We undertook an unannounced inspection of Urmston House on 22 and 24 May 2018. When the service was last inspected in January 2016, no breaches of the legal requirements were identified.

Urmston House provides accommodation for people with learning difficulties, sensory impairment, those who could emit challenging behaviour and autism who require personal care to a maximum of six people. Urmston House is a purpose built care home. People have their own self-contained apartment on the ground floor of the home. The apartments include an ensuite and kitchen facilities. At the time of our inspection there were six people living at the 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.

At the last inspection in January 2016, the service was rated as good in all the areas of Safe, Effective, Caring, Responsive and Well Led. At this inspection, we found the service had improved and was now outstanding in effective. The overall rating was good.

There was registered manager in post. A registered manager is a person who has registered with the 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.

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.

Outstanding and innovative care practices were delivered by staff to maximise people's independence and help them achieve significantly positive life experiences. This included making sure the environment was suitable for people with a visual impairment. The staff had been creative in their approach in reducing falls for one person because of the simple but creative adaptations that had been made to their environment. For another person their bedroom had been adapted to enable them to return from hospital because suitable training and equipment had been put in place to support them effectively and responsively. Relatives were extremely positive about the care and support that was in place. They described a unique service that was person centred with high levels of staffing. This meant that people were supported on a one to one basis enabling them to lead the life they wanted. People were at the heart of the service. Staff knew what mattered to people. They continued to explore options for people in respect of activities.

People remained safe at the home. There were sufficient numbers of staff to meet people’s needs and to spend time socialising with them. The registered manager had responded to a recommendation that was made at the last inspection to ensure there was a team leader working in the home at all times. This was in accordance with the staffing profile/assessment for the service. Risk assessments were carried out to enable people to receive care with minimum risk to themselves or others. People received their medicines safely.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management, checks on the equipment, fire systems and safe recruitment processes.

People were supported with their nutrition and hydration needs. People had access to healthcare professionals when needed and the home had a good relationship with the local GP. Care records contained guidance on how to support people who may not be able to communicate their

We undertook an unannounced inspection of Urmston House on 19 January 2016. When the service was last inspected in April 2014 no breaches of the legal requirements were identified.

Urmston House provides accommodation for people with learning difficulties, sensory impairment and autism who require personal care to a maximum of six people. Urmston House is a purpose built care home. People have their own self-contained flat on the ground floor of the home. The flats include en-suite and kitchen facilities. At the time of our inspection there were six people living at the home. Five people lived there permanently and one person was receiving respite care.

A registered manager was in post. 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.

We have made a recommendation about ensuring that staff are deployed in a consistent way in line with the home’s assessed requirements.

People’s medicines were managed and administered safely by trained and competent staff. Regular checks and audits of medicines were completed by senior staff. The home ensured the appropriate pre-employment checks were completed before staff began working. Staff had been trained and demonstrated good knowledge of safeguarding vulnerable adults. Staff knew how to respond to concerns of suspected or actual abuse.

Systems were in place to review and monitor reported accident and incidents. Changes were made to reduce and prevent reoccurrences. Risk assessments were in place for people which promoted independence whilst keeping people safe. Suitable health and safety audits were completed on equipment and the environment.

The registered manager had ensured the Deprivation of Liberty Safeguards (DoLS) had been applied for when appropriate. DoLS is a legal framework to lawfully deprive a person of their liberty when they lack the capacity to make certain decisions in regards to their care and treatment. When a person lacked capacity to make a particular decision a process was followed in line with the Mental Capacity Act 2005 (MCA). Staff showed good understanding of the principles of the MCA and gave examples of how they applied this in their work.

There was clear documentation when a best interests decisions was made and what the outcome was. These were made with the involvement of family, staff, other health and social care professionals and advocates.

People were supported with their nutrition and hydration needs. People had access to healthcare professionals when needed and the home had a good relationship with the local GP. Care records contained guidance on how to support people who may not be able to communicate their healthcare needs.

People received support from staff who showed kindness and respect. Relatives were welcome at any time and people had access to an independent advocate. Care plans showed how people’s dignity and privacy was maintained. They also showed people’s personal preferences and how people would communicate these.

Care records contained personalised information which ensured the home was responsive to people’s needs. Staff were knowledgeable about what was important to individuals. People and relatives had access to the complaints procedure in a format they could understand.

The home was well led and run. The registered manager communicated effectively with staff and relatives. The registered manager had systems in place to regularly assess and monitor the quality of the service provided to people.

During our inspections we set out to answer a number of key questions about a service: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service caring?

Support plans that we viewed were person centred, reflecting the individual needs and wished of people using the service. There were risk assessments in place to ensure that people were cared for safely.

Staff interacted with people respectfully and encouraged independence where possible. For example, we observed one person being encouraged to help with the laundry. This person also took their plate back in to the kitchen after their lunchtime meal. This was reflected in people’s support plans, which described how people could achieve independence through support such as hand over hand guidance.

Staff were knowledgeable about the people they supported and told us for example about the ways in which people communicated and the activities they enjoyed taking part in.

Is the service responsive?

We saw that the service worked with other health and social care professionals to ensure that people’s health needs were met. Care records documented when other professionals had visited people in the service to attend to the health needs.

People using the service had regular access to the community. We saw for example, that people were supported to go to the cinema and local cafes.

Is the service safe?

There were systems in place to ensure that people were supported in a safe way with their medication. Controlled drugs were stored securely with only suitably trained staff having access to them. A stock take of these was completed each day.

Protocols were in place to guide staff on when and how PRN or ‘as required’ medication should be administered.

Staff responded appropriately in potentially emergency situations. We saw a report from the ambulance service which detailed how they had been called to support an individual in line with guidance in their support plan.

Where decisions were being made on behalf of people using the service, we saw that appropriate procedures were followed to ensure that their best interests were considered.

Staffing levels were sufficient to ensure that people were cared for safely. Risk assessments were in place to assess the staffing levels that were required for individual activities.

Is the service effective?

There were clear goals in place to document what individuals were working to achieve. People’s care needs were reviewed regularly to monitor how well people were being supported to achieve their aims.

We saw that monthly reports were completed for each individual which detailed any significant health concerns and the activities they had undertaken towards achieving their goals. This was reflected in people daily records also. For one person, we noted that they had been out for frequent walks as part of encouraging a healthy lifestyle.

Where possible, family members and representatives were involved in decision making about important aspects of people’s care. For example, we saw that for one person a decision was made about whether dental treatment was necessary. A relative had been involved in making this decision.

Is the service well led?

There was a programme of audit in place which covered various aspects of the service, such as medications and infection control. Action plans were in place to improve the service with dates specified as to when they should be completed.

The views of representatives of people in the home were sought and taken in to consideration. Visiting professionals were also asked for the views.

People living at Urmston House were not able to communicate with us verbally, however we were able to speak with one relative on the day of our visit and we also spoke with three members of staff. The relative that we spoke with was very positive about the care at Urmston House and on the day of our visit had been involved in decision making about dental treatment.

Staff were knowledgeable about the people they were supporting and were able to tell us about people's individual behaviours and communication. We viewed care plans and found that these were sufficiently detailed and described people's needs well. Staff told us that recent changes in care records had made information more easily accessible. Information was held about people's mental capacity and where they were not able to make decisions, decisions were made in their best interest.

People were cared for in a clean and hygienic environment and systems were in place to monitor infection control.

People were supported by staff who received regular training and supervision to support them in their work. No formal complaints had been made about the service, however there were systems in place to manage complaints should it be required.

The people living at Urmston House had complex needs and were not able to give us their views about the service that they received. The home’s staff however had got to know how people communicated their needs and expressed their feelings about things.

Each person had their own self-contained flat which was personalised and provided facilities which promoted their independence. We saw for example that people were able to make drinks and snacks in their own kitchens with the support of staff. The daily routines were flexible to take account of people's individual circumstances and their wishes at the time.

In addition to having a visual impairment, the people who used the service had a high level of dependency. As a result, they relied on staff to ensure that their health and personal care needs were met. We found that people’s care was not always being well planned, which meant that there was a risk to their health and wellbeing. We also found that the home’s training plan for staff did not reflect the needs of the people they supported and the specialist nature of the service.

There are five people living at the home who have a learning disability. All the people have complex needs and need support in all aspects of their lifestyle including their communication and accessing the community.

As we were unable to communicate verbally with people to tell us their views, we spent time in the communal areas of the home observing their routines, and interaction with staff to help us understand their experiences of living there.

Although information for service provided was not in a format that is accessible to the people use the service, steps had already been started to make improvements.