Upfield is a residential home which provides care and accommodation for up to six adults with learning disabilities including autism. On the day of our inspection six people were living in the home. People had varied communication needs and abilities. Some people were able to express themselves verbally; others used body language to communicate their needs. Some of the people needed more support as they could become distressed and anxious.

There was 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 registered manager and the provider was the same person. The registered manager was not present on the day of the inspection as she was supporting people on holiday. Instead we were supported by a manger from another of the Providers service

At the last inspection on 15 May 2015, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good

People were safe because staff understood risks involved in people’s care and took action to minimise these risks. There were sufficient staff on duty to ensure that people received the care they needed and to keep people safe. Staff understood their roles and responsibilities in keeping people safe and protecting them from harm and abuse. The registered manager carried out appropriate pre-employment checks before staff started work.

Medicines were managed, stored and administered safely. Accidents and incidents were recorded and reviewed with a plan in place to minimise the risk of them occurring again.

People’s care was provided by regular staff that knew their needs well and provided support in a consistent way. Staff had access to the induction, training and support they needed to do their jobs. People’s choices and views were respected. Care was provided in the least restrictive way to people.

People were supported to eat food they enjoyed and were encouraged to maintain a healthy diet. Staff were aware of dietary restrictions involved in people’s care. People’s health and well being were managed as they had access to the appropriate health and social care professionals. People who had on-going conditions were supported to see specialist healthcare professionals regularly.

People enjoyed living at the home and had developed positive relationships with staff. Staff treated people with respect and maintained their privacy and dignity. People were supported to maintain relationships with their friends and families and were able to invite guests whenever they wished. People were encouraged to be independent and were supported by staff to learn and develop new skills.

People and their relatives were encouraged to give their views about the service they received and the registered manager responded positively to feedback. People had access to activities they enjoyed and had opportunities to enjoy an active social life. People were involved in their local community.

The registered manager provided good leadership for the service. They were experienced in their role and communicated well with people, relatives and staff. Staff felt valued and had access to support and advice from the registered manager if they needed it. Staff shared important information about people’s needs effectively. Team meetings were used to ensure staff provided consistent care that reflected good practice.

The registered manager’s quality monitoring checks ensured people received safe and effective care and support. Staff worked co-operatively with other professionals to ensure people received the care and treatment they needed. Records were well organised and up to date.

Further information is in the detailed findings below.

Upfield is a residential home which provides care and accommodation for up to six adults with learning difficulties including autism. The home a detached house is located in Horley. On the day of our inspection six people were living in the home. People had varied communication needs and abilities. Some people were able to express themselves verbally; others used body language to communicate their needs. Some of the people’s behaviour presented challenges and was responded to with one to one support from staff.

This inspection took place on 15 May 2015 and was unannounced.

The home was run by a registered manager, who was present on the day of the inspection visit. ‘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.

Staff had written information about risks to people and how to manage these. We found the registered manager considered additional risks to people in relation to community activities and changes had been reflected in people’s support plans.

The service was creative in the way it involved and worked with people, respected their diverse needs, and challenges discrimination. It seeks ways to continually improve and puts changes into practice and sustains them.

Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. One staff member said they would report any concerns to the registered manager. They knew of types of abuse and where to find contact numbers for the local safeguarding team if they needed to raise concerns.

Care was provided to people by a sufficient number of staff who were appropriately trained. Staff were seen to support people to keep them safe. People did not have to wait to be assisted.

People who may harm themselves or displayed behaviour that challenged others had shown a reduction of incidents since being at the home and the number of staff on duty were adequate for their individual needs.

Processes were in place in relation to the correct storage of medicine. All of the medicines were administered and disposed of in a safe way. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

The Care Quality commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The registered manager and staff explained their understanding of their responsibilities of the Mental Capacity Act (MCA) 2005 and DoLS and what they needed to do should someone lack capacity or need to be restricted.

People were provided with homemade, freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night. We were told by the registered manager that people could go out for lunch if they wished.

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. We observed positive interactions and it was evident people enjoyed talking to staff. People were able to see their friends and families as they wanted and there were no restrictions on when people could visit the home.

People were at the heart of the service; and took part in a wide range of community activities on a daily basis; for example trips to the shops, and attending college. The choice of activities was specific an innovative to each person and had been identified through the assessment process and the regular house meetings held.

People had an individual support plans, detailing the support they needed and how they wanted this to be provided. We read in the support plans that staff ensured people had access to healthcare professionals when they needed. For example, the doctor, learning disablement team or the optician. People’s care had been planned and this was regularly reviewed with their or their relative’s involvement. A relative told us, “We do feel involved”. The registered manager told us, “It is vital to know the whole person and to talk with all the people who know them, their likes and dislikes, so we can connect with them.”

The registered manager told us how they were involved in the day to day running of the home. It was clear from our observation that the manager new the people very well and that people looked at them as a person to trust. Staff felt valued and inspired under the leadership of the registered manager.

The home seeks ways to continually improve and puts changes into practice and sustains them.

The had a robust system of auditing processes in place to regularly assess and monitor the quality of the service or manage risks to people in carrying out the regulated activity. The registered manager had assessed incidents and accidents, staff recruitment practices, care and support documentation, medicines and decided if any actions were required to make sure improvements to practice were being made.

The registered manager kept up to date with any changes in legislation that may affect the service, and participated in monthly forums with other managers from other services where good practice was discussed. They pro-actively researched specialised publications and websites to identify innovative ways to enhance people’s quality of life and introduced these to the service.

The service notified the Care Quality Commission of any significant events that affected people or the service and promoted a good relationship with stakeholders.

Complaint procedures were up to date and people and relatives told us they would know how to make a complaint. Confidential and procedural documents were stored safely and updated in a timely manner.

Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe.

People’s views were obtained by holding residents meetings and sending out an annual satisfaction survey which staff supported people to complete using different methods of communication.

As part of our inspection we spoke with people who lived at Upfield and observed interactions between people and staff as some people were not always able to express their views. People we spoke with told us they were "Happy" at Upfield and "Liked" the staff. We noted that staff interactions were positive and people seemed comfortable speaking with the Registered Manager about any concerns they had.

We found that people had been encouraged to express their preferences and choices about their care, but had concerns that the provider had not acted in accordance with the requirements of the Mental Capacity Act (2005) where people did not have capacity to make some decisions.

We saw that people's care had been reviewed regularly and the service had completed detailed plans of care with each individual. However, people's care had not always been delivered in line with their needs.

People told us they felt "Safe" at Upfield. We found that staff were up to date with training around safeguarding vulnerable adults. However, the service had not always reported incidents or possible allegations of abuse to the appropriate authority for investigation.

One relative told us that "The staff here are all pretty good". Staff told us that they felt supported and enjoyed their role, although felt that they did not have enough staff to meet the specific needs for each individual. We found that the appropriate checks had not always been completed to ensure that staff were suitable to work with vulnerable adults.

We found that the service did not have suitable procedures in place to monitor the effectiveness and safety of the care provided.

Some of the people who used services had complex needs which meant that they were not able to tell us about their experiences of using the service; we therefore used our observations to help inform some of our judgements. We observed staff interacting with people who used the service in a respectful manner, calling people by their first names and offering choices. People who used the service appeared relaxed, content and at ease in their surroundings. Records showed that people who used the service were encouraged to be active and be part of the local community. People were able to engage in a wide range of activities, attend college and to undertake voluntary work. Staff were very supportive to people and there were arrangements in place to make sure the risk of confrontation between people using the service was minimised and that they were kept safe.

Staff had been well trained and knew how to recognise safeguarding situations and how to report concerns to the local authority safeguarding team. People's diversity, values and human rights were promoted and respected.