The inspection took place on 31 January 2018 and was unannounced. At our last inspection in November 2015, the service was meeting the regulations inspected.

Wells Road Care Home is registered with us to support up to six people with complex learning disabilities and or mental health needs. At the time of our visit there were six people living there.

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. This means people with learning disabilities and autism using the service can live life to their full potential.

There was a registered manager for the service. 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 told us they felt safe and staff knew how to protect people from the risk of harm and abuse in the home and when they were in the community. Risks that people may face were identified and then managed safely. Medicines were managed safely. People were able to look after their own medicines. This was with assistance from staff when needed.

People were involved in planning menus and their wishes in relation to meal choices were included in the options available. People were supported to eat and drink enough to stay healthy. People were supported to build up confidence in self budgeting and preparing and cooking their own meals.

Staff were properly supported to do their job effectively. This was because they were well supervised in their work. Staff were also being trained and updated. This meant they knew how to provide people with effective care.

People we met were positive in their views of the staff team and how they supported them. People felt well supported with their particular and often complex needs. People were treated with warmth and attentiveness from the staff that supported them at the home. We saw how staff spent plenty of time speaking with people they were supporting. There were also many positive and warm interactions between them. People looked relaxed with the staff when they wanted to speak with them.

People’s range of needs were assessed and their care was properly planned with their involvement if this was what they wanted. Care plans supported and set out for staff the care to be delivered. This was explained in detail in a way that properly met the needs of the person that the care plan was about. The staff team conveyed to us they had an up to date understanding and insight into the complex needs of the people they supported.

There were systems in place to protect people’s rights in the home. The staff followed the Mental Capacity Act 2005 if people lacked capacity to make informed decisions in their daily lives. The provider had completed an application under the Mental Capacity Act Deprivation of Liberty Safeguards for one person. This had been accepted and DoLS safeguards were in place for the person concerned.

The registered manager investigated and responded to people’s complaints, promptly and openly. They did this by ensuring they followed the provider’s complaints procedure.

People were supported to take part in activities and events that were meaningful to them in the home and the local community. Staff supported people to gain independence with a wide range of activities in the home and the community.

People who lived at the home felt supported by the registered manager. People also said they could approach and see the registered manager at any time if they wanted to speak with them.

The registered manager worked hard to learn from any mistakes and to make sure people were safe. The registered manager was open

This inspection took place on 22 October 2015 and was unannounced. When Wells Road was last inspected in September 2014 there were no breaches of the legal requirements identified.

The service is a care home without nursing and provides care and support for up to a maximum of six people who have either learning disabilities and/or complex care needs. On the day of our inspection there were six people living at the service.

The service has 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.

The staff had received training regarding how to keep people safe and they were aware of the service safeguarding and whistle-blowing policy and procedures.

Staffing was arranged in a flexible way to respond to people’s individual needs.

There were suitable arrangements in place for the safe storage, receipt and administration of people’s medicines.

People were provided with regular opportunities to express their needs, wishes and preferences regarding how they lived their daily lives. This included meetings with their social worker or designated member of staff who was their keyworker.

Each person was supported to access and attend a range of working, educational and social activities. People were supported by the staff to use the local community facilities and had been supported to develop skills which promoted their independence.

People’s needs were regularly assessed and resulting support plans provided guidance to staff on how people were to be supported. Support in planning people’s care, treatment and support was personalised to reflect people’s preferences and personalities.

The staff had a clear knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. Meetings had been arranged in order to enable people’s best interest to be assessed when it had been identified that they lacked the capacity to consent to their care and treatment.

There was a robust staff recruitment process in operation designed to employ staff that would have or be able to develop the skills to keep people safe and support individuals to meet their needs.

Staff demonstrated a detailed knowledge of people’s needs and had received training to support people to be safe and respond to their support needs.

The service maintained daily records of how peoples support needs were meet and this included information about medical appointments with GP’s and Dentists for example.

Staff respected people’s privacy and we saw staff working with people in a kind and compassionate way responding to their needs.

There was a complaints procedure for people, families and friends to use and compliments could also be recorded. We saw that the service took time to work with and understand people’s individual way of communicating in order that the service staff could respond appropriately to the person.

The provider had quality monitoring systems in place which were used to bring about improvements to the service.

This inspection was undertaken by one Adult Social Care Inspector. At the time of the inspection six people were living at the home. We spoke with four people who lived there. The purpose of our inspection was to answer these 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. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

Every person who we spoke with told us they felt safe at the home and with the staff who assisted them there. Interactions between people who lived at the home and the staff were positive in tone. People approached the staff on duty for support and to talk with them .This showed that people felt safe in the company of the staff who supported them.

The environment was maintained to a clean hygienic standard. Staff were trained to understand how to minimise infection control risks in the home. They were also able to refer to suitable guidance on the subject when required.

There was a suitable process in place for reviewing and evaluating incidents and accidents which had occurred at the home. The manager had introduced a new recording system. There was also an online reporting system .We saw how both systems captured information after an incident. This included ones where people had shown behaviours that may have been challenging. A senior manager was also able to log in and read the online records. This was to ensure that suitable action had been taken after an incident or occurrence at the home.

Is the service effective?

Everyone we spoke with told us they were satisfied with the care and support that they received at Wells Road.

Staff were observed providing assistance in a calm and attentive approach. The staff spent time with people who needed one to one support. This was due to their particular complex needs that impacted on how they carried out their own personal care. Staff were heard prompting people with their needs in a discrete and respectful way.

Is the service caring?

Everyone we spoke with told us staff were “nice”. We saw how people who used the service were supported with their needs by staff. The staff were respectful and attentive in approach. Staff were also patient in manner when they assisted people who they needed regular prompting and reassurance about certain matters in their life.

The staff showed they understood how to support people with their complex needs. The staff we spoke with also had insight into the impact that peoples mental health needs and learning disabilities had in their daily life. For example they knew that one of their roles was to prompt and support people with their personal care.

Is the service responsive?

Care plans and risk assessments were detailed and informative. They clearly explained how to support people with their learning disability and their mental health needs. For example, we saw there was guidance information and clear strategies for staff to follow so that they safely responded to people when they needed additional support. The staff told us they followed these approaches when people’s mood and behaviours changed.

Staff told us they had been provided with suitable training so they were able to safely respond to potentially violent and aggressive incidents. The training enabled staff to use non-confrontational techniques. Staff were able to give us examples of times when they had responded to situations that may have been challenging with people who lived at the home.

Staff were supervised to ensure that their performance and development was properly monitored. If staff required additional support, for example after an incident or occurrence this was provided by the manager. The staff told us they felt properly supported when they had responded to behaviours that were particularly challenging.

Is the service well-led?

People who lived at the home felt well supported by the manager of the service. Everyone we spoke with was observed to have a close and trusting relationship with the manager. For example, one person wanted to talk to the manager about their plans for the day and we saw them asked the manager for their advice.

We saw that regular ‘house meetings’ were held at the home. The minutes we viewed showed people’s views were sought about the way the home was run. People who lived at the home also told us they were often asked by their key worker and the manager to give their views of the care and support they had received.

People’s independence was being promoted. They told us that they were able to do a lot of things by themselves but had support which helped them to maintain good relationships and to learn new skills. People told us about the activities that they enjoyed, such as attending college and doing things in the community.

Each person had a number of individual plans which set out their needs and goals. The plans helped to ensure that staff were consistent in their approach and provided people with the support that had been agreed. This included support with medication; we found that suitable arrangements were being made for the management of people’s medication.

People who used the service said that they helped out with the domestic work. The home looked clean when we visited and we saw that there were procedures in place for infection control.

One person said that one of the best things about the home was “having a key worker”. This meant that they had a staff member assigned to them who they could talk to about their needs and how they were feeling. We were also told about meetings when people talked together about things that were important to them. We found that people’s complaints were being taken seriously and followed up.

We had visited the home in May 2012 and found that people’s care plans were not being completed consistently. There had been a lack of information about risks and the support that people needed to be safe. Audits were being carried out as part of a system of quality assurance, however it was taking a long time for the action plans to be completed.

We visited the home again on 2 August 2012 to see what had improved. We were told about the changes that had been made. The people who used the service said they had talked to staff and agreed what they wanted to be included in their individual plans. They met with their key workers each month to talk about the progress they were making and new things they would like to do.

Overall we found that a lot of work had been carried out to ensure there was good information about people’s needs and the support that they wanted. We also saw that there was a more effective system in place for quality assurance.

People told us they were happy living at Wells Road. One person commented ‘it’s cool’ when we asked them what they liked about the home. People said they were treated with respect. They had been given the information they needed about the home and the local area. A monthly meeting called ‘Your Voice’ was being held when people talked about the day to day arrangements and agreed house rules.

People said they were able to do a lot of things outside the home. Staff helped people to find activities that interested them, such as looking after animals and attending college courses. People told us they did “fun things” and got “out and about”.

People received a lot of support with their relationships and were encouraged to act independently. However, we found that the appropriate support plans and risk assessments were not always being completed.

People told us they could pass on their views and they knew who to talk to if they had a concern. Systems were in place for monitoring the service, although these were not always effective in ensuring that good standards were maintained.