Wellcroft House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Wellcroft House is a care home without nursing, which can accommodate up to six people. At the time of our inspection six people were using the service and these included people with a learning disability or autism.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The inspection visit took place on 23 January 2019 and was unannounced. Calls to relatives were made on 28 January 2019.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post and they were present during 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.

People continued to receive care that made them feel safe and staff understood how to protect people from abuse and harm. Risks to people were assessed and guidance about how to manage these was available for staff to refer to/follow. Safe recruitment of staff was carried out and adequate numbers of staff were available to people. People received medicines as required.

People continued to receive effective support from staff with a sufficient level of skills and knowledge to meet their specific needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were assisted to access appropriate healthcare support and received an adequate diet and hydration.

The care people received was provided with kindness, compassion and dignity. People were supported to express their views and be involved as much as possible in making decisions. Staff supported people to have choices and independence, wherever possible. Staff enabled people to access activities should they so wish.

The provider had effective systems in place to regularly review people’s care provision, with their involvement. People’s care was personalised and care plans contained information about the person, their needs and choices. Care staff knew people’s needs and respected them.

The service continued to be well-led, including making checks and monitoring of the quality of the service. Relatives and staff were positive about the leadership skills of the registered manager. We were provided with information as required.

This inspection took place on 11 March 2016 and was unannounced. The provider is registered to provide accommodation and personal care for up to six people who are transitioning into adult care services. People living at the home have a learning disability, autism and some people had additional sensory and physical impairments. On the day of our inspection six people lived at the home.

At our last inspection of 15 April 2014 the provider was meeting all the regulations we assessed.

There was a manager in post and she was present during our 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 and associated Regulations about how the service is run.

People showed us that they felt safe in the company of staff. Staff knew how to identify harm and abuse and had been trained on how to report and protect people from harm or abuse.

People were supported to take part in everyday living tasks and to do the things that they enjoyed. The risks associated with these activities were well managed so that people could undertake these safely and without any restrictions. Staff told us their training was up to date and that they had the support that enabled them to deliver care safely. We saw staff understood people's needs and helped them to follow their chosen lifestyles and achieve their goals.

Staff supported people to remain healthy and well and to have their medicines at the right time to promote good health. People liked the food and had choices of what they ate. They were involved in the preparation of their meals and ate at the times they preferred.

People were asked for their permission before staff provided care and support so that people were able to consent to their care. Where people were unable to consent to their care because they did not have the mental capacity to do this, decisions were made in their best interests. Staff worked in a way that meant people received care and support in the least restrictive way to meet people’s needs. The registered manager had considered where people’s liberty may need to be restricted to keep them safe.

People had positive and meaningful relationships with staff who knew them well. Staff were attentive and caring towards people. Staff used people's preferred communication to ensure their individual choices were fully respected. People's dignity and privacy needs were met with the provision of equipment they needed to support their needs.

People were actively supported to follow their own daily routines and interests. Staff had supported people to express their views on the care provided and this had led to their care being tailored to meet their needs.

There was a complaints policy in place and staff were aware how they could support people to communicate if they were unhappy about something. We also saw that people had named family or representatives to advocate for them.

Regular checks had been undertaken to maintain the quality of the service. The registered manager had actively looked at ways to benefit the lives of people living at the home. Staffing was organised to accommodate people’s lifestyles and choices. Staff had the support and training they needed to be able to understand and meet people’s complex needs and promote their quality of life.

We visited this service and talked with people to gain a balanced overview of what people experienced, what they thought and how they were cared for and supported. There were six people living in the home at the time of our visit. We saw four people during our visit. We spoke with four members of staff. People using the service had limited verbal communication skills. We observed how people were cared for and how staff interacted with them during our visit to get a view of the care they experienced. We spoke with two relatives of people living in the home.

We considered all of the evidence that we had gathered under the outcomes that we inspected. We used that information to answer the five questions that we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Is the service safe?

We saw that people's individual needs had been assessed and that there were enough suitably trained staff to care for people. We saw that medicines were managed safely so that people received their medication as prescribed. CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes and hospitals. No applications had been made. The manager understood how this legislation applied to people and protected their rights. Staff were alert to the signs of or potential for, abuse of vulnerable adults and procedures were in place, which were reviewed regularly to prevent abuse. We saw that the provider regularly monitored the quality of service provision.

Is the service effective?

People’s care and health needs were assessed and planned for with the involvement of their relatives and professionals acting on their behalf if they were not able to express their opinions. This meant that people’s care was planned and delivered in line with their individual needs.

The environment was safe and clean and met the needs of the people living there because the appropriate adaptations were in place to support people to move around freely and for their needs to be met appropriately.

Staff training was sufficient to meet all the needs of people using the service. People living in the home were supported to meet goals and improve their skills.

Is the service caring?

Staff responded to people’s needs in a caring and appropriate way ensuring that they were comforted. Staff spoke with people in a tone that expressed friendship and support and offered people choices throughout the day. Conversations with staff showed that they considered them to be individuals and expressed concern and respect for them and their relatives.

We saw that people were supported to be involved in activities that ensured that their emotion and social needs were met. People were supported to dress and have hair styles that reflected their individual personalities. People were supported to maintain relationships that were important to them. They were supported so that their preferences, interests, aspirations and diverse needs were met.

All the relatives spoken with and satisfaction surveys carried out by the service showed that they and professionals involved in people’s lives felt the home was caring and met people’s needs appropriately.

Is the service responsive?

We saw that people’s care plans and risk assessments were reviewed on a regular basis to ensure that their changing needs were planned for.

Activities were organised and planned but changed according to people’s needs and wishes.

We saw that actions were taken to protect people’s health as needed. Both relatives spoken with told us that the staff responded quickly to changes in people’s health and kept them informed so that they felt a part of their lives. One relative told us, “They (staff) are on the ball. They will ring me up if they have any concerns.”

We saw that there were systems in place to raise concerns and that these were responded to in a timely manner. One relative told us that when they had raised any issues they had been listened to and taken on board. This meant that the service responded to concerns and addressed them appropriately.

We saw that the environment was refurbished as required and developed to meet people’s needs, for example, a sensory room had been developed to give people space to sit in quietly when they wanted.

Is the service well led?

The registered manager had been in post since the home had opened. The manager was experienced and caring and provided good leadership based on how best to meet the needs of people in an individualised way. It was clear that this staff had also taken on the role of promoting people’s rights. One relative told us, “The manager is effective and communication is good.”

Staff were supported to meet the needs of people through the provision of regular training, supervision and staff meetings that enabled good practice to be developed.

There was a robust system in place to monitor the quality of the service they provided. This included regular audits of all aspects of the care and support given to people and the views of relatives and professionals who visited the home. Action plans were produced and implemented when necessary.

Five people lived at the home on the day of our inspection. No one knew we would be inspecting that day.

During our inspection we spoke with two people who lived there, six staff, and the manager. All staff we spoke with told us that the people were well looked after and were safe. One staff member said, “I think that people are very well looked after. If a relative of mine needed care I would not worry if they came here”. Another staff member said, “People are safe here”.

People who lived there had complex needs and were not able to tell us about the experiences of the care and support that they received. To address that, during our inspection we used different methods to help us understand people’s experiences, including observation. We observed interactions between staff and people who used the service. We saw that people were smiling and were confident to approach staff when they wanted something.

We saw that people were treated with respect and dignity. Staff supported people wherever possible to be independent and to make choices.

People's needs had been assessed to ensure that their health, personal care, and safety needs were monitored and met.

We found that some processes were in place to safeguard people from the risk of abuse. However, systems regarding the safekeeping of people’s money were not robust enough to prevent errors or potential misappropriation. Not all staff had received moving and handling training to prevent people being placed at risk from injury and skin damage.

Generally, we determined that recruitment processes ensured that staff employed were suitable and safe to work with the people who lived there. This protected people who lived there from the risk of harm and abuse.

We saw that complaints processes were in place for people or their relatives to use if they were not happy with the service provided.

There were five people living at the home on the day of our inspection. We spent time with those people to find out about the service provided.

People had complex needs and were not able to tell us about their experiences. We used different methods to help us understand their experiences which included observation.We observed good interactions between staff and people living there. People were smiling and and they looked happy.

Staff told us positive things about the service provided. One staff member told us "The care provided is excellent. The people living here come first at all times they have a good quality of life”. Another staff member said "The care provided is brilliant, everyone is safe and well looked after" .

People's needs had been assessed by a range of health professionals including doctors and the optician.This meant that people's health care needs had been monitored and met. People were supported by staff to engage in the activities that they enjoyed.

Risks with eating and drinking had been identified and managed to prevent choking and malnutrition. People were given choices about the food and drinks provided.

We saw that medication systems were safe and people had been given their medication as it had been prescribed by their doctor.

We found that the home was adequately staffed by staff who had been trained and were well supported.

Records and staff both confirmed that systems had been used to monitor how the home had been run.

A number of people had difficulty expressing their wishes clearly. We therefore spent time observing what life was like for people living at the home.

We observed the care that was given to people during our visit and saw that staff actively engaged with people regularly. We saw staff gave people encouragement to do their daily activities.

We saw that communication cards were used by staff to prompt interaction with people. The cards had pictures on them to help people make choices.

We saw that staff used various items to increase stimulation with people living at the home which were specific for people’s needs.

We also saw that staff prompted independence where possible to people and were patient when giving support.

We saw that reassurance was given to people throughout our visit when people appeared unsure about what was happening. We saw that when staff moved people using a hoist then reassurance and support was given.

During our visit we saw that staff sought to engage in conversation with people and continued if there was limited response from the person they were speaking to. The way staff spoke to people encouraged a positive response.

Staff treated people respectfully and in a dignified manner. Through discussion with staff we heard that they had good understanding of what was important for people living at Wellcroft House.

Staff had a good understanding of people’s individual preferences and what their likes and dislikes were in respect of daily activity. They also told us how people’s activities promoted independence.

We spoke with staff about the arrangements in place to support them to do their job well. Staff told us that they were well supported with training and the management were approachable.