Vicarage Road (A) is a residential home which provides care to people who have learning disabilities. The service is registered to provide personal care for up to six people. At the time of our inspection the service was supporting six people.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

People at the home were safe. Staff demonstrated that they were aware of the action to take should they suspect that someone was being abused. Staff knew the risks associated with people’s specific conditions and the actions required in order to minimise the possibility of harm. There were enough staff to meet people’s care and support needs promptly. People received their medicines when they needed them although action was needed to accurately record medicine storage temperatures.

People were supported by staff who had the skills and knowledge to meet their needs. People were supported to have the maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Menus had been developed in response to people’s preferences and nutritional needs. When necessary people were helped to eat by staff. People in the home were supported to make use of the services of a variety of mental and physical health professionals.

People told us that the registered manager and staff were caring. People were supported by regular staff who spoke fondly about the people they supported. People had key workers who understood people’s preferred communication styles and assisted them when necessary to express their views. Staff promoted people’s independence however staff sometimes used infantile language when recording how people required supporting. The registered manager told us they would take action to address this.

Staff supported people to engage in activities they enjoyed. On occasion some people were left without stimulation or meaningful interactions from staff. People’s care and support was planned in partnership with them so their care plans reflected their views and wishes. People told us that the nominated individual, registered manager and staff were approachable and would take action if they were not happy or had a complaint. The registered manager was developing a process to review and assess informal complaints and comments for any trends and themes.

People told us that the home was well run. The registered manager was aware of their responsibilities to the commission and they were knowledgeable of the type of events they were required to notify us of. Staff told us that the registered manager was supportive and led the staff team well. People had the opportunity to influence and develop the service they received. The provider and registered manager made checks to help ensure that the standard of care was maintained.

Further information is in the detailed findings below.

This inspection took place on 26 March 2015 and was unannounced. At our last inspection in April 2013 the provider was meeting the requirements of the regulations we looked at.

Vicarage Road (A) is a residential home which provides care to people who have learning disabilities. The service is registered to provide personal care for up to six people, however at the time of our inspection only four people were using the service There was a registered manager at this location. 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.

We observed staff continually ask people how they wanted their care to be delivered and supported them in line with their requests. People were relaxed with staff and confident to approach them for support. Staff said they enjoyed supporting people and how to assist them to pursue the interests they said they liked. Staff were knowledgeable about the individual support people required in order to maintain their privacy and dignity. People were also supported to be as independent as they wished such as helping with tasks around the home and going out to places of interest.

People were supported to maintain relationships which were important to them. Relatives regularly visited and people in the home had developed friendships with each other. People expressed their views about the service at regular meetings and were involved in discussing the care they received. Relatives told us they were involved in the planning and reviewing their relative’s care and were often invited by the provider to comment on the service when they visited or spoke to staff on the telephone. People told that they knew how to make a compliant and were confident that they would be responded to.

The provider had conducted assessments to identify if people were at risk of harm and if so had included guidance about how this could be reduced. The provider had taken action to reduce the risk of harm when people had been put at risk. Records which monitored people’s nutritional intake and weight were up to date so that people were supported to eat and drink enough to keep them well. These record however did not always record the quantities people had consumed. We saw that, when necessary, the provider had involved other healthcare professionals in people’s care.

All the relatives and staff we spoke with told us that they felt there were enough staff to meet people’s care needs. The provider told us they would review their staffing levels when additional people started to use the service to ensure people’s needs continued to be met. Staff were able to demonstrate they had the skills and knowledge to communicate effectively with the people who used the service. They expressed a good knowledge of what people liked to do and their individual preferences. Staff were supported with their personal development and to deliver what was required of their roles.

People were kept safe and staff knew how to recognise when people might be at risk of harm and were aware of the provider’s processes for reporting any concerns. Relatives told us that the provider took appropriate action when people had been at risk of harm. Records showed that the provider had worked with other agencies when they had received information of concern in order to keep people safe.

Medication was managed appropriately because staff were aware of the provider’s medication policy and people received medication in line with their care plans.

The provider understood their responsibilities under the Mental Capacity Act 2005 (MCA) They had conducted assessments when people were thought to lack mental capacity or held meetings to ensure decisions were made in the best interests of the people who used the service. The provider had ensured that staff were clear about the requirements of the Mental Capacity Act 2005 (MCA) and that people were supported with the least restrictions of their liberties.

Relatives told us the provider regularly sought their views when assessing the quality of the service and that the provider acted on their comments. Staff said the registered manager was approachable and responded to their concerns promptly. There were processes in place to enable staff to express their views and records showed that the provider had taken action in response to issues raised at regular meetings. The provider had ensured that staff were aware of the aims and vision of the service.

The provider had a system to assess the quality of the service and identify how it could be improved. The provider had developed an action plan to implement improvements at the service.

One person told us that they were happy at the home and we heard them discussing plans for a holiday abroad with staff. Other people could not give us their views on the service because of their complex needs and conditions. We used a structured observation method to try to understand their experience of the service.

We found that people were comfortable with the staff that supported them and actively engaged with them. We noted that they were offered opportunities to go out during the day and supported to make decisions about how they wanted to spend their day. Staff understood how people communicated and interacted with them continuously.

People's needs were assessed to establish the care that they needed. There were systems in place to monitor people's health care needs. Health risks had been assessed and plans were in place to manage the risks. People had access to their GP and to other community and specialist healthcare workers. We found that staff quickly noticed when a person became unwell and took the necessary action to protect their health.

We found that people were cared for in a clean, hygienic environment and were protected from the risk of infection because appropriate guidance had been followed. The home was clean and tidy and there was a written policy and procedures in place for infection control and for cleaning. Records showed that staff at the service followed the provider organisation's procedures and that the manager monitored this regularly.

We visited the service on 30 August 2012 and we met all five people who lived there at that time. Most people were not able to give us their views on the service because of their complex needs and conditions.

We used a variety of methods to gauge other people's experience of the service including reviewing records and talking to workers. We spent three and a half hours in

the communal areas of the home observing how workers cared for and supported people. We used the Short Observational Framework for Inspection method to understand how people who could not answer our questions experienced the service.

We saw that care workers and managers treated people with respect and spoke to them with warmth, friendliness and good humour. Workers were able to communicate with people because they knew them well and people looked at ease with their care workers. People were supported to actively participate in their daily living arrangements and they were engaged in what was going on in the home.

One person told us that they liked living at the home. Comparing their experience of living at Vicarage Rd with a large institution that they lived in some time ago they told us "staff are not bullies like they were at the old place."

People we met had all lived at 264 A Vicarage Road for many years, and appeared comfortable and relaxed in the home. We found that staff and people had built up strong friendships and that they knew each other well.

We found that some opportunities were provided for people to be independent as much as they were able. We saw staff make some decisions for people which they could have made themselves.

We found people had been supported to see the health professionals they needed. We did not find that the records in the home about each person were as up to date as they should be, or that they had been updated as people's needs had changed.

People did have some opportunity to do interesting things. We were informed that these opportunities had decreased recently, and people who were able to speak about this were disappointed this had happened.