Worth Crescent is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Worth Crescent accommodates up to 10 people in one adapted building for respite care. Worth Crescent supports up to 56 people, of which 40 people receive personal care. There were four people who were staying at the service at the time of our inspection.

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.

This inspection took place 24 and 27 July 2018. The 24 July 2018 was unannounced which means the provider did not know we were coming. We arranged to go back to the service on 27 July 2018 so we could meet people who were staying at Worth Crescent.

Worth Crescent 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.

People continued to be kept safe with the care they received from the staff who supported them. Staff recognised signs of abuse and knew how to report this. The registered manager had identified potential risks to people and had put plans in place to support staff. Staff were consistent with management of risk while also promoting people’s independence. There were enough staff on duty to support people with their care and emotional needs. People were supported with their medicines in a safe way. Staff understood the importance of reducing the risk of infection to keep people safe.

Staff were involved in the assessment and reviews of people’s care with external health and social care professionals to ensure a joined-up approach was adapted for consistency. People were supported to have a healthy balanced diet. Where people required additional support with their eating and drinking staff knew who required this support. People were supported 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 support this practice.

Staff continued to treat people in a respectful and dignified way which had a positive impact on their well-being. People and relatives felt the staff team were kind, friendly and supportive. Staff helped people to make choices about their care and the views and decisions they had made about their care were listened and acted upon.

People continued to receive personalised care and were supported to continue with their hobbies and interests and daily routine which promoted their independence and confidence. People had access to information about how they could complain about the service should they need to.

The provider listened to people’s views about the service and the way it was run. People and relatives felt they had the opportunity to raise their suggestions and ideas and found the registered manager approachable and supportive. Staff worked well as a team and were supported by the provider to carry out their roles and responsibilities effectively, through training and daily contact with the registered manager. Staff felt involved in the service and were able to share their ideas about the way in which the service was run.

This inspection took place on 3 and 5 March 2016 and was unannounced.

The provider is registered to provide accommodation for personal care for a maximum of 10 people. The home provides periods of replacement or respite care and the number of people staying at the home varies day to day. There were 10 people staying when we visited on 5 March 2016.

At the time of our inspection there was a registered manager in post. 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 we spoke with who were staying at the home told us that they felt safe and well cared for during their stay. Staff were able to tell us about how they kept people safe and the action they would take if they felt people were at risk of harm or abuse. People’s medicines were looked after by staff at the home and their medicines were recorded to show when they had received them. Records showed the medicines people arrived and left with.

People gave their consent to staff before care and support was provided. Staff ensured they asked people before assisting them and waited for a response. People received care from staff that had been trained and were knowledgeable about a range care needs. People had their own healthcare professionals that provided treatment and the home had recorded those involved. These were then contacted if required during a person’s stay. People told us they enjoyed the food and were able to assist in making them if they wanted. Staff knew the meals people liked and where people had certain nutritional requirements.

The atmosphere in the lounge was calm and people relaxed in the company of staff .People’s requests for assistance were answered by staff and staff recognised people’s needs by looking at visual clues. Relatives said that they were very happy with the care of their family member and were pleased with the overall service offered.

People’s needs were met and recorded in care plans. These had been developed with the person and their relative to detail the care and support needed when staying at Worth Crescent. Staff told us they updated the records as needed and they were reviewed every year. People, their relatives and staff told us that they would raise concerns with the staff or the management team and were confident that any issues they highlighted were responded to.

The management team had kept their knowledge current and they led by example. The management team were approachable and people knew them. The provider ensured regular checks were completed to monitor the quality of the care that people received and look at where improvements may be needed and change things if needed.

When we visited 35 Worth Crescent, we spoke with the registered manager, three care staff, two people who used the service and a relative of a person who accessed the service. Speaking with these people helped answer our five 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 want to see the evidence supporting our summary please read our full report.

Is the service safe?

There were five people receiving care and support in this service on the day of our inspection. We spoke with one person who lived at the home. They told us they were satisfied with the care and attention shown by staff and confirmed if they needed anything, staff would respond promptly. They said "I like it here and I look forward to coming".

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. We found that when people had accessed hospital services the provider had translated the care plan into an easy-to-read and understandable format.

We found evidence that learning took place from incidents and investigations within the service and appropriate changes were implemented to improve the service.

The provider had taken steps to provide care in an environment that was suitable and adequately maintained. People who lived at the home were care for in a safe environment.

Is the service effective?

People told us the care they received met their needs. People told us they had been involved in planning the care they received.

Our discussions with the manager and care staff demonstrated the provider was fully aware of each person's individual care needs. Care plans and risk assessments were in place to be able to respond to frequently changing health care needs.

Is the service caring?

Some people living at the home had Autistic Spectrum Disorders (ASD). We saw staff interacting with people with ASD with a structured and thoughtful approach. Staff were helping people to develop social skills and manage stress.

We saw the service used schedules and timetables to give the necessary structure and visual cues to people with ASD.

Is the service responsive?

We reviewed four people's care records in detail and found they included assessments of their individual needs and contained clear guidelines for staff to follow. This ensured people's health and personal care needs were met. People's care records included a life history and a record of the individual's needs and preferences.

People had access to activities that were important to them and had been supported by staff to fully participate in the activity.

Is the service well led?

We found the home had systems in place to assure the quality of service they provided. The way the service was run had been regularly and robustly reviewed. We were satisfied that the recruitment systems the home had in place ensured people

working at 35 Worth Crescent had been suitably vetted for their posts. This meant people who lived at the home were protected from the risks associated with unsuitable staff.

Our discussions with three care staff showed there was a confidential way for them to raise concerns about risks to people, poor practice and adverse events. Staff understood the reporting system and felt confident to use it. The staff described the manager as very approachable, totally transparent and an inspirational leader.

The service benefited from effective leadership.

We were unable to speak with all people that used the service at Worth Crescent due to the complexity of their health needs. However we spoke with four staff, four relatives and the registered manager. We also observed how staff cared for people.

We looked at care plans for people who used the service. They covered a range of needs and had been reviewed regularly to ensure that staff had up to date information. There were also detailed assessments about the person's health so that staff could support people to keep healthy and well. All the staff we spoke with had knowledge of the needs of the people who lived there.

People who used the service were supported to make choices around the care they received. A relative told us: “There is no doubt that everyone’s wishes are respected here”.

We saw that staff helped and supported people. We saw that people received care that met their individual needs.

Staff had knowledge of keeping people safeguarded from abuse.

We found that the provider had responded appropriately when complaints had been received.

During this inspection we spoke with two people who used the service and with staff. We also looked at how staff cared for the people who used the service.

We saw that people appeared relaxed and comfortable and they were being cared for in a way that they preferred. One person we spoke with said, "Look after me", another person said, "It's nice here".

Medicines were being appropriately stored and administered and all medicine records were accurate.

Staff employed at the service had access to further training and told us that they felt supported by their peers and the registered manager.

Regular audits, and regular contact with the families meant that the provider was able to monitor the quality of the service it provided.

35 Worth Crescent provides respite or short stay accommodation for people with mild to moderate learning disabilities. On arriving at Worth Crescent we were informed that nobody using the service was currently in. Everybody who had stayed there the night before our visit had gone out to day services. One person was due to return that afternoon while other people were going to be returning to their own homes. The service was expecting another three people to come to Worth Crescent that afternoon.

We were able to observe some interactions between staff members and people using the service when people first arrived during the afternoon. People appeared to be very relaxed with each other as well as with members of staff. We observed staff offering a choice of drink as well as engaging in small activities. We saw a care worker looking through a cook book with one person while tea was being prepared. In addition we witnessed staff talking with people about the plans for that evening such as going to a dance or to the pub.

As nobody resides permanently at 35 Worth Crescent bedrooms were not very personalised. People can however bring items in from home should they wish. We saw that staff had affixed a photograph of the person due to occupy the bedroom on its door.

We looked over the care plans of three people to see how their care was to be carried out. One care plan was found to contain insufficient up to date information. Staff on duty did however have a good knowledge of people’s individual care needs.

The staff on duty had sufficient knowledge regarding their individual responsibility to ensure that people are kept safe from potential abuse.

35 Worth Crescent had systems in place to manage people’s medication. During our visit we found occasions when staff had failed to record medication satisfactorily and therefore were not always able to account for some items.