Blakesley is a 'care home' for people with complex learning disabilities. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The model of care is based on the Rudolf Steiner principles of providing a spiritually oriented community, supporting people with learning disabilities to continually develop, regardless of disability. Blakesley accommodates up to six people in an adapted two storey building in the centre of a village.

At the time of the inspection there were six people living there. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

We had previously inspected this service in June 2016, at that inspection the service was rated ‘Good’. This inspection took place on the 12, 14 and 15 June 2018. The service had remained ‘Good’ and we found that there were areas which had continued to be improved and have rated the service overall as ‘Outstanding.’

The service demonstrated an excellent commitment to providing outstanding care which put people at the heart of everything. The provider and registered manager led and inspired the staff to deliver person- centred care which had achieved consistently outstanding outcomes for people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff continuously went the ‘extra mile’ to ensure that people lived as fulfilled and enriched lives as possible. They respected people’s individuality and enabled people to express their wishes and make choices for themselves. Positive therapeutic relationships had been developed and staff were proud of the support that they had provided to people and the positive outcomes they had observed.

People who demonstrated behaviour that may challenge services received care that was based upon best practice guidelines that met their individual needs and successfully reduced incidents within the home and community.

Staff demonstrated the provider's values of offering person - centred care that respected people as individuals in all their interactions with people. People, their relatives and the professionals involved in people's care consistently told us that the service provided ‘exceptional care’ to people. People could be assured that they would be supported by sufficient numbers of staff. Records showed that people received their care in the way they needed to maintain their safety.

People were supported to use communication aids and information was provided to people in an accessible format to enable them to make decisions about their care and support.

People's health and well-being was monitored by staff and they were supported to access health professionals in a timely manner when they needed to. People were supported to have sufficient amounts to eat and drink to maintain a balanced diet. People experienced caring relationships with staff and good interaction was evident.

Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns. Care plans contained risk assessments which gave detailed instructions to staff as to how to mitigate risks; these enabled and empowered people to live as independent a life as possible safely.

There was a very effective system of quality assurance led by the provider and registered manager that ensured people consistently received exceptional care and support. The people living at Blakesley had an enhanced sense of well-being and quali

The inspection took place on 21 March 2016 and was unannounced. The service provides care for up to six people with learning disabilities or autistic spectrum disorder. There were six people living at the service at the time of the inspection.

A registered manager was 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.

People were safe and protected from harm. The staff had a good understanding of what abuse meant and the safeguarding procedures to follow to report abuse.

Risk assessments were in place to reduce and manage the risks to peoples’ health and welfare. Systems were in place to monitor accidents and incidents so that preventative action could be taken to reduce the number of occurrences.

Robust staff and volunteer recruitment systems ensured that staff were safe to work with people living at the service. The staffing arrangements ensured that people received one to one staff support to meet their care and support needs.

Robust arrangements were in place for ordering, storing and administering medicines.

Staff had comprehensive induction training and on-going training, which ensured that they had the knowledge and skills to meet the needs of all people living at the service.

Staff supervision and annual appraisal systems enabled them to reflect on their work practice and continually plan their learning and development needs.

The staff treated people with dignity and respect and ensured their rights were upheld. Consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were fully met.

People had a choice of healthy, nutritious food. Healthy eating was integral to promoting well-being. Appropriate referrals were made to health professionals where any health concerns were identified.

The staff were highly motivated and inspired to offer care that was kind, caring and compassionate. They worked in partnership with relatives, who felt informed and involved in their family members care and treatment.

People had individualised care plans in place that clearly detailed and reflected their needs and choices about how they preferred their care and support to be provided. The staff were observant to people's moods and behaviours and were proactive in following individual strategies to minimise people's anxiety. They followed the advice and support from other health professionals to minimise the risks of poor health.

People were encouraged and supported to engage in purposeful social, occupational and recreational activities to enhance well-being.

There were regular meetings for staff which gave them an opportunity to share ideas, and give information about possible areas for improvements to the registered manager.

People were encouraged to raise any concerns they had about the quality of the service they received and complaints were taken seriously and responded to immediately. There was an emphasis on the service continually striving to improve.

The vision and values of the service were person-centred and made sure people living at the service and their representatives were fully consulted, involved and in control of their care.

Robust quality assurance systems were carried out to assess and monitor the quality of the service. The views of people living at the service and their representatives were sought about the quality of the service and acted upon to make positive changes.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

The staff on duty had a good understanding of how to meet the needs of people who used the service. We saw that people felt safe and comfortable in the presence of staff. Staff received regular training and support which helped them to provide safe care. Relatives we spoke with told us that their family member was well looked after and they were in a safe place.

We saw that health and safety information was kept up to date. People and staff were involved in fire drill training so they knew what to do if there was a fire at the service. Health and safety checks were carried out to make sure the premises and people using the service were kept safe. Risk assessments were in place which identified any specific hazards for people who used the service.

Is the service effective?

People’s health and care needs were assessed and plans of care were put in place to meet their needs. Information about how people communicated their needs and wishes were clearly identified in care plans which helped ensure that all staff were able to provide appropriate care. We saw that care plans were being updated by staff when people’s needs changed. This ensured staff had information about people’s new needs.

Is the service caring?

People were treated with dignity and respect by the staff. We saw staff approached people who used the service in a caring manner. People’s preferences, interests, and needs had been recorded and care and support had been provided accordingly. All the people we spoke with told us that the staff were very “caring” and they liked them. The relatives we spoke with told us that the staff spoke to people in a respectful manner and were very caring. One relative told us that they raised a concern with the staff and staff made them feel comfortable and listened to and sorted their concern straight away. They told us that their family member was very happy at the service and they liked the staff and enjoyed the food and the activities. They said my relative “sees this place as their home”.

Is the service responsive?

Staff had good understanding of people’s needs. One person told us if they were not happy, they told the staff and they listened and supported them to meet their needs. We saw people had individualised care plans and they had been involved in discussing how they wanted their care to be provided. Relatives we spoke with told us that the staff kept them updated about their family members care needs. They also told us that the staff had good skills and knowledge and met their family member’s needs well. One relative told us that they attended their family members review meetings and staff had “listened to us and acted on our opinions”.

Is the service well-led?

We found that the service was being well managed by the provider and there were systems in place to identify and make improvements where necessary. Staff received training, supervision and support from management, which helped them to provide safe and effective care.

The provider had monitoring systems in place to ensure that medication administration records were fully completed. Staff training records and people’s care plans were updated to meet their current needs. We saw that health and safety checks were also undertaken regularly to ensure all systems were up to date and kept people safe.

We saw that people were supported to engage in activities that met their needs. We spoke with a person that used the service who told us they were happy.

We spoke with a relative of a person that used the service who told us they were happy with the care their relative received. They told us “We are extremely happy with the care (our relative) receives”. They also told us “The service is excellent”.

We spoke with three staff members who all told us they felt well supported in their roles. One staff member told us “We work with people at their pace”.

We found that people’s needs were assessed and care and support plans were put in place to ensure their needs were met. We saw that work placements and activities were arranged that met people’s needs and promoted their well-being. We found that appropriate checks were carried out on equipment to ensure people’s safety. We found that pre-employment checks were carried out on staff to ensure people were supported by suitable staff.

However, we found concerns relating to the management of medication at the service.

We spoke with two people who lived at Blakesley. One person told us "I feel safe" and "the staff are nice".

We spoke with two relatives of people who lived at Blakesley. They told us "the care is wonderful, the staff are all very friendly and very professional" and "it's a brilliant place for our son, it suits him down to the ground".

We spoke with one staff member who told us that they felt that the care that people receive is fantastic and that people who use the service got a lot of choices as they got one to one support. Another staff member told us "it's one of the best care environments for young people that I've been involved in".

We found that people who used the service had detailed care and support plans and that care was provided in line with these. People were involved in a wide range of community activities and people's own beliefs were respected. We found that staff felt well supported and the provider assessed and monitored the service.

We carried out this inspection because we had not visited since 02 June 2008.

Two residents told us that they were happy living at Blakesley.

We saw staff talking to residents in a caring and sensitive manner and we saw that people looked well presented and were happy and relaxed.