Agate House is registered with the Care Quality Commission (CQC) to provide accommodation for up to 36 people with a physical disability under the age of 65 years who require personal care or nursing. . At this inspection there were 36 people accommodated at the home.

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

People and their relatives told us that people were safe living in the service. Risks to people were appropriately assessed and managed. There were robust recruitment procedures in place to help ensure staff were of good character and suitable to work at this type of service.There were sufficient numbers of skilled and competent staff available to support people when they needed it.

Staff received appropriate induction, training and support to help them carry out their roles effectively. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). People were supported to have choices and control of their lives and staff supported them to retain as much independence as possible. People received appropriate support to eat and drink sufficient amounts to keep them healthy and people were supported to access a range of health care professionals to meet their individual needs when required.

People who used the service were treated in a kind and caring way by staff who respected their privacy and maintained their dignity. People, relatives and professionals were given the opportunity to feed back on the service and their input was valued and used to improve the service.

People received personalised care that met their individual needs. People were given appropriate support and encouragement to access meaningful activities appropriate to peoples individual abilities and interests. People told us they knew how to complain and were confident they would be listened to if they needed to make a complaint.

The service was being well managed by two deputy managers as the registered manager was off on long term sick leave. The deputy managers had worked hard to create an open, transparent and inclusive atmosphere within the service. There were systems and processes in place to monitor the overall quality of the service and where shortfalls were identified they were promptly acted upon to improve the service.

This inspection took place on the 19 and 21 April 2016 and was unannounced. When we last inspected the service in May 2013 we found that the provider was meeting the legal requirements in the areas that we looked at.

Agate House is a residential home in Ampthill providing nursing care and support to up to 36 people with physical disabilities. At the time of our inspection there were 35 people using the service.

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 safeguarded from avoidable risk of harm and staff understood the process to follow to report concerns regarding people’s safety. There were risk assessments in place which detailed how people could be supported safely. Staff received training in moving and handling which allowed them to move people safely using the correct equipment. People’s care plans were person-centred and included information regarding their backgrounds, preferences and how they could be supported effectively. These were subject to regular review with involvement from people and their relatives where possible.

People’s healthcare needs were identified and met by the service and a dedicated team of nurses with a variety of specialisms. External healthcare support was sought if required from community-based professionals. People had enough to eat and drink and the food and drink on offer took into account their individual needs and choices. There was a creative and vibrant programme of activities on offer so people could pursue their interests in and out of the home. People were treated with dignity and respect and had opportunities to have their opinions and views heard. People gave their consent to receiving care and treatment at the service.

Staff were not always supported through a regular programme of supervision and appraisal. The service did not supervise staff on a regular basis and some staff had been without a formal supervision for an extended period of time. The service had not acted upon their feedback to resolve this issue efficiently.

Staff received a variety of training to enable them to carry out their duties effectively. They completed a thorough induction programme when they first joined the service. The recruitment processes used to employ new staff were safe and ensured that staff employed had the skills, character and experience to meet people’s needs. There were enough staff to keep people safe and protocols in place in case of shortages or staffing issues. The manager held team meetings and sent out staff surveys to provide staff with an opportunity to provide their feedback and contribute to the development of the service. Staff understood the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards (DoLS) and these were applied correctly in practice.

There was a robust quality monitoring system in place for identifying improvements that needed to be made across the service. The service had formed strong links with the local community and had a team of volunteers and fundraisers who were an integral part of the home’s culture and ethos. The environment was clean and well maintained with robust systems in place for monitoring health and safety and controlling the potential spread of infection. Equipment was regularly checked and there were contingency plans in place in case of emergency.

During the inspection we found that the service was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we’ve asked the provider to take at the end of the report.

When we visited Agate House on 16 May 2013, we spoke with five people who lived at the service and observed four others to help us understand their experiences. We observed that staff interacted well with the people using the service and made sure they were fully involved in making decisions about their care and support.

One person told us, "It's great here. The care is really good and the staff are always very kind. I have had an issue before but that was dealt with to my satisfaction." Another person told us, "I am given choices and can do what I want to. I can go out when I want to or stay in and join in with the activities. It's nice living here." A relative told us, "The care is good here. Staff are helpful."

We observed that care plans were person centred and took account of preferences and likes and dislikes, with risk factors being appropriately assessed.

Staff generally felt well supported at work and said they found the home manager to be approachable. They received written and practical supervision and were supported with appropriate training and development to assist them in their roles.

We observed a robust complaints policy prominently displayed. Both staff and people who used the service told us they would feel able to raise any concerns or issues that they had.

During our visit to Agate House on 31 December 2012, we spoke with four people about their experience of living at the home and the care and support they were offered. People told us they were happy living at the home and felt safe in the environment and with the care they were given. One person said, "It seems as though nothing is too much trouble for staff." Another said, "I can do so much more now I am here."

Some of the people were unable to express their views directly because of complex communication problems so we observed engagement between them and staff. It was evident that staff interacted positively with people and respected individual needs and abilities. We saw that people were encouraged to remain independent and were offered choices as to how they spent their free time.

It was evident from our discussions and observations that Agate House was considered as home. We noted that staff were considerate of this when helping people. One example being that staff knocked before entering individual rooms and checked if it was ok to enter. This showed that people's dignity and respect was valued.

We noted that the weekly activity schedule had been discussed with people prior to being commenced. People told us that they were given choices as to whether they attended activities on a regular basis and if they wished to remain in their room, this was not a problem for care staff. One person said, "It's our home, its our choice."

We spoke with several people during our visit and they were all very positive about the care that they received at Agate House. One person said, "Its a lovely, lovely place". Another person told us that the staff had gone to great lengths to help them settle in when they first moved in and had understood the difficulties for them of having to have given up their own home.

One person told us that the staff were good at offering choices and asking for the person's opinion. Another said that they did not usually have to wait long for the call bell to be answered and that, if for any reason the staff were busy, they always came to explain the reason for the delay.

People told us that staff treated them with respect. They said that staff were mindful of their privacy and that they had a choice about whether they received assistance with personal care from a carer of the same gender. One of the people who spoke with us said that they had been involved in the assessment process prior to them moving in and in the reviews of the care.