This inspection took place on 9 and 11 April 2018 and was unannounced. The service was last inspected in April 2016 and was rated as 'Good'.

77 Gloucester Road North 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.

77 Gloucester Road North accommodates six people in an adapted, detached house. At the time of the inspection there were six people living at the service. The registered manager and staff were working 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 so that people could live an ordinary life.

There was a part time registered manager working in the home. 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.

People were supported by staff who had received training in how to recognise signs of abuse. Staff were aware of what actions they would take if they suspected a person was at risk of harm. Staff would take concerns further until their concerns were resolved.

Staff were aware of the risks to people and planned the best way of supporting them whilst at the same time encouraging people’s independence.

Safe systems of recruitment were in place. However care and support to people living in the home was provided by more casual staff than the permanent staff who knew the people well.

The medicine procedures were not always in place to ensure people received their medicines as prescribed by their GP.

Care records provided staff with the information required to effectively support people's care, health and social well-being. Staff were supported by the management team through regular supervisions, training and team meetings.

People were supported to visit their GP and other healthcare professionals, in order to maintain good health. People were involved in planning their weekly menus and some were encouraged to be involved in the preparation of their food.

Staff obtained people's consent prior to offering 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 supported this practice and people’s rights.

People receive support from staff who treated them with dignity and respect. People were comfortable in the presence of staff, who supported them in a friendly manner. People were provided with information in a format they understood.

Complaints raised were investigated and responded to and where appropriate, lessons were learned. Staff were confident that if people raised a concerns they would be listened to and action would be taken.

Staff were motivated and felt supported in their role and worked with the registered manager's vision for the service.

The provider and home staff carried out regular audits of the service.

People and staff were provided with the opportunity to give feedback on the service, which was then acted on. A variety of audits were in place to assist the registered manager in making improvement across the service.

77 Gloucester Road North provides accommodation and personal care for six people. People who live at the home have a learning disability. There were six people accommodated at the time of the inspection. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting. This inspector took place on the 31 March and 5 April 2016.

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 were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow these procedures. Systems were in place to ensure people were safe. These included risk management, checks on the environment and safe recruitment processes. Staff knew what to do to keep people safe.

People had a care plan that described how they wanted to be supported. These were tailored to the person. Care was effective and responsive to people’s changing needs. People had access to healthcare professionals when they became unwell or required specialist equipment. People received their medicines safely.

People’s rights were upheld and they were involved in decisions about their care and support. Where decisions were more complex these had been discussed with relatives and other health care professionals to ensure it was in the person’s best interest. Staff were knowledgeable about legislation to protect people in relation to making decisions and safeguards in respect of deprivation of liberty safeguards. Appropriate applications had been made in respect of these safeguards ensuring people were protected.

Sufficient staff supported the people living at the service. Where there were shortfalls for example staff absence or vacant posts, these had been covered with bank and agency staff. The staff told us all staff vacancies had recently been filled and they were looking forward to working as a full team.

Staff had received appropriate training to support the people living at the service. Staff were supported in their role and received regular supervisions. Supervisions are where a member of staff meets with a senior manager to discuss their role, performance and training needs.

Systems were in place to ensure that any complaints were responded to. People’s views were sought through an annual survey that was completed by a representative from Milestones Trust. This was done using an observational tool as many of the people living at 77 Gloucester Road North were unable to express their views due to their learning disability.

The staff, the manager and a representative from Milestones Trust completed regular checks on the systems that were in operation in the home to ensure they were effective.

People were provided with a safe, effective, caring and responsive service that was well led. The organisation’s values and philosophy were clearly explained to staff.

The purpose of the inspection was to answer our five 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. The summary is based on our observations during the inspection, discussions with the manager and three staff that were on duty and looking at records.

People living in the home had a learning disability and therefore did not communicate verbally. In order to understand their experiences we observed staff interactions with people over the course of our inspection.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Care plans were person centred and detailed the individual's personal preferences and information to keep them safe. Risk assessments were seen covering all areas of daily living. This included support with moving and handling, personal care, accessing the community and eating and drinking. This meant that staff had guidance to support people safely.

Systems were in place to make sure that the registered manager and staff learnt from events such as accidents and incidents. This minimised the risks to people and helped the service to improve and ensure people’s safety.

Staff told us that information was shared with them during handover and team meetings and they had time to read care plans. This enabled them to be kept informed about changes to people’s needs and what they need to do to keep people safe.

The manager told us there was no one presently accommodated that had been subject to an application for a Deprivation of Liberty Safeguard. However, they were reviewing this as new guidance on the legislation had been given to them due to a recent Supreme Court Judgement. This meant that the provider took into consideration changes in legislation. In addition people’s safety was considered along with their human rights.

We saw that there were sufficient staff on duty to meet the needs of the people living in the home. This included supporting people in the community. Clear plans of care were in place detailing the support that each person needed and the staff required to do this safely. Staff confirmed the staffing levels were suitable to meet the needs of the people.

Is the service effective?

People’s health and care needs were assessed and a plan of care was put in place. Staff were aware of the needs of the individuals living in the home and how care was being delivered.

We saw that people received the care set out in their care plan and people received the support that they needed.

There were systems in place to monitor the effectiveness of the care. Care was reviewed to ensure that it was appropriate and suitable for the individual. Care was reviewed at three monthly intervals or as needs changed. Care plans had recently been rewritten involving the staff that were supporting the person.

People in the home had a learning disability and communicated using non-verbal communication. Each person had a communication dictionary to describe how their communicated day to day needs including when they were unhappy, in pain, hungry or thirsty. Staff were aware how people communicated which enabled them to effectively meet their needs. Staff observed and monitor people’s reactions to activities or personal care to ensure the care was appropriate.

People’s care had been discussed at team meetings to ensure staff were following the care plans that were in place. Staff told us that daily handovers took place to ensure that important information was passed between staff to ensure that the care of people was planned and responsive to their needs. This meant the staff team were continually reviewing the care and support to ensure it was effective.

Is the service caring?

We observed staff meeting the needs of the people they were supporting. People were spoken to in a respectful manner using their preferred name. Staff were attentive to people’s needs.

People’s daily routines had been recorded and care and support had been provided in accordance with people’s wishes. This meant that people were treated as individuals and their preferences were recognised. Care records were person centred and described the positive attributes of a person.

Is the service responsive?

We observed staff following the plans of care with moving and handling and supporting people in the home with daily activities. This included observing people being supported with their lunchtime meal appropriately. Staff were responsive to the needs of the people living in the home.

People were supported by other professionals including speech and language therapists and physiotherapists. Referrals to other health professionals had been made and their recommendations were included in the plan of care for the person.

Care files included information about how the staff were supporting people with their health care needs and staying healthy. People were registered with a GP and had access to a dentist, chiropodist and optician. Where people’s needs had changed, care plans had been reviewed and amended and referrals made to other professionals.

Is the service well-led?

There was a manager in the service that was registered with the Care Quality Commission.

The service had a quality assurance system in place. The records that we looked at evidenced that where shortfalls had been identified these had been addressed.

Regular staff meetings were being held to discuss the care needs and the running of the home. Where actions had been identified these had been followed up. The manager and staff continued to look at the needs of people who used the service and ways to improve. One way they had achieved this was through monthly staff meetings. This meant the staff’s views were valued and sought in improving the service.

People living at the home were supported to make day to day decisions as much as they were able. Staff had good knowledge of the Mental Capacity Act 2005 and ensured that where decisions needed to be made in people's best interest this was done legally.

People were unable to tell us about their experiences of care. We observed staff interactions in communal areas and saw that staff spoke to people with respect. People's care was planned and when their needs changed their care plans were updated. Appropriate assessments were in place to assess and manage risk. Staff knew people well and were able to tell us about their likes, dislikes and care needs.

Professionals who worked with the home told us that staff were always well-prepared. They discussed people's needs before meeting with professionals and ensured that a member of staff who knew the person well was available to support them.

The home was clean and free from odours throughout. There was clear guidance available for staff on the prevention and control of infection and staff were able to demonstrate clear knowledge in this area.

The provider was unable to demonstrate that effective recruitment procedures had been followed, the three staff files we looked at were incomplete and did not contain evidence that appropriate checks had been carried out.

Staff knew how to support people to make complaints and we saw evidence that the home had advocated for one person.

Due to the level of their disability people were not able to speak with us about their care. We spent the majority of the day in communal areas of the house in order to observe what happened over the course of the day and how staff communicated with people.

Staff were warm and friendly to people and treated them kindly. It was apparent from what staff told us that they knew people very well and had developed ways of communicating. Staff told us they enjoyed working in the home and thought the people who lived there were happy.

People’s rooms were decorated nicely, had co-ordinated colour themes and were age-appropriate. The registered manager told us they had chosen the colour scheme for one person’s room with the person’s relative . The most recent residents had their rooms decorated with the colours they had in their previous accommodation to help them feel more at home. All the rooms had ensuite facilities.

Statements from staff included, “It’s one of the best homes I’ve worked in”, “It’s a smaller place, there is always time for people”.