About the service:

Vision Care Homes – 1B 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 five people living at 1B 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 1B 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, “The home is totally brilliant and the staff have been absolutely amazing. The staff have done remarkably well with [our family member] and they’ve lifted us up and supported us as well.” External professionals were very complimentary about the service provided by the staff and all said they would recommend the home.

People were safe and 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 10 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.

Vision Homes, 1B Toll Gate Road is a five bedded care home for adults with a learning disability. There were five people living at 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 the risk of harm and abuse by staff who knew how to recognise and respond appropriately to any concerns that they had. Staff knew how to support people safely. Risks associated with people’s care and support had been appropriately assessed and included ways to enable people to take risks which respected people's desires to try new things. Staff were knowledgeable about the Mental Capacity Act and enabled people to make decisions for themselves as far as possible.

There were sufficient staff employed to meet the needs of each individual living at the service. Staff did not start work until checks had been made to make sure they were suitable to support people and keep them safe. People had their nutritional needs assessed. Mealtimes were friendly and sociable occasions with much interaction between people and staff. People received their medicines as prescribed by staff who knew what they were for. Medicines were ordered, stored and dispensed according to national guidelines.

People were supported by a staff team who had received excellent levels of staff training and support to be able to enhance the people's lives. People's independence was actively promoted. People were included in any decision making and their views respected about what they wanted to do each day. Relatives were fully involved in the lives of their family members and good levels of communication were undertaken. People were actively supported to access external healthcare support when required. The staff team had developed excellent collaborative relationships with the external professionals. They all worked together to ensure people's health needs were proactively met.

Staff supported people in a caring, respectful and dignified way. People and their families were fully involved in the development of individual care and support plans. Activities were individual to the person and much support was provided to enable people to take part. People were actively supported to talk about their views on the service provided, and make a complaint if required.

The registered manager was approachable. There was a positive and inclusive culture in the service where the staff and 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 12 August 2014. As part of this inspection we spoke with the registered manager, the staff and we reviewed information given to us by the provider. We met four of the five people who lived at the home. Although they could only communicate with us in a limited way, 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 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 safeguard 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 and 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.

The environment of the building and outside areas was suitable, safe and met the needs of the five people who lived at the home who all had a visual impairment.

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 we looked at provided evidence that people were supported to live active lives and participate in activities within the community.

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 that the people who lived at the home were able to easily move around the building without support from staff, even though they all had a visual impairment.

We saw evidence that people were supported by a wide range of health and social care professionals. 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, consideration and respect for the people. We saw that staff ensured people’s dignity was maintained at all times.

The registered manager and 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 focused upon the needs of the individual and contained detailed information about people's choices and preferences. The information showed that each person had an individual support plan 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.

We saw that staff received regular training which equipped them with the knowledge and skills to meet people’s support needs.

Is the service well-led?

The home had a clear management structure in place. The registered manager and the staff we spoke with were very 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.

We were told by the deputy manager that the majority of the staff had worked with the people for some time. We observed that staff seemed to really enjoy their work. The registered manager told about planned changes within the management structure which were taking place. These changes were being organised to minimise the effects upon the people who lived at the home.

1B Toll Gate Road provides accommodation and support for people with learning disabilities. Four of the five people living in the home at the time of our inspection were also blind. No one we met living in the home 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 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. All the medicine records we checked were accurate.

The staff we spoke with told us that they were well supported by the management. We saw evidence of regular supervision and appraisal of staff.

We found that the provider regularly monitored the quality and performance of the service it provided.

We visited the service on 31 July 2012. We used a number of methods to help us to understand the experience of people who used the service, because people were not all able to tell us their views.

Two people indicated they were happy living at the home. We observed staff interaction with three people using an observational tool designed for the Care Quality Commission. We spoke with seven staff, the Head of Service, and observed a shift handover meeting. We looked at one person’s care records and another person’s behaviour plan, as well as staff training records.

Some records about people and running the home were not available. After our visit we spoke with the manager who told us of actions they intended to take within the next week, to address any matters we raised for people’s wellbeing and to respect their rights.

Staff interaction was positive. The atmosphere was friendly but noisy. Most people led active lives and had opportunity to worship in line with their interests and wishes. Staff sought people's daily consent or cooperation with care, and health professionals made best interest treatment decisions. Health and welfare was monitored and we observed that people were well cared for.

There were enough staff on our visit to meet people's needs flexibly and planned activities took place. Staff felt well supported and were trained for their roles. There were systems to act upon and learn from safeguarding, incidents, comments and complaints should they arise.