This inspection took place on 29 and 30 November 2016 and the first day was unannounced.

Birnbeck House provides accommodation and personal care for up to 13 people with learning disabilities. It is large Edwardian style house located in a residential area of Weston-super-Mare within easy reach of local amenities, the town centre and the beach. The home supports people who are highly dependent but also has facilities for more independent people.

There is 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.

Where records were duplicated, for example completing bowel charts, staff did not always record information accurately. Where additional records were required, such as monitoring a person after a head injury, these records were not completed. .

Relatives told us people were kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.

Systems, processes and standard operating procedures around medicines were reliable and appropriate to keep people safe. Monitoring the safety of these systems were robust.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring.

Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and families were involved in making decisions about their care.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Staff told us the registered manager was accessible and approachable. Staff and relatives felt able to speak with the manager and provided feedback on the service.

The registered manager undertook spot checks to review the quality of the service provided and made the necessary improvements to the service. Regular audits were completed.

We observed care practices, met people, talked to staff and viewed records to help us understand how people viewed the support they received at this service. This was because people did not communicate verbally and were not able to tell us about their experiences.

Care records were person centred, clear to read and ensured people and their families were at the centre of all choices and support decisions. Care records were regularly reviewed to remain up to date.

We saw staff offered people choices and were knowledgeable about how people communicated those choices. We saw that staff listened to people and were aware of people's facial expressions and body language. Through their actions, staff showed how well they knew each person’s individual needs. Staff were respectful and supported people patiently.

The service had policies and procedures in place that kept people safe. Staff were knowledgeable and confident about their safeguarding responsibilities and how they would respond to any concerns they may have.

There were processes in place to monitor the quality of service being provided, and we saw that the opinions of people’s families were obtained through surveys.

The people living at Birnbeck House had complex needs and were unable to tell us about their care. We carried out observations of the interaction between the staff and the people they supported in different areas of the home. Staff were respectful in their approach and peoples' behaviour indicated they felt comfortable in their communications with staff.

People were spending time in communal areas; some in their rooms whilst others were involved in structured activities. One person was in his room having his hands massaged and a group were in the lounge making music. We noted that wherever people were, there would be staff alongside them or nearby providing support when required.

Staff were able to tell us what peoples' expressions meant because this information was collected by staff observing how people responded to their likes and dislikes. We saw that staff had developed good relationships with people and were knowledgeable about their individual care needs.

We looked at peoples' care files and saw that peoples' care and support was planned and delivered in a way that ensured people's welfare and safety. For instance plans set out what was a good day for a person and what would be a bad day for them. We also saw charts explaining to staff the methods people used to communicate and what they meant.

Having assessed the available evidence, we considered the service demonstrated how it met the safety and welfare needs of the people living in Birnbeck House.

Birnbeck House provides a service for people who have learning difficulties which can make communication difficult. We were able to gain some comments that people liked the home and were happy there. People’s requests and choices are considered when they are asked if they would like to get up in the morning, if they refuse then staff will ask again later. We saw that staff eat with people who use the service and were seen to be cutting up food and assisting people as required. We were told that one person didn’t like pasta so an alternative was provided. Some people who use the service wish to eat outside of the main meal times or have an early breakfast and this is catered for.