed and measures had been put in place to mitigate these risks. There were enough staff on duty to keep people safe and meet their needs. Accidents and incidents were monitored and analysed to reduce the likelihood of recurrence. There were plans in place to ensure that people’s care would not be interrupted in the event of an emergency.

People’s medicines were managed safely, in accordance with current regulations and through guidance for staff, who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People received consistent care and support from an established staff team who knew and understood their needs. They were happy, comfortable and relaxed with staff and said they felt safe. They received care and support from staff who were appropriately trained and confident to meet their individual needs and they were able to access health, social and medical care, as required. There were opportunities for additional staff training specific to the needs of the service. Staff received one-to-one supervision meetings with their manager. Formal personal development plans, such as annual appraisals, were also in place.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s best interests had been considered when they needed support to make decisions and applications for DoLS authorisations had been submitted where restrictions were imposed to keep people safe.

People were protected from risks associated with eating and drinking as their nutritional needs were assessed and any specific dietary requirements were managed effectively. Staff enabled people to make informed choices about what they ate and supported them to maintain a balanced diet. People were supported to maintain good health and to obtain treatment when they needed it. The service had effective relationships with healthcare professionals, which ensured people received the care and treatment they needed in a timely manner.

People were supported with patience, consideration and kindness and their privacy and dignity was respected. Staff made sure people had the information they needed to make informed choices and to understand information that was important to them. People were supported to maintain relationships with their friends and families.

Safe recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Such checks helped to ensure new staff were safe to work within the care sector.

There was a formal complaints process in place. People and their relatives were encouraged and supported to express their views about the care and support provided and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

Due to people’s communication skills they were unable to tell us about their experiences of care. We observed staff supporting people on a one to one basis throughout our visit.

Information was recorded in the support plans regarding people’s capacity to make decisions. Where it was identified that people lacked capacity to make decisions information was recorded on how people’s needs were to be met in their best interests.

People’s family members we spoke with were positive about the service, comments included, “x seems happier now than previous care services they have lived at.” This person told us that their relative always seemed happy to return to the service and said, “they see the service as their home, which is reassuring.”

People’s method of communication was recorded in their support plans. This ensured staff could support people according to their preference and choice.

Support plans provided clear and up-to-date information that was tailored to meet people’s needs and preferences. People’s cultural and spiritual preferences were also included in their support plans.

Sufficient numbers of staff were on duty to ensure people’s needs were met effectively.

There were four people living at 9 Blunt Street when we visited. Due to people’s communication skills they were unable to communicate their experiences of care to us. We observed staff supporting people on a one to one basis throughout our visit.

From our observations and discussions with staff, it was clear that they had a good understanding of people’s support needs. The relationship between staff and the people using the service was positive and it was evident that people felt comfortable with the support they received.

People’s family members we spoke with were very positive about the service, comments included, “ the staff understand people’s needs, they are all treated as individuals in their own right, I think the support provided is excellent. “

People’s method of communication was recorded in their support plans. This ensured staff could support people according to their preference and choice.

Staff training records demonstrated that staff were provided with all areas of mandatory training and training specific to the needs of the people using the service. The records seen confirmed that updates were provided as required.

The provider had systems in place, that were managed effectively to monitor the care and services provided, and to identify and manage risks to ensure the service was run safely.

Because of the degree of learning disability exhibited by all of the people living at he home, we did not speak directly to them about their lives there.

The manager and staff told us how the services and support provided at the home had steadily improved with better resources – financial and people – being made available. This is particularly well demonstrated in better care documentation and records that were genuinely aimed at a ’person centred approach’, continuous improvements in the quality of the premises and more individualised decorating and refurbishments, and improved staffing levels.

The latter has lead to staff being able to ’offer a wide range of activities which have increased satisfaction levels and reduced negative behaviours’.

We were given many examples of the range of activities the people living at the home enjoy and although day centre attendance has continued for one, everybody has at least one day when they are supported to enjoy activities from home. New activities are continually being tried and staff enjoy opportunities to discuss and analyse successes as well as failures.