Beulah House is a small location providing accommodation for up to five people with learning disabilities and who require nursing or personal care. At this inspection five people were living there.

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

People continued to remain safe as staff knew how to recognise and respond to concerns of ill-treatment and abuse. There were enough staff to support people to meet their needs. The provider followed safe recruitment procedures when employing new staff members.

People continued to receive care that was effective. They were assisted by a staff team who were well supported and had the skills and training to effectively support people. People were supported to have 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.

The support people received continued to be caring. People were supported by a kind and considerate staff team. Staff spoke about those they supported with warmth and respect. People were supported at times of upset and distress.

People continued to be involved in developing their own care and support plans. Regular reviews took place and accounted for any changes in people’s needs. People’s individual preferences were known by staff members who supported them as they wished. People and relatives were encouraged to raise any concerns or complaints.

Beulah House continued to be well-led. People were involved in decisions about their home and their suggestions were valued by the provider. Staff members believed their opinions and ideas were listened to by the provider and, if appropriate, implemented. The provider had systems in place to monitor the quality of service they provided and where necessary made changes to drive improvements.

Further information is in the detailed findings below.

This inspection took place on 22 May 2015 and was unannounced.

Beulah House provides accommodation and personal care for five people who have a learning disability, the home was fully occupied when we inspected.

The home had a registered manager in post who was present for our inspection. 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.

One person told us that they felt safe living in the home and staff were aware of how to protect people from potential harm. Risk assessments were in place that told staff how to promote people’s independence and ensure their safety whilst doing so. A record of accidents was maintained and monitored to find out if there were any trends and where necessary risk assessments had been reviewed to prevent the accident happening again. We saw that there were enough staff on duty to ensure people’s needs were met. People’s prescribed medicines were managed by staff and systems and practices in place ensured they received their medicines as prescribed.

Staff told us that they were supported by the manager to carry out their role and had access to regular supervision and training. People’s human rights were supported because staff understood how to include them in decision making about their care. We saw that people had a choice of meals and were supported to eat and drink enough. People were supported to access relevant healthcare services when needed.

Staff were caring and compassionate when supporting people and they looked at ease with staff. People were encouraged to be involved in their care planning. We saw that staff promoted people’s right to privacy and dignity.

People had access to a variety of social activities to reflect their interests. Arrangements were in place to enable people to share their concerns and these were listened to and taken seriously.

People had a say in the running of the home and who worked with them. There was a clear leadership within the home and staff told us that the manager and regional manager were approachable and that they felt well supported. People and their relatives were able to tell the provider about their experience of using the service and care plans were reviewed in relation to information collated from quality assurance questionnaires to drive improvements. Audits were carried out to monitor the service provided and staff told us that they had access to regular meetings and that their views were listened to.

Beulah House provides care and support for up to five people who have a learning disability. Five people were using the service at the time of our inspection.

The service had a manager in place who had been registered with us since May 2011. This meant there was a named and registered person who was responsible for the management of the service.

Some systems were in place to assess and manage the risks posed to people who used the service and the staff understood their responsibilities to ensure people were cared for safely. Improvements were required to ensure these systems were effective at protecting people from the risks associated with their medicines. You can see what action we told the provider to take at the back of this report.

Staff understood the needs of the people who used the service. Systems were in place to ensure that care records contained the information staff needed to provide care that was based upon each person’s personal preferences. However, this information was not always stored securely which meant there was a risk this could be lost or destroyed.

Care was provided with kindness and compassion by staff who were appropriately trained and skilled. People and their families told us they were happy with the care and support provided.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the procedures in place to protect people who could not make decisions about their care, support and safety. These procedures followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). This legislation sets requirements to ensure that where appropriate decisions are made in people’s best interests.

The home promoted an inclusive culture. People were involved in making choices and decisions about their care and their choices and decisions were respected by the staff. People’s independence was also promoted.

We saw some examples of care that was based on best practice. The registered manager assessed and monitored the quality of some aspects of the care provided so that improvements could be made.

During our inspection we spoke with all five people living at Beulah House, five members of staff and three visitors. Our discussions and observations indicated close, positive and warm relationships between people using the service and staff who responded well to people's needs. People were relaxed and seemed happy. This was also the positive view expressed by visitors. One relative said, "It is excellent here I don't lose any sleep anymore worrying about X". Another relative said, "It is brilliant and the best thing that ever happened to X".

People were involved wherever possible in daily choices and decisions about their care. Where they were unable to make more complex decisions for themselves the provider acted in accordance with the Mental Capacity Act 2005.

Care records contained detailed information about people's needs. Risk assessments were in place to protect them. Health professionals regularly reviewed health care needs. Care and treatment was planned in a way to ensure people's safety and wellbeing.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We found that correct recruitment checks had been carried out before staff commenced work to ensure that people were protected from potential harm by inappropriate staff.

Effective systems were in place to regularly assess, maintain and monitor the service so that improvements could be made. .

Although we met most people in the home, they were not able to express their views about the service in any detail. However, everyone we met appeared happy in the home. People were comfortable with the staff and their surroundings. Two people were looking at photographs on iPads. One person was keen to show us photographs of a party they had attended.

A relative told us that their son was, “Very happy” in the home and that staff were, “Wonderful, caring, and cheerful.”

Staff met people's care and support needs in ways that they preferred and we saw that detailed records gave staff the information they needed to do this. Plans were in place to support people to enjoy their lives and staff were aware of risks, people's rights and their responsibilities.

We saw that every aspect of each care plan had been reproduced in an easy to read format with pictures or photos to help people understand and be involved with their care planning.

Staff told us they felt well supported but that they missed the daily presence of the manager who was on secondment to another home. Staff had received appropriate training to support people living in the home.

We saw that the staff effectively ensured that people's views were considered and listened to.

We visited Beulah House to see what changes had been made since we last visited. We met all five people who lived at the home. Not everyone was able to verbally share their experiences of what it was like to live at the home. The people who were able to told us they liked living there and that they liked the staff. One person shared their photographs with us of their recent trips to London and Blackpool. They said they had a really good time. People said or indicated to us that they liked their meals. Two people showed us their bedrooms that were personalised and reflected their tastes and gender. People who were unable to tell us their experiences appeared happy living at the home and were relaxed in the company of the people they lived with and the staff.

One person told us they attended their meetings with their designated worker and other people and talked about things that were important to them. They said they were supported to go out shopping, chose what they wanted to eat and helped out in the kitchen. They said staff helped them with keeping their room clean and tidy. Another person had recently been taken to watch a local football match as they loved football. Staff had decorated their bedroom in the colours they chose and in their favourite football team.

We watched the way staff supported people in their care. We saw that people were supported by a skilled and committed staff team who were passionate about their work. They had an excellent understanding of people’s individual needs. Staff were very good at knowing how each person made their wishes and choices known. They had good approaches with people, involving them in discussions and speaking respectfully with them. We saw people being offered choices throughout our visit and staff were respectful of people's decisions.

We spoke with a visiting relative to gain their views about the service provided. They told us their relative was happy living at the home and staff were “excellent” when supporting their relative following a major operation. They said they were always made welcome when they visited the home.