About the service:

Vision Care Homes - 1A Toll Gate Road is a residential care home that provides personal care to up to five adults. People who live there have complex needs relating to visual impairment, along with other conditions, such as learning disability, physical disability or acquired brain injury. This care home is one of three bungalows on one site, which all provide care to a similar group of people. A fourth bungalow on the site provides additional communal space. On the day we visited there were four people living at 1A Toll Gate Road.

The three care homes were inspected on the same day. Although they each have a registered manager and their own staff team, they work closely together and provide the same level of service. The three reports of the inspections are therefore very similar.

People’s experience of using this service:

People who lived at 1A Toll Gate Road received outstanding care from a staff team who were passionate about delivering a high-quality, person-centred service. People were truly valued and were cared for and supported by an exceptionally dedicated, compassionate and caring team of staff and managers. Staff knew each person exceedingly well, which meant they could provide the highest quality service to meet individual needs and preferences.

People’s views were respected and they were involved in everything that happened in the home. People showed they were happy to be living there and had very good relationships with the staff. A relative said, “We appreciate the loving care that the staff bestow upon [our family member]. In summary we are very happy with [name’s] care; communication is excellent and we have no concerns.” External professionals were very complimentary about the service provided by the staff and all said they would recommend the home.

People were safe, protected by practices and procedures that put their safety and well-being as a priority. The provider had systems in place to manage risks and keep people safe from avoidable harm. Staff followed good practice guidelines to prevent the spread of infection and gave people their medicines safely.

There were enough staff to meet people’s care and support needs. Staff had been recruited well to ensure they were suitable to work at this home. They had undertaken training in a wide range of topics to make sure they could do their job properly. Staff felt valued and supported by the provider, their managers and each other.

Staff supported people 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 supported this practice.

The size of service meets current best practice guidance. This promotes people living in a small domestic style property to enable them to have the opportunity of living a full life.

The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes, that include control, choice and independence. At this inspection the provider had ensured they were applied.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways: promotion of choice and control, independence and inclusion. People's support focused on them having as fulfilling and enjoyable a life as they chose to lead.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection we rated this service Good (report published on 15 August 2016).

Why we inspected: This was a planned inspection based on the last rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we might inspect sooner.

This inspection took place on 26 April 2016 and was unannounced.

1A, Toll Gate Road is registered to provide accommodation with personal care for up to five people who have a learning disability. There were four people using the service when we inspected.

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.

People were protected from harm and abuse by staff who knew how to recognise and respond appropriately to any concerns they had. Risks associated with people's care and support had been appropriately assessed which respected people's choices.

Staff asked people's permission before they helped them with any care or support, and were confident to support people to make decisions for themselves where possible. Where people were not able to so, the staff team were able to undertake best interests decisions .

People were supported by enough staff to meet their needs. Checks were made before staff started working to ensure they were suitable to support people and keep them safe. New staff were supported to learn how to support each person's needs in a meaningful way.

People had their nutritional needs assessed and monitored when required. Staff ate with people to support them to eat well and provide a social atmosphere

People received their medicines safely from staff who were trained and assessed as competent to support them.

Staff supported people in a caring, respectful and dignified way. People's independence was actively promoted. People were supported to undertake their choice of pastimes. Family members were encouraged to be actively involved in the planning of care and support provided.

The staff team was supported by a registered manager who led by example. Staff and the registered manager worked together as a team to ensure people's needs and wishes were met.

The provider had checks in place to monitor the quality of the service and encouraged staff to drive improvements in the service.

A single inspector carried out this inspection on 25 July 2014. As part of this inspection we spoke with the deputy manager, the staff and we reviewed information given to us by the provider. We met and spent time the four people of the five people who lived at the home. They were not able to communicate with us. They appeared to be happy, relaxed and comfortable with the staff that supported them.

Below is a summary of what we found. The summary is based on our observations during the inspection, observations of people using the service, the staff supporting them and from looking at records. We used the evidence we collected during our inspection to answer the five questions.

Is the service safe?

From our observations and the information we saw set out in care plans, policies, procedures and audits the provider's safety monitoring systems were robust. The staff showed that they had a clear understanding of their role in providing care and in safeguarding the people they supported. The staff demonstrated that they knew the people well and worked to provide the best possible level of care and support.

We saw evidence that when people lacked the capacity to make decisions on important areas of their lives, best interests, safeguarding and deprivation of liberty discussions had taken place.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw that all the people who lived at the home had current deprivation of liberty safeguards orders in place. All the records were correct and up to date with review dates in place.

The staff rotas showed that the management had taken people's care needs into account when making decisions about the number of staff required, the skills and experience staff would need. The night time staffing levels and on call system showed that the provider had taken steps to ensure the staffing provision was safe out of main hours.

There were systems in place to make sure that management and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This meant that people were benefiting from a service that was taking on board lessons learnt.

Is the service effective?

People's care needs had been assessed and detailed care plans were in place. There was evidence that people and their families were involved in the assessments of their needs and care plan reviews as much as possible.

The staff we spoke with and activity plans showed us that people were supported to participate in activities they enjoyed.

All care, activity plans and risk assessment were reviewed regularly. We saw evidence in care plans that the care provided was constantly adapted to meet people’s needs.

We saw evidence that people were supported by a wide range of health and social care professional. This meant their health and welfare needs were being met.

Is the service caring?

We observed that the staff supported each person in a way which met their individual needs. The staff showed warmth and consideration. The staff showed respect and ensured people’s dignity was maintained at all times

The staff we spoke with told us they were committed to provide a good caring service to support and look after the people so they could have a good life. They demonstrated that they were aware of potential risks, people's rights and their responsibilities

Is the service responsive?

We saw the care plans were person centred and contained detailed information about people's choices and preferences. We saw in the notes the information showed that each person was supported in an individual way which was adapted regularly to meet their changing needs. We saw that people’s health and support plans were regularly updated to reflect people’s changing health care needs.

There was evidence of regular support provided from external social care and health professionals. This meant that people’s health and welfare was regularly reviewed and monitored.

The staff we spoke with said if they had any concerns, they could always talk with the senior staff, they would always listen and address anything they raised.

The staff said they received regular training which was very good and equipped them with the knowledge to meet people’s support needs.

Is the service well-led?

The home had a clear management structure in place. The deputy manager and the staff we spoke with were knowledgeable about the people who used the service, changes to legislation and developments in care provision.

We saw that senior staff were always around to give advice and support. There were systems in place to provide feedback to staff about changes and developments.

The staff we spoke with said they understood their responsibilities around safeguarding people’s welfare. They all said that if they witnessed poor practice they would report their concerns. They had worked with the people who lived at the home for some time and really enjoyed their work. They said that they felt they were supported and involved in the development of the service.

Although we met most people living in the home, no one was able to express their views about their experience in any detail. However, everyone we met appeared happy in the home. They all seemed comfortable with the staff and their surroundings.

We found that the people who received a service were not able to be involved in the planning and delivery of their care to any great extent because of their learning disabilities. However, we saw that the staff had involved people’s families whenever appropriate. We also saw that one person had an independent advocate.

We found that care plans were very person centred and contained lots of information about people’s choices, preferences and their likes and dislikes. We saw people being treated with kindness and respect by the staff.

We found that medicines were safely stored, handled and administered. Medicine records were accurate and doctors’ instructions were properly acted upon.

We were satisfied that the provider made all the appropriate checks on staff before their full employment started.

We found that the provider regularly monitored quality and performance, although they did not always formally record this.

We visited the service on 24 May 2012. We used a number of methods to help us understand the experience of people who used the service, because people were not able to tell us their views.

We observed the way six staff and the manager interacted with five people, using an observational tool designed for the Care Quality Commission. We spoke with four staff, the manager and area manager. We looked in detail at care records for one person and parts of records for four other people. We looked at a few policies, records about staff training and running of the home.

People we observed were treated as individuals and privacy was respected. People took part in their care in line with their abilities. Individual support was provided for personal care, during meals and for activities people enjoyed in the home and community.

People were unable to make care and treatment decisions, so these were regularly reviewed with families and health professionals. Best interest decisions were recorded and carried out.

Any risks to people’s health and welfare were monitored and reduced by the home working in cooperation with others and by arrangements in place to manage emergencies.

The provider and manager ensured that staff had appropriate professional development for their roles and to understand people’s conditions. Staff felt well supported and had appraisal to maintain high standards of care we observed.

There were no complaints or safeguarding concerns and few accidents took place. Staff knew how to recognise and respond if concerns arose, which would involve the local safeguarding process. There was a safe system which accounted for people’s money.

Information about the service and how to make a complaint were in accessible formats for use by people’s representatives or professionals on their behalf.