The inspection took place on 17 May 2017. The inspection was unannounced.

Bewick House is a residential support home based in Darlington. The home provides personal support for people with learning disabilities who also experience mental ill health. It is situated close to the local amenities and transport links. The service is registered to provide support to six people and on the day of our inspection there were six people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We last inspected the service in January 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ overall. The atmosphere of the home was vibrant, homely, warm and welcoming. People who used the service were relaxed in their home environment and visitors offered praise of the service and were always welcomed.

Without exception people were empowered on a daily basis to have choice and control over their lives from being supported by person centred approaches. Person centred is when the person is central to their support and their preferences are respected.

The home was extremely person centred, inclusive and was underpinned by a genuine desire to offer a quality personalised service.

Visiting professionals offered praise of the service and especially the person centred values and support offered to people.

People were empowered to forward plan goals and to achieve them to improve their quality of life.

We spent time observing the support that took place in the service. We saw that people were always respected by staff and treated with kindness. We saw staff being respectful, considerate and communicating exceptionally well with people well.

Support plans were developed in partnership with people and not for people and these set out exactly how people liked to be supported and what goals they wanted to achieve.

People’s support plans were written in plain english and reflected the person centred values of the home. They included targets that people wanted to achieve and a ‘one page profile’ that made use of, personal history and described individual’s support needs. These were regularly reviewed; and people were always at the centre of the process.

People were encouraged to have their say and get involved in engagement opportunities with advocacy organisations on wider issues such as the ‘transforming care agenda’ that is tailoring services in the community for people who are currently in long stay hospital and treatment centres across the UK.

People were supported to play an active role within their local community by making regular use of local resources, clubs and amenities.

People were equal partners and fully involved in all aspects of the staff recruitment process.

People influenced how the home was run by voicing their opinions regularly and these were acted upon.

Support plans contained person centred risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm to enable them to do the things they wanted to live their lives fully.The support plans we viewed also showed us that people’s health was monitored and referrals were made to other health support professionals where necessary, for example: their GP, community nurse or optician.

People were enhancing their wellbeing on a daily basis by taking part in flexible person centred activities both at home and within the local community. Activities encouraged and maximised peoples independence and impacted positively on people’s lives.

We saw people were encouraged to eat and drink sufficient amounts to meet

We inspected Bewick House on 25 November 2014. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Bewick House provides care and support for six people who have a learning disability and/or mental health problems. The home does not provide nursing care. It is a large detached house situated on a housing estate in Darlington and is close to large supermarket and other amenities.

The home had a registered manager in place and they have been in post since the home opened. 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 majority of the people living at the home required staff to provide support to assist, to develop impulse control, and to manage their behaviour and reactions to their emotional experiences. The structured environment staff provided was similar to that offered in mental health nursing services but people’s level of need could be managed within a residential setting. We found that the manager had taken appropriate steps if people’s needs changed and staff struggled to meet their needs.

People we spoke with told us they felt safe in the home and the staff made sure they were kept safe. People told us that the staff worked with them to see how to reduce risks when going out and about. We saw there were systems and processes in place to protect people from the risk of harm.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. A designated infection control champion was in post and we found that all relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.

We found that people were encouraged and supported to take responsible risks and positive risk-raking practices were followed. Those people who were able to were encouraged and supported to go out independently and others routinely went out with staff.

Staff had received a range of training, which covered mandatory courses such as fire safety as well as condition specific training such as mental health disorders. Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training and clearly understood the requirements of the Act which meant they were working within the law to support people who may lack capacity to make their own decisions. We found that the staff had the skills and knowledge to provide support to the people who lived at the home. People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. We saw that four to five staff routinely provided support to people.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We observed that staff had developed very positive relationships with the people who used the service. We saw that the staff were able to discreetly keep people focused on the present, reduce the impact of the difficulties people experience with impulse control and anger management. There were interactions between people and staff that were jovial and supportive. Staff were kind and respectful, we saw that they were aware of how to respect people’s privacy and dignity. People told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice.

People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.

We saw that people living at Bewick House were supported to maintain good health and access a range healthcare professionals and services. We found that staff worked well with people’s healthcare professional such as consultants and community nurses. People were encouraged to have regular health checks and staff accompanied people to their hospital appointments.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans. The people we spoke with discussed their support plans and how they had worked with staff to create them.

People told us how staff encouraged them to develop their daily living skills and supported them with their courses, hobbies and leisure interests inside and outside of the home. During the visit we saw staff join people doing creative work and identify activities people would enjoy doing.

We saw that the provider had a system in place for dealing with people’s concerns and complaints. People we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

The provider had developed a range of systems to monitor and improve the quality of the service provided. We saw that the manager had implemented these and used them to critically review the service. This had led to the systems being extremely effective and the service being well-led.