This inspection took place on the 10 January 2016. We announced the inspection 24 hours beforehand as 463 is a small service and we needed to make sure someone was at the property. This is the first inspection for this service.

463 is registered to provide personal care and accommodation with nursing for up to 7 young people who have life limiting or life threatening conditions. At the time of our inspection there were 4 people living at the home.

463 was taken over by the Francis House Families Limited in February 2016. The young people then living at 463 re-located temporarily to the nearby Francis House Children’s Hospice while 463 was completely re-furbished and enlarged. The provider notified the Care Quality Commission (CQC) of this temporary move. The four young people moved back to 463 in November 2016 with their own dedicated staff team. People could choose to continue to access the Francis House Children’s Hospice for respite care whilst living at 463.

The service had a registered manager in place. 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.

All the people we spoke with said they enjoyed living at 463 and felt safe with the staff support they received. People said staff knew their needs well and there were enough staff on duty to meet their needs.

The registered manager had a clear vision for the service and that the young people’s life limiting or life threatening condition should not prevent them from being independent and participating in educational and leisure opportunities. Staff were positive about their role.

People said staff were kind and caring. We observed positive interactions between the young people and staff during our inspection. People told us they got on with most staff, but not all. They had told the registered manager about this. The registered manager was working with the staff and recognised staff needing training and support to change from working in a children’s hospice environment where children visited for respite care to an residential adult service supporting the same people over a longer period.

People were active and able to choose what they wanted to do. People were supported to be independent travelling to and participating in their chosen activities. However one person said they would like to go out socially more with staff, which the registered manager was aware of.

Staff had received training in safeguarding vulnerable adults and knew the correct action to take if they witnessed or suspected abuse had taken place. They were confident the registered manager would act on their concerns.

Care plans and risk assessments were in place to guide staff on the support people required and the tasks they were able to complete for themselves. The care plans were written in a person centred way. Where required a detailed moving and handling plan was in place. The risk assessments were generic and written for all four people together, although they did cover all the identified risks for each person. The registered manager said individual risk assessments would be written as more people moved in to 463 depending on each person’s needs.

People had spoken with staff about their wishes at the end of their lives if they had wanted to. These wishes needed to be part of each person’s care file as they were currently kept at the children’s hospice.

Staff had received training relevant to their roles and the needs of the people they were supporting. Information and guidelines were available about each person’s medical condition and any equipment they used. Staff competency was checked by the use of workbooks and observation for using any equipment.

The recruitment process was robust and all required che