This was an announced inspection that took place on 30 August 2016.

Walnut House is a care home for adults with learning disabilities or autistic spectrum disorder. The home can accommodate up to five people. The home has a communal lounge and dining room and people who use the service each have their own bedroom and bathroom. At the time of our visit four people were living at the home.

The home had a registered manager. 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 told us they worked as part of a team, that the home was a good place to work and staff were committed to providing care that was centred on people's individual needs. There was a strong caring culture in the care and support team.

Staff received the training they needed to deliver a high standard of care. They told us that they received a lot of good quality training that was relevant to their job. Everyone we spoke with including people's relatives and staff said people received individualised care in relation to all of their needs. They said the service provided good quality, specialist care for people.

There were effective systems in place to manage risks, safeguarding and medication, and this made sure people were kept safe. Where people displayed behaviour that some people may view as challenging there was training and guidance given to staff. This helped them to manage situations in a consistent and positive way, and protected people's dignity and rights.

People received care and support that was responsive to their needs. Care plans provided detailed information about people so staff knew exactly how they wished to be supported. People were at the forefront of the service and encouraged to develop and maintain their independence. People participated in a wide and varied range of activities. Regular outings were organised and people were encouraged to pursue their interests and hobbies.

The staff recruited had the right values and skills to work with people who used the service. Staffing levels remained at the levels required to make sure every person's needs were met and helped to keep people safe.

Systems were in place which continuously assessed and monitored the quality of the service, including obtaining feedback from people who used the service and their relatives. Systems for recording and managing complaints, safeguarding concerns, incidents and accidents were managed well. The management took steps to learn from such events and put measures in place. This meant that lessons were learnt and similar incidents were less likely to happen again.

The inspection team was made up of one inspector. We set out to answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found.

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

Is the service safe?

We saw that recruitment practice was safe and thorough. Staff told us they enjoyed their work and were appropriately trained. Staff demonstrated that they understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

We saw that Walnut House was clean and tidy and staff understood their role with regard to infection control. The provider told us that improvements would be made to their cleaning records to ensure that they could demonstrate when tasks were undertaken.

Is the service effective?

We observed good relationships between staff and people who used the service. Staff we spoke with demonstrated they understood how to meet people’s individual needs. Care plans were up to date and provided detailed information on how people wished to be supported. People told us they liked living at Walnut House.

Is the service caring?

We saw that people were supported by staff who were kind and respectful. One person commented, “The staff are very kind.” Care records contained information about people’s preferences and it was clear that people had been involved in planning their care. One relative told us, “X is incredibly happy at Walnut House. It’s like home from home.”

Is the service responsive?

We saw that support was provided in a way that was intended to ensure people’s safety and welfare. Risk assessments were reviewed and updated regularly to ensure that people were able to access activities of their choice. A relative told us, “We are kept informed about doctor’s appointments and medication. We attend an annual review.”

Is the service well led?

The provider had a number of systems in place to ensure that the quality of the service was regularly assessed. For example, relatives and people who used the service were regularly asked for their views. Monthly quality checks took place and covered a wide range of areas. There was evidence that the provider took action to improve the service when this was required.

People told us that this service felt like their home and that the staff were supportive. One person told us that, “l like it here and it’s my home.” This showed us that people’s privacy, dignity and independence were respected.

We reviewed one set of individual care records. This demonstrated that individual needs were recorded and were met in line with their assessed need. This meant that people experienced care, treatment and support that met their needs and protected their rights.

People told us that they enjoyed the food provided, went food shopping each week with staff and helped with preparing meals and other kitchen tasks around this service. This demonstrated to us that people were protected from the risks of inadequate nutrition and dehydration.

The staff spoken with confirmed that they had received updated training in the management of medicines. This demonstrated to us that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Staff received induction, on-going training and supervision This showed us that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The service was audited monthly and we noted that any actions arising had been addressed. This meant that the provider had an effective system to regularly assess and monitor the quality of service provided.

During our inspection on 21 November 2012 we found concerns in relation to medication systems in place at Walnut House.

At that inspection, Walnut House did not have policies and procedures in relation to the medication process it had in place. We found that medication stock had not been accounted for and that no controlled drug procedures were in place.

The purpose of this inspection, carried out on 01 February 2013, was to ensure that the necessary improvements had been made. We found that they had.

We spent some time speaking with all four people living at Walnut House and each person told, or indicated, to us that they were very happy living at the home. One person commented "I am happy living at Walnut." We asked another person if they got the support they needed from the staff at Walnut House and they indicated by smiling and nodding "Yes" that they did. A third person said "There are no improvements that could be made, I am very happy with my room." They went on to tell us how they had recently been supported to refurnish their bedroom in a style which they had chosen.

We observed staff interactions during the evening and saw that staff spoke to people in a kind and respectful manner. We saw that staff gave people time to respond to questions and encouraged people to take part in activities such as the preparation of dinner.

However, when we asked to be provided with written policies and/or procedures in relation to the medication practices in the home, we could only be provided with a procedure for the administration of medication. We found no guidance available to describe the practices for stock control and management, recording, handling or disposal of medications.

We found that appropriate recruitment and selection process were in place and that staff were appropriately skilled to carry out their roles.

People’s personal records including medical records were accurate and fit for purpose.

Although the majority of people were unable to communicate their views verbally, we were able to observe people's non verbal communication cue's to inform us that people were relaxed and at ease with the staff who were supporting them. However one person we spoke to was able to tell us that they liked the staff and that they "Were kind to them and took them on holidays."

Although the majority of people living in Whitstone house could not communicate tehri views verbally, they showed many signs of well being. They interacted confidently with staff and were able to make their needs known by using a simple sign language.

People living in Walnut house were able to communicate their views and stated that they "liked the staff and that they are taken on nice holidays and out for lunch." Another person we spoke to said that they "Liked the staff and that people take me out to my daycentre." One person was also happy to show the inspector around the home showing that they were proud of where they lived and showed many signs of well being.

One person spoken to said that they "Liked the staff and that they were kind." Three people spoken to in Walnut house all felt that staff "were kind," caring and that they felt safe".

One person said that if they had a problem they would "Go to the staff and report it."

People living in Walnut house were able to confirm that they have regular service user meetings with one person stating that they "like meetings with their friends and the staff."