We inspected this service on 9 May 2018. The inspection was unannounced.

Vale House consists of six self-contained flats providing residential accommodation and nursing support for males with learning disabilities, autism and associated complex needs. The home has communal areas on the ground floor and a passenger lift provided access to the first floor. The home stands in its own grounds in a residential area of Horwich, Bolton. The home is situated close to Horwich town centre and local amenities.

Vale House 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 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.

There was a registered manager 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.

At our last inspection in March 2016, we rated the service as good. At this inspection we found the service had continued to develop and further strengthened a very caring approach and responsiveness and leadership of the service. People continued to receive a high standard of care in the community where they felt valued and had a sense of belonging.

The service was well led. The registered manager, supported by a deputy manager and a well-established staff team had a strong sense of providing people with an enhanced quality of life which took into account individual wishes and needs so each person was valued and treated with equality. This inclusive ethos enabled people to carry on living their lives, pursuing their interests and maintaining and building relationships.

Staff treated each person as an individual and respected their life history and experiences. Staff had an excellent understanding of the people they were supporting and what was important to them and significant events in their lives. They focussed on the uniqueness of each person rather than labelling them with a diagnosis or condition.

We saw that staff treated people with dignity and respect and there was a good rapport between people living at Vale House and the staff team.

Each person living at the home was supported individually during the day by a member of staff. On occasions two members of staff were required to provide support. Staffing levels were planned depending on daily events. For example hospital appointments, GP visits and for some trips and outings.

Staff were safely recruited and completed a thorough induction programme on commencing work. Staff had access to safeguarding policies and procedures and had completed safeguarding training. Staff safety was paramount and staff carried personal alarms at all times.

Staff completed mandatory and specialist training as required. Staff supervisions and annual appraisals were on-going. Medicines were safely stored in locked cabinets in people’s own flats. Staff supported people with their medicines and medicine administration records (MARS) were completed.

Health and safety checks were in place and equipment had been serviced in line with the manufactures instructions.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Care files and support plans were person centred and contained comprehensive information around a range of health needs and wellbei

This is the first inspection since the service registered in 2015. This unannounced inspection took place on 22 March 2016.

The service is registered to provide 24 hour nursing and residential support for up to six gentlemen with learning disabilities. On the day of our inspection there were two gentlemen living and the home. A third person was visiting Vale House and was in the process of transitioning over from another service.

The service consists of six self contained flats and two communal lounges. Vale House is in a residential area Horwich and is close to the town centre and other local amenities.

The service had two registered manager who share the responsibilities of managing the service.

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 were able to demonstrate their understanding of whistle-blowing procedures and they knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

We found that people were supported by sufficient numbers of suitably skilled and experienced staff who were safely recruited. We saw that staff received the essential training and support necessary to enable them to do their job effectively and care for people safely.

People who used the service told us that they felt the staff had the skills and experience to meet their needs. People were happy with the care and support they received and spoke positively of the kindness and caring attitude of the staff.

We found the system for managing medicines was safe. Each person had their own locked medicines cupboard in their flat. People who used the service were supported by staff to manage their own medicines.

We saw there were risk assessments in place for the safety of the premises. We saw in the care records that people had a personal emergency evacuation plan (PEEPs) which informs the emergency services of the layout of the building and what assistance each person required to get them out the service safely. All areas of the home were clean and well maintained.

People’s care records contained detailed information to guide staff on the care and support required. The care records showed that risks to people’s health and well-being was identified and plans were in place to help reduce and eliminate the risk. People and their relatives (where appropriate) were involved and consulted about the development of their care records. This helped to ensure the wishes of people who used the service were considered and planned for.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff demonstrated an understanding of both MCA and DoLS.

Staff we spoke with had a good understanding of the care and support that people required. People’s independence was encouraged and staff were available to assist and offer advice and support.

To help ensure that people received safe and effective care and support, systems were in place to monitor the quality of the service provided. Regular checks were undertaken on all aspects of running the service and opportunities were available for people to comment on the facilities of the service and support provided.