22 De Parys Avenue 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.

The service can accommodate up to seven people living with a learning disability or autistic spectrum disorder. The accommodation is arranged over three floors with accessible outside space. At the time of this inspection there were five men living at the service.

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 ongoing 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.

Why the service is still rated good:

People were protected from abuse and avoidable harm. Staff had been trained to recognise signs of potential abuse and knew how to keep people safe. Processes were also in place to ensure risks to people were managed safely.

There were enough staff, with the right training and support, to meet people’s needs and help them to stay safe. The provider carried out checks on new staff to make sure they were suitable and safe to work at the service. Staff provided care and support in a kind and compassionate way.

Systems were in place to ensure people received their medicines in a safe way and people were protected by the prevention and control of infection.

The service responded in an open and transparent way when things went wrong, so that lessons could be learnt and improvements made.

People received care and support that promoted a good quality of life and was delivered in line with current legislation and standards.

People were supported to eat and drink enough. They were actively involved in choosing what they ate and helped to prepare meals for each other.

Staff worked with other external teams and services to ensure people received effective care, support and treatment. People had access to healthcare services, and received appropriate support with their on-going healthcare needs.

The building provided people with sufficient accessible space, including a garden, to meet their needs. The service operated 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.

The service acted in line with legislation and guidance regarding seeking people’s consent. People were enabled 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 supported this practice.

People’s privacy, dignity, and independence was respected and promoted. They received personalised care and were given opportunities to participate in activities, both in and out of the service.

Systems were in place for people to raise any concerns or complaints they might have about the service. Feedback was responded to in a positive way, to improve the quality of service provided.

Arrangements were in place to ensure people at the end of their life had a comfortable, dignified and pain free death, if the need arose.

There was strong leadership at the service which promoted a positive culture that was person centred and open. Since the last inspection a new registered manager had come into post. Everyone spoke very highly of them, and the changes they had made, which had resulted in some positive outcomes for people living at the service.

Arrangements were in place to involve people in developing the service and seek their feedback.

Systems were in place to monitor the quality of service provision and to drive continuous improvement.

Opportunities for the service to learn and improve were w

Our inspection took place on 20 January 2016 and was unannounced. At the last inspection in May 2014, the provider was meeting the regulations we looked at.

22 De Parys Avenue provides care and support for up to seven people who may have a range of care needs, including learning disabilities and autistic spectrum conditions. It is situated in a residential part of Bedford. On the day of our visit, there were six people living in the service.

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 felt safe in the service. There were appropriate systems in place to safeguard people from the risk of harm and we found that staff understood the process of reporting suspected abuse. Risks to people were assessed, managed and reviewed on a regular basis and assessments detailed the control measures in place to minimise the potential for future risk to occur. Systems were also in place to protect people from the risks associated from medicines, incidents and emergencies.

There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety and independence. Robust recruitment processes had been followed to ensure that staff were suitable to work with people. Safe systems were in place for the administration, storage and recording of medicines.

New staff received induction training, which provided them with the essential skills required to support people in accordance with their needs. Staff also received regular training that provided them with the knowledge and skills to meet people’s needs in an individualised manner.

Staff understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS.) A flexible approach to mealtimes was used to ensure people could access suitable amounts of food and drink that met their individual preferences. People’s health and wellbeing needs were closely monitored and the staff worked very well with other professionals to ensure these needs were met.

Staff were knowledgeable about how to meet people’s needs and understood how people preferred to be supported on a daily basis. We found there was a positive atmosphere within the home and that people were very much at the heart of the service. People were involved in their care planning and staff ensured that the service’s core values were implemented so that people had a meaningful and enjoyable life. Staff understood how to promote and protect people’s rights and maintain their privacy and dignity. Relationships with family members were considered important and staff supported people to maintain these.

People received person-centred care, based on their likes, dislikes and individual preferences. Staff supported and encouraged people to access the community and participate in activities, including work placements that were important to them. People and their relatives were encouraged to contribute to the development of the service. Their feedback was used to help identify areas for development in the future. People were aware of the provider’s complaints system and information about this was available in an easy read format.

The registered manager regularly assessed and monitored the quality of care provided to people. Staff were encouraged to contribute to the development of the service and understood the provider’s visions and values. The service had an open, positive and forward thinking culture. There were internal and external quality control systems in place to monitor quality and safety and to drive improvements.

As part of this inspection, we checked if the provider had made improvements following our previous inspection on 16 October 2013, when we found concerns about how they managed one person's care. We found they had taken action to move the person to enable them to access more effective care and treatment. We also gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Is the service safe?

People told us they felt safe. We saw that the provider was making the necessary improvements to ensure that people were cared for in an environment that was safe, clean and hygienic. People's needs had been assessed, and risk assessments described how any identified risks to people were minimised. The recruitment practice was safe and thorough, and the provider took action to ensure staff competence. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Is the service effective?

Detailed care plans were in place, and people told us their needs were being met. Staff received training to support people with various care needs. They also sought additional support from other health and social care professionals, to ensure positive care outcomes for people using the service. The service provided people with adequate and nutritious food and drink that ensured they maintained good health.

Is the service caring?

People were supported by kind and attentive staff. It was clear from our observations and from speaking with the staff, that they had a good understanding of the needs of the people they supported. People told us the staff were caring. One person said, "The staff are all friendly."

Is the service responsive to people's needs?

We observed that staff responded promptly to people's needs. We saw that care plans had been updated when people's needs changed, and that referrals had been made to other health and social care professionals when required. The service took account of individual preferences, and people were supported to access a variety of activities of their choice.

Is the service well-led?

In this report the name of a registered manager appears who was not in post and not managing the regulated activities at this location at the time of the inspection. However in their new role as the operations manager, they have continued to support the deputy manager in the day to day management of the home. The process of recruiting a new manager was also underway. We saw that the provider had effective systems to assess and monitor the quality of the service they provided. They regularly sought the views of people using the service and their representatives, and took account of these to improve the service.

During our inspection on 16 October 2013, people told us they were happy living at 22 De Parys Avenue.

We found systems in place to obtain consent from people in respect of the care and support provided to them. Where this was not possible, appropriate arrangements were in place to ensure that decisions made on people’s behalf, were made in their best interests.

Overall, people experienced effective, safe and appropriate care. However, we were concerned about one person whose needs were not being met fully by staff, despite their best efforts. There was evidence that the manager had sought more appropriate external intervention and support for the person, but this had not been put in place at the time of our inspection. This meant there were no clear plans for the person’s future and their welfare and safety was at risk.

We found that people living in the home received their prescribed medication when they needed it and in a way that suited them.

Overall, there were enough staff on duty with the right knowledge and skills to meet the majority of people’s needs. There were also plans to provide further training to staff; to ensure they were properly supported to meet everyone’s assessed needs.

Suitable arrangements were in place to address people’s comments and complaints, and ensure they were listened to.

During our visit on 08 November 2012, we spoke with two people living in the home and observed the support being provided to a third person. We also spoke with five members of staff, including the manager.

People living in the home spoke positively about the service and told us that the staff were kind and “did a good job.”

We observed some good interaction between staff and people using the service, which showed that staff understood the needs of the people they were supporting and how best to communicate with them.

We found that people were supported to maintain their independence as far as possible.

Staff supported people to stay safe and people’s views were listened to.