The inspection was carried out on 31 August 2017 and was announced.

Oak Avenue is a small care service providing personal care and accommodation for up to three adults with complex learning disabilities and mental health illness. Some people were also living with living with physical disabilities and behaviours that may cause harm to themselves or others. There were three people using the service. People living at the service were not socially excluded due to their behaviours because they were enabled to live their chosen lifestyles with intensive specialised care from staff. Oak Avenue is one of a small group of care services owned by Insight Specialist Behavioural Service Ltd and this service shares a registered manager and staff team with another Insight service nearby.

People had moved to this service within the last year from another local service also run by Insight Specialist Behavioural Service Ltd. This service had been adapted to suit the individual complex needs of the three people who lived there. The building was spacious and airy and has been designed with input from the people moving in and behaviour support specialist to meet individual needs. The service had a communal kitchen, dining/lounge room and secure garden.

A registered manager was employed at 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.

Person centred care and people’s safety was at the heart of the care people experienced. The two owners of the care service (The providers) shared and embedded their vision and values so that they were understood by the staff team. The providers led from the front by involving themselves in the detailed planning and daily operations of the service.

The providers had fully embraced the principals of Positive Behavioural Support (PBS). This is recognised in the UK as one of the best way of supporting people who display, or are at risk of displaying, behaviour which challenges care services. The providers had modelled the service care in accordance with current PBS best practice principles. The providers, registered manager and staff participated in research and the collection of behavioural data aimed at improving the quality of care. They recognised that harmful behaviours were also a form of communication.

The providers gave people the opportunity to share their views by training staff to understand people’s communication styles, using objects of reference and collecting detailed data about people’s moods, facial expressions and body language. Actions taken by the provider and planned improvements were focused on improving people's quality of life, based on the research and in partnership with external experts. People, their relatives and healthcare professionals were encouraged to share their opinions about the quality of the service, to ensure planned improvements focused on people's experiences.

Positive risk taking was promoted and safety systems were reviewed and audited to reduce the risk of harm. Risk assessments were detailed and were seen as working documents. Risk levels were reviewed and changes to interventions and staffing levels were linked to individual risk levels from hour to hour. The providers played a key role in chairing weekly clinical review and safety meetings.

The training and supervision staff received enabled them to recognise and respond to communications and behaviours to reduce the risk of violence and aggression occurring. Staff consistently implemented responses that were tailored to the individuals needs and that had been planned by behavioural analysis and specialist behavioural therapist and external health and social care professionals.

The Care Quality Commission (C