About the service:

Vision Care Homes – 1C 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 1C 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 1C 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 wrote to the staff and said, “Thank you all for the lovely way you take care of [our family member] – she is very lucky to be with VHA (Vision Homes Association).” 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.

1C, Toll Gate Road is a service that provides accommodation and support for up to five people with learning difficulties. There were five people using the service when we inspected.

This inspection took place on 27 April 2016 and was unannounced.

There was a registered manager in post who was on leave at the time of the inspection. 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. The registered manager was not managing the service on the day of the inspection. The deputy manager was present on the day of the inspection.

There was positive feedback about the home and staff from people and relatives.

People who lived at the home were kept safe by a staff team who understood how to identify when people were at risk of harm or abuse and prevent it happening. Risks to people's health and well-being were discussed with people and support provided to minimise risks without restricting people's choice or independence.

People were supported by sufficient staff on duty to meet their needs. People were assisted by a staff team who had received training and guidance which enabled them to support people well. New staff received support which identified their personal abilities and allowed them to gain confidence in providing person-centred support. People were enabled to be actively involved in making decisions about their care and support. People were supported to take their medicines as prescribed by a staff team who knew why they were taking the medicines. People were supported to maintain good health and access care and treatment from external healthcare services when required.

People were supported to make their own decisions about what they did each day. Where people were not able to make decisions independently, they were supported by the staff team to do so. People were supported to eat and drink enough to ensure they received a balanced diet. Mealtimes were enjoyable, social occasions.

People received individualised care and support which was dignified, compassionate and respectful. They were encouraged to make their own day to day decisions about what care and support they wanted to receive. People were enabled to take part in activities of their choice, and to develop new interests. People were also encouraged and supported to attend the Vision Homes art studio if they wished.

People were supported to comment about the care and support they received. Their views were sought constantly by the staff team. They were able to complain if they wished to. The provider ensured people had access to easy read complaints procedures.

People were supported by a management team and provider who were committed to their vision and culture. This was to put people at the centre of the home and provide an enabling environment where each person was supported to reach their full potential.

A single inspector carried out this inspection on 12 August 2014. As part of this inspection we spoke with the registered manager, deputy manager, three members of staff and we reviewed information given to us by the provider. We met the five people who lived at the home; they were relaxed and comfortable, and we saw that the staff had a good rapport with 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 training records showed that the staff received regular training on safeguarding. 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 recently had a mental capacity assessment and current safeguards orders were 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.

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 assessments 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 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 people. One member of staff we spoke with said. “I like to do everything I can to support the people to live a good life. It is a good staff team here and we try to make it like a real home”. We saw that staff ensured people’s dignity was maintained at all times.

We spoke with one of the people who lived at the home, they said. “It is really good here. I am glad I came. I do a lot more now; I can go to church and yoga. We go to the disco, and it is great”.

The registered manager and staff we spoke with told us they were committed to provide a good caring service to support and look after people so they could have a good life. One of the staff we spoke with said, “It is good to be able to have time to spend with the people, to show compassion in the care we give and ensure they are a person not a number”. The staff we spoke with 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 and that, 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. One of the staff we spoke with said, “There is always someone to ask and often they can help you to look at things from a different perspective”. 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 us 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.

There were five people living in the home when we visited. Only one person was able and willing to talk to us. They said, “I love it here”. They told us that the staff were, “Lovely, really nice”.

We saw people being treated with dignity and respect throughout our visit. We were told that the staff sought people’s views and acted upon them.

We found that care plans were very person centred and contained lots of information about people’s choices, preferences and their likes and dislikes. The staff consulted relatives if people were not able to make their own choices.

We found that there were enough staff on duty to provide good care and that there was a robust system in place to minimise the risk of staff shortages.

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

We found that the provider regularly monitored quality and performance and followed up action points from previous audits.

We visited the service on 11 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.

We spoke with one person living at the home, three staff and the company training co-ordinator. The manager was on leave. We observed staff interaction with three people using an observational tool designed for the Care Quality Commission, and we observed a shift handover meeting. We looked at one person’s care records in detail, and a few records about other people. We looked at records about staff and running of the home.

People were treated as individuals and were well cared for. The atmosphere was friendly but people were subdued due to recent bereavements. There was opportunity for stimulation and to take part in daily living tasks if people wanted to.

Consent was sought and people’s views respected. Health and social care professionals recorded best interest care and treatment decisions made with staff. People had health checks and their health and wellbeing was monitored with doctors.

Staff understood people’s needs and the way people communicated. Staff felt well supported and had professional development for their roles.

People trusted staff to make sure they were safe. Staff knew how to report any concerns about people’s safety if they arose. There were systems in place to respond to and learn from comments or complaints.