The inspection took place on 31 January 2019 and was unannounced. The previous inspection took place on 1 August 2016 and the service was rated as Good.

Blossom House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to provide residential accommodation and personal care for up two people living with a learning disability. At the time of our inspection two people were living at the home.

We have written this inspection report in a shorter format because our overall rating of the service as Good has not changed since our last inspection.

People felt safe at the service and staff understood how to safeguard people and knew what to do if they had any concerns.

People told us staff were kind to them. People were involved in a range of activities outside of the home and friendships were encouraged and supported.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; but the service could not evidence they had all the relevant paperwork in place to support this practice. There was a focus of person centred care within the service, which staff followed in practice to ensure people led a full and varied life.

Staff were safely recruited and were trained and supervised so they could support people effectively. Care records were up to date and risk assessments were in place.

This meant that care staff were provided with guidance on how to minimise the identified risk to keep people safe and free from harm.

Medicines were safely managed.

People were encouraged to be as independent as possible and told us they were responsible for tasks about the house and for caring for themselves.

The registered manager carried out audits to check the quality of the service.

Maintenance checks of gas, electricity and fire equipment took place to make sure the house was safe to live in. Regular fire drills took place.

Further information is in the detailed findings below.

We carried out this inspection on 1 August 2016. We announced the inspection on the 29 July 2016. When we visited the service unannounced we found that people and staff were out on a trip and we could not carry out the inspection on the day we initially planned on 29 July 2016.

Blossom House is registered to provide accommodation and support for two people with a learning disability. At the time of our inspection there were two people living in the home.

There was 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.

Staff were knowledgeable about safeguarding procedures. They were able to tell us what actions they took to keep people safe. Staff knew how to manage risks to promote people’s safety and followed guidance in how to mitigate the risks and promote people`s rights and independence in the same time. Risk assessments were comprehensive and these were reviewed regularly to enable staff to minimise the potential for risks to occur.

There were adequate numbers of staff on duty to support people safely and to ensure that people were supported to take part in activities and undertake their preferred daily routines. Recruitment processes were robust and ensured staff employed at the service were fit to carry out their responsibilities and meet people`s needs.

People were supported to take their medicines safely by appropriately trained staff. People were encouraged and enabled to take their own medicines.

Staff felt supported to carry out their roles. There was a thorough induction and training schedule for staff to help them meet the needs of the people who lived at the service. They had regular supervisions, appraisals and on-going professional development.

People’s consent was gained before care and support was delivered. Staff understood the processes in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberties Safeguards (DoLS).

People were able to choose their own meals and had access to snacks and fluids throughout the day. Staff supported them to participate in food preparation when appropriate. People had access to health care professionals to make sure they received care and treatment to meet their individual healthcare needs. Staff supported people to follow advice given by professionals to make sure they maintained their health.

People were relaxed, comfortable and happy with the staff that supported them. Positive relationships had been developed between people and staff who treated them with kindness and compassion. Staff were knowledgeable about how to meet people’s needs and understood how people preferred to be supported on a daily basis. Staff’s approach to people was to help maintain their skills and develop their independence.

Staff understood how to promote and protect people’s rights and maintain their privacy and dignity. People were supported to pursue their hobbies and interests, attend day centre, trips and holidays, which they thoroughly enjoyed.

Regular reviews of care enabled people’s care to be person centred and individual along with being monitored to ensure that it remained reflective of people’s current needs. People knew who to speak to if they wanted to raise a concern. There were systems in place for responding to complaints.

There was good leadership within the service, staff were positive in their desire to provide good quality care for people and ensured that effective quality monitoring processes were used to drive future improvement. The registered manager promoted a positive and open culture within the service and placed people in the centre of the c

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found:

Is the service safe?

We found that people were treated respectfully and spoken with in an appropriate manner. People told us that they were supported to express their views and were involved in making decisions about their care and support.

Is the service effective?

A health professional told us that there had been significant improvement in a person’s wellbeing since they had lived at Blossom House; they said that this was because the person’s individual choices were respected and had been well managed.

Is the service caring?

We noted that staff members were courteous, warm and friendly in their interactions with people who used the service.

Is the service responsive?

We saw that people were supported to express their hopes and aims and received support to achieve these. For example, one person had said that they would like to learn to use a laptop, to go to the cinema and to go to London to see the Christmas lights. We noted from records that these goals had been achieved.

Is the service well led?

We found that the people who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

The manager undertook quality audits of the services and facilities on a three monthly basis and health and safety and environmental checks were regularly undertaken.

A health professional confirmed to us that the service acted promptly on any feedback they received.

People who used the service told us that they were very happy living at the home, that they liked the staff and they were able to do what they wanted to. We observed people to be relaxed around staff and one person took comfort from a member of staff when they became upset. Although one person told us that they had a set time they had to be in their room at night which was not their choice.

There was a range of food available for people and people were able to access drinks and snacks when they wanted to.

We found that care plans contained a lot of detail, although improvements were needed to ensure people who used the service could be more involved. Mental capacity assessments had not been undertaken but people had been asked to sign and agree to something and it was unclear whether they would understand. We also saw an example where one person’s emotional needs were not met.

Quality monitoring arrangements were in place, although audits had not identified issues we found during our inspection and where issues had been identified they were not always supported by an action.

We spoke with both people who used the service. They told us that they liked living at Blossom House and that the staff were nice. They told us about some trips they went on and activities that they enjoyed. This told us that people had good opportunities to participate in the community.

Although we heard that people had regular ‘talking time’ with staff, we heard that they were not sure if they made decisions about their care. We found that, although people signed them, people’s care plans were not written in an accessible format. This did not promote people to be involved in making choices.

We saw that people were supported to meet their health needs and that there were good systems in place to manage medication safely.

Staff told us that they felt supported and that training opportunities were good. This is important because it ensured that staff developed their skills to do their job well.

We found that the systems to monitor the quality of the service were not effective. There was no system to analyse incidents or to evaluate the effectiveness of care. For example, the manager told us that incidents of challenging behaviour for one person had reduced since moving into the house. We could not verify this as no monitoring of patterns of behaviour or effectiveness of support was carried out.

We saw that care records were being stored on shelving in an unlocked office. This meant that personal information about people’s care was not securely kept.

The people who live in the home told us that they were very happy there. They told us that the staff look after them very well and that they have a full life. This year they had two holidays which they enjoyed very much. they said that they are saving for their holiday next year.

They told us that they are included in discussions on all aspects of their lives and if they don't like something they will say so.

If they have a problem they have a number of people they can approach for help and assistance.