This inspection visit took place on the 3 and 4 December 2018 and was unannounced.

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.

231 Brook Lane is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission [CQC] regulates both the premises and the care provided, and both were looked at during this inspection.

The home is registered to provide care and support for 10 younger adults with learning disabilities, autistic spectrum disorder and or sensory impairment. At the time of our inspection six people were living at the home. Due to people’s complex health needs we were not able to verbally seek people’s views on the care and support they received.

There was 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 service followed the principles and values that underpin the Registering the Right Support and other best practice guidance for people with a learning disability living in a care home environment. 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.

Staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by the management team.

Medicines were stored safely and securely. Procedures were in place to ensure people received their medicines as prescribed.

The service had robust recruitment procedures to make sure staff had the required skills and were of suitable character and background.

Staff understood the requirements of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way, while promoting their independence.

There was a range of activities available to people living at 231 Brook Lane.

People’s care records reflected the person’s current health and social care needs. Care records contained up to date risk assessments. There were systems in place for care records to be regularly reviewed.

There were effective systems in place to monitor and improve the quality of the service provided. Safety and maintenance checks for the premises and equipment were in place and up to date.

Relatives and staff told us the registered manager was supportive and approachable.

Further information is in the detailed findings below.

The inspection took place on the 12 and 13 September 2016 and was unannounced.

231 Brook Lane is registered to provide accommodation and support for 10 younger adults with learning disabilities, autistic spectrum disorder and or sensory impairment. At the time of our inspection five people were living at the home. Due to people’s complex health needs we were not able to verbally seek people’s views on the care and support they received.

The service had 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 provider had systems in place to respond and manage safeguarding matters and make sure that safeguarding concerns were raised with other agencies.

Relatives and health care professionals told us people were cared for safely at the home and if they had any concerns they were confident these would be quickly addressed by the staff or manager

Assessments were in place to identify risks that may be involved when meeting people’s needs. Staff were aware of people’s individual risks and were able to tell of the strategies’ in place to keep people safe.

There were sufficient numbers of qualified, skilled and experienced staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe and effective recruitment procedures.

Medicines were ordered, stored, administered and disposed of safely.

Staff received supervision and appraisals providing them with appropriate support to carry out their roles.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. At the time of our inspection five people living at the home were subject to a DoLS and the provider was complying with the conditions applied to the authorisation. The manager understood when an application should be made and how to submit one.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

People were involved in their care planning. Staff supported people with health care appointments and visits from health care professionals. Care plans were updated accordingly to show any changes. Care plans were routinely reviewed to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed.

We spoke with two health professionals, two members of staff and the service’s manager. We used a variety of methods to understand people’s experiences of the care they received. This included observation of support and the interaction between people and staff during our inspection. The health professionals were very positive about the staff and the care they provided. They told us staff were “very respectful” and seemed to genuinely care about the people they supported, and one of them said “I would be happy to trust the staff here with a member of my family”.

The provider had taken steps to ensure people’s preferences were known and their wishes respected. People were put at the centre of the planning and delivery of care and support. We reviewed care plans for three of the five people at the service and they were detailed and person-centred. People living at the service and staff got on well with each other, and support was observed to be responsive to individual needs.

People were protected from the risks of the risk of abuse because the provider had taken steps to ensure appropriate safeguarding measures were in place.

Effective recruitment processes ensured people were cared for by staff with the right aptitude, skills and qualifications to meet their needs.

There were effective systems for assessing and monitoring the quality of service provided. These enabled the provider to identify and carry out improvements for the benefit of people at the service.

231 Brook Lane is registered to provide accommodation and support for 10 younger adults with learning disabilities, autistic spectrum disorder and / or sensory Impairment. During our visit we spent time in the main house and adjoining annex of the home. Due to people’s complex health needs we were not able to verbally seek people’s views on the care and support they received.

We undertook an unannounced inspection of 231 Brook Lane on 5 and 7 November 2014. This inspection was done to check that improvements to meet legal requirements planned by the provider after our inspection on 28 and 29 July 2014 had been made. This is because the service was not meeting some relevant legal requirements. At the last inspection on 28 and 29 July 2014 we asked the provider to take action to make improvements to ensure that they acted in accordance with legal requirements for people who did not have the capacity to give consent to care and treatment. This action has now been completed.

On the day of our visit six people were living at the home. Five people lived in the main building and one person lived in a purpose built annex which was attached to the main building.

We observed staff talking with people in a friendly and respectful manner. The service had a personalised culture and staff told us they were encouraged to raise any concerns about possible abuse. One member of staff said, “Everyone works so hard to ensure we keep people safe”.

The service did not have a registered manager in post at the time of 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 2008 and associated Regulations about how the service is run. A temporary manager from within Care Management Group was overseeing the running of the home. An application to become registered manager at this location had been submitted to the Care Quality Commission and was in progress.

Staff understood the needs of the people and we saw care was provided with kindness and compassion. People were dressed in appropriate clothing and were clean and tidy, as was the home. People were supported to take part in activities they had chosen. These took place both in the home and out in the community. One member of staff said, “We try very hard to ensure the people living here have active and fulfilled lives. We like people to spend as much time away from the home as they can so that they can feel and be part of a wider community”.

We saw that people were treated with respect and care was based on people’s preferences and aimed at supporting people to develop their skills and to be as independent as possible. We observed that people appeared to be relaxed and their expressions indicated they were settled and happy

Staff were appropriately trained and skilled and provided care in a safe environment. They all received a thorough induction when they started work at the home and fully understood their roles and responsibilities. Staff also completed training to ensure the care delivered to people was safe and effective.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. People’s freedoms were not unlawfully restricted and staff were knowledgeable about when a DoLS application should be made.

People were supported to make decisions about their life. Where people lacked the capacity to make decisions these were made in their best interest.

Referrals to health care professionals were made quickly when people became unwell. One health care professional told us the staff were responsive to people’s changing health needs and that referrals to them were made in a pro-active manner.

We found that people were having their needs assessed and that plans of care were in place. These were personalised and took account of each person’s individual wishes and preferences. People were supported to access health care services including attending well person clinics and specialist services. Risks to people were identified and plans were in place to make sure people were kept safe whilst ensuring their rights were promoted.

There were robust recruitment procedures in place that involved the people who lived at 231 Brook Lane. Staff were supported and trained to ensure they were able to provide care at the required standard to ensure people’s needs were met.

We saw that systems were in place to monitor and check the quality of care and to make sure the environment was safe and well maintained.

Regular staff meetings were held and we saw that, where required, actions resulting from these were assigned to named staff to follow up. The manager used team meetings to provide staff with feedback from within the organisation which helped them to be clear about the aims and objectives within the service both locally and at provider level.