281-287 St George’s Road is registered to provide care and accommodation for 12 adults who are living with a learning disability or physical disability. The service consists of four bungalows situated close to local shops, transport links and local amenities.

At the time of our inspection there were 11 people using the service.

The service had 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.

The service was last inspected on 10 September 2015 and was rated as ‘Good’ overall. At this inspection we found the service remained ‘Good’.

People who used the service were supported by staff who understood the importance of protecting them from harm. Staff had completed training in how to identify abuse and report this to the appropriate authorities. We found staff were recruited in a safe way and all checks were in place before they started work. The staff had completed an in-depth comprehensive induction and essential training at the beginning of their employment and we saw periodic refresher training to update their knowledge and skills had followed this. Staffing levels were sufficient to meet people’s needs.

Risks to people were identified and plans were put in place to help manage the risk and minimise them from occurring. Medicines were managed safely with an effective system in place. Staff competences, around administering medication, were regularly checked.

We found the service to be clean and tidy. Staff told us the infection control practices were good and we saw the service was well maintained.

We looked at how the service used the Mental Capacity Act 2005 to ensure when people were assessed as lacking capacity to make their own decisions, best interest meetings were held in order to make important decisions on their behalf.

We observed staff were kind and caring in their approach and interactions with people who used the service. They had a good understanding and knowledge of people’s individual needs and their preferences for how they wished to be supported. We saw staff obtained consent and offered explanations to people before undertaking any support tasks.

People who used the service and their relatives told us they were supported by kind and caring staff who knew them well and understood their preferences for how their care and support should be delivered. We saw people were treated with dignity and respect throughout our inspection. It was clear staff were aware of people's preferences for how care and support should be provided.

Staff supported people in the least restrictive way possible, the policies and procedures within the organisation supported this practice. People who used the service were supported to access health care professionals when required.

We saw records confirming that reviews took place periodically and people who used the service or those acting on their behalf were involved with the planning and on-going assessments of their care when possible.

The provider had developed and embedded an effective quality assurance system that consisted of audits, daily checks and questionnaires. Action was taken to improve the service when shortfalls were identified. People who used the service, relatives and staff were able to express their views on how the service was run through surveys and a range of meetings.

There was a complaints policy in place and available in easy to read format within the service. The registered manager understood the requirements to report accidents, incidents and other notifiable incidents to the CQC.

Further information is in the detailed findings below.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We observed how support was provided, reviewed records, spoke with staff and spoke with relatives to help us understand their experiences.

There were clear care plans for staff to follow about how to support people safely and promote their independence. We saw people had access to a variety of social activities and stimulation within the service and the community.

People who used the service were provided with a balanced and varied diet. Health professionals provided guidance and treatment when required.

The premises were in a good state of repair and were clean and fresh.

Background checks had been carried out on staff before they started to work at the service to make sure they were suitable to work with vulnerable people. Throughout our inspection we observed good interactions and found people who used the service were relaxed and happy in the care of the staff.

We saw the complaints procedure was available to people who used and visited the service. Staff told us how they would support people to raise concerns if they could not do so themselves.

Because the people who used the service had complex needs we used a number of different methods to help us understand their experiences.

We saw that when staff helped people they spoke calmly and provided clear information about choices and alternatives available. They were sensitive to people’s needs and provided reassurance and guidance when needed.

We saw that people were safeguarded from abuse because staff had received training and there was guidance for staff to follow if they witnessed or became aware of any abuse.

We saw that staff had received adequate training which helped them to care for the people who used the service and to meet their needs.

We found that the services offered at the home were regularly monitored and people had the opportunity to have a say about how the home was run.

We did not speak with people who use the services regarding these outcome areas. This was because the information we examined as part of this review was all held at the Head Office and not at the location.

Due to people having a variety of complex needs and communication difficulties, they were not able to tell us directly about their care.

281-287 St Georges Road consists of four separate bungalows that are registered to provide care for up to a maximum of twelve people with a learning disability. They are all part of the Avocet Trust organisation, which is a registered charity.

The service had 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.

This inspection took place on 29 September 2015 and was unannounced. The previous inspection of the service took place on 12 September 2013 and was found to be compliant with all of the regulations that were inspected.

The Care Quality Commission [CQC] monitors the operation and implementation of the Deprivation of Liberty Safeguards [DoLS]. The registered manager had followed the correct process to submit applications to the local authority for a DoLS where it was identified this was required to keep people safe. At the time of the inspection there were no DoLS authorisations in place and the service was waiting for assessments and approval of the applications that had been submitted.

The people who lived at the service had complex needs which meant they could not tell us their experiences. We used a number of different methods to help us understand the experiences of the people who used the service including the Short Observational Framework for Inspection [SOFI]. SOFI is a way of observing care to help us understand the experiences of people who were unable to talk with us.

We saw staff engaging with the people who used the service in a kind and considerate way. The staff knew people’s preferences for how care and treatment was to be provided and had developed a clear understanding of how to meet people’s assessed needs.

Staff had undertaken a range of training pertinent to their role and were supported during one to one meetings and annual appraisals with the manager. They told us they had completed a nationally recognised qualification in care and were encouraged to continually develop their skills and knowledge.

Staff were deployed in sufficient numbers to meet the needs of the people who used the service. We saw that before prospective staff were offered a role within the service checks were carried out to ensure they were suitable to work with vulnerable people.

A quality monitoring system was in place that consisted of audits, checks, monthly assessments and stakeholder surveys. We saw that when shortfalls were noted; action was taken to improve the service as required. However, the system required further development to ensure all aspects of care delivery were assessed. The audits and monthly assessments had failed to ensure infection control practices were reviewed which led to shortfalls not being highlighted.

We undertook a tour of every bungalow and found them to clean, tidy and free from odours. A bathroom in one of the bungalows had open shelving which meant towels and other linen were not stored appropriately and increased the risk cross infection and the spreading of infections through the home. The bath lowering table was not clean after being serviced, we mentioned this to the manager who ensured it was cleaned thoroughly.

People who used the service had their health and social care needs assessed periodically. The assessments were used to develop support plans which stated how staff should provide care and support using the least restrictive interventions. Throughout the inspection we observed staff treating people with dignity and respect.

People were supported to maintain a healthy balanced diet. Food was provided to meet people’s needs for example cut into small pieces or blended to reduce the risk of choking. When required, relevant professionals had been contacted for their support and guidance in this area.

Medicines were ordered, stored, administered or disposed of safely. Personalised support plans had been developed to ensure people received the medicines in line with their preferences and needs.