The inspection took place on 24 January 2017 and was unannounced.

Birchwood Bungalow provides accommodation and personal care for up to seven people with learning disabilities. It does not provide nursing care.

The home had a registered manager. 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 on 29 July 2014 and found the service was meeting the required standards at that time.

People who used the service were unable to communicate verbally due to their complex needs. However, people’s relatives told us that they felt that people were safe living at Birchwood Bungalow. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued. People received support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

People’s relatives complimented the staff team for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care as much as they were able. Visitors to the home were encouraged at any time of the day. There were areas of the home that did not always promote people’s dignity and these were scheduled for refurbishment to help make the home a more pleasant place for people to live.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider regularly monitored the health and safety of the environment and the quality of the care and support provided for people who used the service. The layout of the home was appropriate to meet people’s needs however, some areas would benefit from a programme of refurbishment.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was unannounced.  When we inspected the service on 31 May 2013 we found that the service satisfied the legal requirements in the areas that we looked at.

Birchwood Bungalow provides accommodation and personal care for seven people who have learning difficulties. The registered manager has been in place since January 2013. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The Mental Capacity Act 2005 sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care or treatment. This includes decisions about depriving people of their liberty so that they get the care and treatment they need where there is no less restrictive way of achieving this. DoLS require providers to submit applications to a ‘Supervisory Body’, the appropriate local authority, for authority to do so. We found that the service had complied with the requirements of MCA and DoLS.

Because of people’s complex needs they were unable to communicate verbally. However, staff members communicated with people effectively and used different ways of enhancing that communication.  Staff treated people in a caring, responsive and respectful way and with dignity and respect. They knew the people they cared for and supported well and always used people’s preferred names.

People were involved in deciding what food and drink they had. They were supported to access healthcare services to maintain and promote their health and well-being. They were encouraged to make their rooms at the home their own personal space. People, their relatives or advocates had been involved in the development of their care plans which were reviewed on an annual basis, or more frequently if required. They were supported in a wide range of interests and hobbies, both as group activities or on an individual basis, which suited to their needs. They were encouraged to pursue their interests outside of the home to enable them to develop links with the local community.

There were enough qualified, skilled and experienced staff to meet people’s needs.  All necessary checks had been completed before new staff members had started work at the home and they had completed an induction programme when they started work. Staff members received additional training in areas that improved their capability in providing care and support to people who lived at the home and had regular supervision and appraisal meetings with the manager at which their performance and development were discussed 

Staff members were able to demonstrate a good understanding of procedures in connection with the prevention of abuse. Risks in respect of the home and the provision of care and support to people had been identified, regularly reviewed and steps taken to reduce the on-going risk.

The provider had an effective system to regularly assess and monitor the quality of service that people received and an effective complaints system. 

We used a number of different methods to help us assess the experiences of people using the service, because they had complex needs which meant they were not able to tell us their experiences. However, they were able to express that they were happy with the care and support they received from the staff by their facial gestures and by pointing at objects they liked, such as toys and magazines.

We found that the home was meeting the standards we inspected. People received care and support that met their needs. The environment was comfortable, safe and well maintained. There were sufficient numbers of staff on duty to meet the needs of people. Confidential records had been kept safely and securely.

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 that people were smiling when spoken to and when informed that they were going out for lunch, they went to the front door and waited for staff to take them to the minibus. We also observed that people were happily looking at magazines of their choosing, some were participating in an art and craft session and others were watching the television.

You can see our judgements on the front page of this report.

During our site visit, we met all seven people using the service. They were not able to give verbal feedback. However, they all communicated with us with sounds and gestures and with expressions of contentment. They interacted well with members of staff, who understood the way in which they communicated.

A relative we spoke with said that the person using the service “is very happy living in the home.” The same relative commented, “We see different staff all the time; there is no continuity of care. However all the staff we’ve met are very good; they are very helpful and polite.”

This was echoed by another relative we spoke with who commented, “The service has a high turnover of staff and managers. My relative is being cared for by different staff each time I visit. There is no stability or continuity of care. However, all the staff are superb. I can’t fault them.”

When asked about informed choices and decision-making, a relative said, “The staff keep us informed of any changes or incidents. We attended the annual review. The social worker and the staff from the service were present. We were given the care plan to sign afterwards.”