Visions (Bristol) Limited is registered to provide accommodation and personal care for up to four people with a learning disability. At the time of our inspection four people were living at the service.

At the last inspection, the service was rated Good.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Risks to people were assessed and where required a risk management plan was in place to support people manage an identified risk and keep the person safe.

Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely. People told us they felt safe living at the service.

The provider ensured that new staff completed an induction training programme which prepared them for their role. Training was completed in essential matters to ensure staff and people at the service were safe. Staff were supported through a supervision programme

People were supported to maintain good health and had access to external health care professionals when required.

Staff were caring towards people and there was a good relationship between people and staff. Staff demonstrated and in-depth understanding of the needs and preferences of the people they cared for.

Support provided to people met their needs. Supporting records highlighted personalised information about what was important to people and how to support them. People were involved in activities of their choice.

There were systems in place to assess, monitor and improve the quality and safety of the service . Staff described the registered manager as supportive and approachable . Comments from a recent survey confirmed that people were happy with the service and the support received.

Further information is in the detailed findings below.

This inspection took place on 14 March 2015 and was unannounced. The previous inspection was carried out on 21 August 2014 and there had been no breaches of legal requirements at that time.

Visions (Bristol) Limited is registered to provide accommodation and personal care for up to four people with a learning disability. At the time of our inspection four people were living in the home.

A registered manager was in post at the time of 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.

Staff received training to help them understand their obligations under the Mental Capacity Act 2005 and how it had an impact on their work. Staff we spoke with confirmed they had a good understanding. Within people’s support plans we found the service had acted in accordance with legal requirements when decisions had been made when people lacked capacity to make that decision themselves.

Staff had attended Deprivation of Liberty Safeguards training (DoLS). This is legislation to protect people who lack mental capacity and need to have their freedom restricted to keep them safe. No one living in the home was subject to such an authorisation at the time of our inspection.

We found the provider had systems in place that safeguarded people. A person we spoke with told us “yes I’m happy and yes I’m safe”.

There were sufficient staff numbers to enable them to perform their roles effectively. Rotas confirmed people were supported to go out of the home and staffing numbers were sufficient to achieve this.

The provider had ensured that staff had the knowledge and skills they needed to carry out their roles effectively. Relevant training was provided to ensure staff’s knowledge was up to date.

Systems were in place to safely manage people’s medicines. A policy was in place to guide staff through the process of ordering, stock control and the disposal of any unused medicines.

People were involved in reviews of their care needs to ensure that staff had up to date information about how to meet people’s needs.

People’s records demonstrated their involvement in their support planning and decision making processes. People we spoke with confirmed their involvement in the process and how staff respected their wishes.

Quality and safety in the home was monitored to support the registered manager in identifying any issues of concern. There were systems in place to obtain the views of people who used the service and their relatives. This included resident meetings and yearly satisfaction surveys.

Staff we spoke with felt the service was well led and the registered manager ensured an open and transparent culture within the service. Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded.

We set out to answer our five questions during our inspection; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

At the time of our inspection there were four people living in the home. During our inspection we observed the staff interactions with people that used the service in the communal areas of the home. We examined the care documentation and supporting records to make a judgement on the quality of care that people received.

We spoke with three people that used the service who were able to tell us of their experiences and we spoke with one member of staff to gain their understanding of how they met the needs of people living in the home.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is it safe?

Staffing was maintained at safe levels. During our inspection people's needs were responded to in a timely manner. People we spoke with told us they enjoyed living in the home. One person told us “Yes I am happy, I like X”.

Procedures were in place and staff understood their role in safeguarding the people they supported. All staff received regular training in safeguarding adults. The member of staff we spoke with during our inspection had a good understanding of who they needed to contact should they have any concerns around people's welfare.

People who used the service were cared for by staff who knew how to protect them from the risk of abuse. The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Records confirmed no one currently living in the home was subject to such an application. However, relevant staff had been trained to understand when an application may be required. This meant that people were safeguarded from abuse.

Is it caring?

People were supported by sensitive and attentive staff. Comments we received from people living in the home were positive. Comments included: “X is my keyworker. X is nice”. “I’m going out today with my Dad. I like that”. Another person told us, “We had a BBQ”.

We saw that care staff showed patience and gave encouragement when supporting people. The observations we made demonstrated staff supported people in a calm unhurried manner, using communication methods in line with their individual assessed needs.

Is it effective?

We found people's health and care needs were assessed with them and reviewed regularly. Care plans provided guidance for staff to follow to ensure people's individual specific needs were met. Care plans were reflective of people's current level of need. It was clear from our observations and from speaking with a member of staff they had a good understanding of people's care and support needs and that they knew them well.

Is it responsive?

People received co-ordinated care. We saw evidence in people's care plans that demonstrated people had been visited by their GP and other health care professionals. For example, people's files held information and advice sought from the Community Learning Disability Team (CLDT).

Records demonstrated people were also visited by their social worker and other professionals when the service had noted a change in their needs. People's support plans were adjusted to reflect the advice that was given.

Is it well led?

A stable management team was in place. We were told the registered manager was approachable and staff we spoke with felt supported by the whole management team. Staff comments included: “X is very supportive they put me through my diploma level 2 & 3” and “We are a good team”.

People that used the service, their relatives and external professionals completed a satisfaction survey once a year. The member of staff told us if any concerns were raised these would be addressed promptly. People were encouraged to raise any concerns or worries on a daily basis and at residents meetings. Minutes we viewed confirmed this.

During our inspection there were four people living in the home. Overall people had positive things to say about the staff and the care they received. Comments included; “I like it here, its ok", "I’ve been on holiday to butlins, its good". Another person told us "I like the staff they help me".

Not all people were fully able to tell us how they had been involved in decisions relating to their care due to their individual communication and support needs. However, we were able to observe staff interactions, looked at care records and spoke with staff to gain an understanding of the care that was being provided.

Staff demonstrated a good awareness of people needs and explained how people communicated if verbal communication was not possible. We observed positive interactions between the staff and the individuals living in the home.

People appeared relaxed and supported in their environment. We observed staff offering support to people to get ready to go out on their daily activities. Support was offered in an appropriate and sensitive manner in line with their care and support plans. People were also observed undertaking activities within their local community on the day of our inspection.

We spoke to three of the four people living at the home. They all told us they were happy living in the home and liked the staff that supported them. People were moving freely around their home accessing both the communal rooms and their bedrooms.

People were unable to fully tell us how they had been involved in decisions relating to their care due to the complexity of their learning disability. However, we were able to observe interactions between members of staff and the people they support and we also spoke with staff, relatives and looked at care records.

People were being supported during our visit in an appropriate and caring manner by the staff. Staff were offering people choices about what they wanted to eat and drink and what activities they wanted to participate in. Staff knocked on bathroom and bedroom doors before they entered a room.

After our visit to Visions we contacted some relatives of people who live at the home, one person told us “I visit the home all the time, it is like one big happy familiy”, “My son has made some positive improvements within their life”, I have no concerns or complaints as all”. Another relative told us “the staff are good as gold, we are very happy with the care our raltive receives”, they also said “Our relative goes out to a local club, he goes to The farm and is looking forward to their holiday later this year”. “It is a very good home

At the time of our inspection there were four people living in the home who were all present during our inspection. People were able to tell us what it was like living there. We also spoke with two relatives that were visiting the home and the member of staff on duty.

We looked at people’s personal care records to see how they were supported with their daily routines. We found people’s records to be comprehensive and were a true reflection of their support needs.

The deputy manager demonstrated a good awareness of people’s needs and explained how people communicated if verbal communication was not possible. We observed positive interactions between the staff and the individuals living in the home.

People appeared relaxed and supported in their daily routines. We observed staff offering support to people while preparing the evening meal and asked a person if they would like to set the table. Support was offered in an appropriate and sensitive manner in line with their care and support plans.

People we spoke with had positive comments to make about the service. Comments included; “I went on all the rides at the West Midlands safari park”. “I am happy and safe, staff are nice” and “Yes I am happy, I go on holiday”.

Relatives comments included; “everyone is lovely here. He’s happy we are very happy with the care here”. “Brilliant here. It’s the best thing we could have done for X, they have independence”.