Abacus House offers accommodation and support for up to seven people who have learning disabilities. The home is a large domestic house, situated near to the town centre of Swindon. Accommodation is provided on three floors. People have their own bedrooms and there are spacious shared areas. There were seven people using the service at the time of the inspection.

At the last inspection on 13 November 2014 the service was rated Good. At this inspection we found the service remained Good overall. However, we found the team were often going the extra mile when caring for people and we rated the Caring domain as Outstanding.

People were supported by kind and attentive staff who went to extensive measures to ensure they were supported during difficult times. The registered manager and staff had given a lot of thought and time to ensure people were reassured, given relevant information and felt cared for when they experienced a crisis. People were supported in a respectful dignified manner. Staff discussed interventions with people before providing support. People had access to advocacy support when they were unable to express their views clearly. Staff were very knowledgeable about people’s abilities and preferences, and were aware about how to communicate with people in a way that met their individual needs.

Staff were trained in safeguarding and had a good understanding of how to respond to safeguarding concerns. The registered provider ensured there were sufficient numbers of staff on duty to support people with their assessed needs. Risks to people and the environment were assessed and plans put in place to mitigate any identified risks. Policies and procedures were in place to manage medicines. The registered provider followed safe recruitment procedures. This meant the service was acting appropriately to keep people safe.

The registered provider had ensured staff had been appropriately trained to meet the needs of the people using the service. Staff were supervised in their roles and had opportunities to progress in their jobs. People were provided with a healthy and varied menu to meet their nutritional needs. 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 support this practice. This meant the service were effective in meeting people’s needs.

Support plans were individualised and person centred focussing on people’s abilities and what was needed to ensure their care was individual to them. Plans were reviewed and evaluated regularly to ensure planned care was current and up to date. People had access to health care when necessary and were supported with health and well-being appointments. People were supported to do activities they enjoyed. Complaints information was clear but no complaints had been received.

The service was well led by an experienced registered manager who put people in the service at the heart of all actions. Staff expressed confidence in the management and felt valued in their roles. There were robust quality assurance processes in place to drive improvement in the service.

This was an unannounced inspection which took place on 13 November 2014.

The service offers accommodation and support for up to seven people who have learning disabilities. The home is a large domestic sized house, near to the town centre of Swindon. Accommodation is provided on three floors. Individuals have their own bedrooms and there are spacious shared areas.

There was a registered manager running 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 about how the service is run.

At the last inspection on 2 May 2014, we told the provider to take action to make improvements to obtaining people’s consent and acting in their best interests. This action had been completed.

The staff team understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision.DoLS provide a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm.They had taken any necessary action to ensure they were working in a way which recognised and maintained people’s rights. The staff team liaised with the local authority with regard to people’s mental capacity and was prompt in making DoLS referrals.

People were encouraged to make choices and decisions for themselves. They had as much control over their daily lives as they were able to have. Staff were instructed on how to help people to make their own decisions and choices.

At the last inspection on 2 May 2014, we asked the provider to make sure they were safeguarding people against the risk of abuse and protecting them from the risk of potentially unlawful excessive control or restraint. This action had been completed.

At the last inspection on 2 May 2014, we asked the provider to protect people from the risk of infection. This action had been completed.

The home used various methods to keep people as safe as possible. Care workers were trained in, and understood, how to protect people in their care from harm or abuse. People told us they felt very safe in the home.

General risks, and those specific to each person were identified and managed appropriately. Risk assessments identified any behaviour that might be distressing to people and staff developed behaviour management plans accordingly. The staff team did not use physical restraint. They were trained in a method called positive behaviour management techniques. This was a system where staff were trained to ‘spot’ signs of distress early, distract people and use particular voice tones and gestures to help people to manage behaviour that could put themselves or others at risk of harm or distress.

The home was clean and hygienic. People said they were proud of their home. Some redecoration work had been carried out in some areas of the home. The staff team used daily and weekly cleaning schedules to ensure the cleanliness of the home was of an acceptable standard.

The home’s recruitment process tried to ensure the staff they employed were suitable and safe to work there. People were supported to take their medication or it was given to them, safely.

People were helped to look after their health and attend appointments with various health and well-being professionals. They were encouraged to be as independent as they were able to be, as safely as possible. People were given the opportunity to participate in activities of their choice. They were treated with dignity and respect at all times.

At our inspection of 2 May 2014, we told the provider to improve the way they assessed and monitored the quality of service provision. This action had been completed.

The provider and the registered manager checked the quality of care they were providing by using a variety of methods. These including the manager regularly looking at all aspects of the running of the home and a senior manager visiting the home every month. People who used the service and other interested parties were formally asked for their views every year. Improvements and developments were made as a result of the quality checks.

The staff team were well supported by the registered manager to ensure they were able to offer good care to people. The home worked co-operatively with other community services to make sure people received any other assistance they needed. People and staff told us the registered manager was very approachable. Everyone felt valued and involved in the running of the home and were confident to talk to the manager about anything.

At our inspection of 2 May 2014. We asked the provider to improve record keeping. This action had been completed.

Records relating to the care of people and the running of the home were generally accurate, up-to-date and well kept.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

We spoke with the deputy manager and four staff, three people living in the home and looked at five records.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had not been cared for in an environment that was safe, clean and hygienic.

Staff training records showed that staff had access to relevant training which demonstrated that staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

We found there were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We found that some people were deprived of their liberty and applications needed to be submitted. We found that proper policies and procedures were not in place. Staff we spoke with did not demonstrate an understanding of when an application should be made.

CQC monitors the operation of the Mental Capacity Act which applies to all services providing care and support for people. We found that the provider had not followed legal requirements in obtaining appropriate consent for some people who did not have capacity to consent to some decisions made on their behalf.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. One person told us. "staff are really nice” Another that “they liked living in the home”. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this

Is the service responsive?

People’s needs had been assessed before they moved into the home. We found some people had not had reviews of their funding authority so people’s plans were not up to date. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place but these were not effective in some areas. For example in the cleanliness of the home, recording of relevant information and the effective operation of systems to monitor and assess the quality of the services provided in carrying out the activity.

The manager had not ensured the maintenance of appropriate standards of cleanliness and hygiene relating to the premises for the purpose of carrying out the regulated activity.

Some people told us they were asked for their feedback on the service they received and that they were supported to complete customer satisfaction surveys. Because of their communication difficulties some people were unable to tell us what their views were.

Staff told us they were able to understand some people and could tell when they were unhappy with the care and support as their behaviour changed. One person told us their complaint had been listened to and changes put in place to reduce the chance of it happening again.

We found staff were not clear about their roles and responsibilities in keeping the home and people’s rooms clean.

We found the manager did not have an effective system in place to monitor the quality of services provided to protect people against the risk of inappropriate or unsafe care.

We spoke with four people. One person told us that the staff were helping them with their goal of becoming independent. They told us that the staff supported them with daily living skills such as cleaning, shopping and cooking. Three people told us that the staff supported them to go out. One of them had been shopping and showed us what they had bought. Two people had been involved in a sports day at a day service and had won medals. They said that they enjoyed going to the day service.

People told us that they were involved in developing their care plans and gave consent to their care and support. Each person had a series of care plans to make sure that all their support needs were met.

People said that they felt safe in the home. There were systems to make sure that people were protected from abuse. When we looked around the home we saw that it was clean and hygienic and was well maintained.

We saw that there were enough staff on duty to support people to go out and to do household tasks such as washing and cooking. People told us that there were enough staff to support them.

We found that there were checks to make sure that the home was safe for people to live in. We saw that there had been surveys so that people could give their views about the service and these had been acted upon. People told us that there were residents meetings and they were asked their views.

We spoke with staff, three people living in the home and examined records and meeting minutes. One person told us "Staff help me to be independent and if I have a problem I always have the option to talk to someone". Another person said that they were happy at the home, the staff treated them well, and were always there to help them.

We found that people had been involved in planning their care and what they could do each day. We saw that the staff were familiar with people's needs and gave them opportunities to make choices.

Permanent staff had received an appropriate induction and the temporary manager provided staff with regular supervision. Staff were also supported through a system of appraisals. Due to the high turnover of staff, bank and agency staff had been used to cover staffing shortfalls. This did not appear to have had a detrimental effect on the people living in the home.

The provider did not have effective systems in place to ensure the CQC were notified of safeguarding incidents.

The provider's quality assurance systems were not effective in ensuring the performance of the home was adequately monitored, and that the views of people living in the home were taken into consideration.

People living in the home were positive about the care staff and the care and support they provided. People said they were treated with respect and that staff were polite and helpful. People told us they were involved in the planning of their care and in the reviewing of support plans. People were very happy with the range of activities they were supported to undertake and of the support they received to access the community and develop their independence skills.

People living in the home made positive comments about the quality and variety of food. They said they were given choice, sufficient quantities and were always involved in planning the meals.

People said they felt safe living there and were able to talk to staff about concerns or issues they wished to complain about.

People told us there were sometimes delays in organising building repairs and maintenance.

People said that staffing numbers were sufficient to meet their needs and staff said they that the training they received was appropriate to the role they performed.