About the service: Bos Y’n Dre is a residential care home that was providing personal care to four people with a learning disability at the time of the inspection.

People’s experience of using this service: Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions effective and well-led to at least good. At this inspection we found the heating system had been improved and systems to manage people’s personal monies were robust.

The service was based in the registered managers home and there was an inclusive and family orientated atmosphere. People were clearly relaxed in their environment and moved around the premises independently. A shared lounge contained people’s possessions and various puzzles, books etc. so people could choose to pick them up at any time.

Everyone we spoke with was positive in their feedback. Comments included; “I am always totally impressed with the care that each resident receives”, “[Relative] has grown into a lovely man since being at the service. He is much more chatty and loves to laugh now which goes to prove how much love and care has been shown him” and “I feel safe, yes, very.”

The providers and registered manager had built trusting relationships with people and knew them well. There were no staff employed at the service other than the registered manager. The providers had originally started and ran the service and were still available to support if necessary. They visited regularly and were an important part of the service, spending time with people and taking part in trips out.

The registered manager had completed training and refreshed it regularly in line with best practice or when circumstances changed. They had no system for keeping up with developments in the care sector and we have made a recommendation about this in the report. The contact details for the service had changed and this had not been updated with the Care Quality Commission (CQC). Because of this oversight we had not received a completed PIR.

Care was planned to meet people’s needs and preferences. The registered manager supported people to be involved in the development of care plans and any reviews. Over time they had developed techniques to encourage people to be more involved and ‘own’ their care plans. They contained positive information about people’s skills and talents. There were descriptions of when people needed support and what they could do independently. People were supported to have maximum choice and control of their lives and the registered manager supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (Published 15 February 2018).

Why we inspected: This was a scheduled inspection which was planned according to the previous rating.

Follow up: We will continue to monitor the service until we return to visit in line with our re-inspection programme. If any concerning information is received we may inspect sooner.

This comprehensive inspection took place on 20 November 2017 and was announced.

Bos Y Dre is a ‘care home’. People in care homes receive accommodation and nursing care as single under one contractual agreement. CQC regulates both the premises and care provided. We looked at both during this inspection. Bos Y'n Dre is situated close to the centre of the town of St Austell with all amenities being a walk or short drive away. The home provides single room accommodation for up to 4 adults with a learning disability who need assistance with personal care. The house is of a domestic nature with no additional adaptations in place as people using the service are mobile and independent. Each person has their own room. There is a shared bathroom and shower. At the time of the inspection there were 4 people living at Bos Y’n Dre.

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. The service had 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.

There was no consistency in heating the first floor of the service which included people’s rooms and a bathroom. Wall heaters and mobile heaters were being used to heat peoples rooms at specific times of the day but there was not a consistent source of heat to ensure rooms were comfortable to use at all times. There was no heating in the bathroom at the time of the inspection. This meant people were not comfortable when using bathing facilities in cold weather.

By not maintaining the environment to a consistent standard meant there was a potential negative impact on people using the service.

Records to record the management of people’s finances were not complete at the time of the inspection. There was not enough accounting evidence in place to effectively audit the information.

There were no additional staff members employed at Bos Y’n Dre. The registered providers supported the registered manager when required.

All the people living at Bos Y’n Dre spoke with us and told us they were happy and supported by the registered manager who cared for them and treated them well. One person who lived at Bos Y Dre said, “I’ve lived here for a long time. It’s home to me and I am very well looked after.”

People were supported to maintain their hobbies and interests for example using interactive technology to play games, including bowling which all the people using the service enjoyed. There were a range of books, DVD’s and music for people to use as and when they wanted to

The registered manager knew the people they supported very well as they had all lived at the service for a long time. This had helped them to build strong and supportive working relationships.

People were supported to have choice and control of their lives and were supported in the least restrictive way possible. For example, how to spend their time, when to get up and go to bed.

People’s rights were protected by the registered manager who under stood the Mental Capacity Act and how this applied to their role. There was no evidence to show people living at Bos Y’n Dre had been subject to any discriminatory practice for example on the grounds of their gender, race, sexual orientation, disability or age. There was a strong focus on protecting people’s human rights.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes

We carried out a comprehensive inspection of Bos Y’n Dre on 14 September 2015. This was an announced inspection. We told the provider two days before our inspection visit that we would be coming. This was because we wanted to make sure people would be at home to speak with us. The service was last inspected in December 2013. The service was meeting regulation requirements at that time.

Bos Y’n Dre provides care and accommodation for up to four people who have a learning disability. Four people were living at the service during this inspection visit.

The service is situated close to the centre of St Austell with access to a public transport network as well as the services own transport. The service is a two storey house of a domestic nature with no requirements for aids and adaptations, as people living there did not require support with their mobility.

The service had a registered manager in place. 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 registered providers also worked and managed the service. There were no additional staff members employed at Bos Y’n Dre. At some points in this report the registered providers and registered manager will be referred to as staff.

Care records were detailed and contained specific information to guide staff who were supporting people. Life history profiles about each person were in place. They provided information about the person, including life events which influenced their development and determine who they were today. Local authority care plan reviews were in pictorial format including large print. This meant staff were able to use them as communication tools. However the services own care planning documents were not in a format which people using the service might be able to understand.

People had access to a range of healthcare professionals as seen in review reports. When health visits had taken place they were recorded on the person’s daily diary log. This information was collective about other daily activities and may not be easily identifiable.

People were supported to manage their individual finances to maintain a level of independence. People were supported to withdraw money when they wanted to and retain their own bank statements. The registered manager was looking at introducing a system to record when cash purchases had been made, and retaining receipts to ensure there was a clear audit.

Staff were very familiar with what support and care people needed. People were supported to lead full and varied lives and staff supported them to engage in a wide variety of activities. For example attending day care and work placements, going out into the community independently and engaging with family. One person had recently re-established a family connection with the support of the registered manager. One person told us, “I like living here. I do lots of things. Yes I do feel safe”. Records showed people were involved in their care planning and reviews.

Medicines were administered as prescribed and at the times required. Record were accurate and medicines were securely stored.

The service was meeting the requirements of the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards.

People had a choice of meals, snacks and drinks, which they told us they enjoyed. There was flexibility in what people might want to eat. One person told us, “I like the food. I am having egg on toast tonight”. Weekly meetings took place with people using the service to decide what meals they would like. Two food deliveries’ a week gave people the flexibility to make their choice or change if they wanted to.

Bos Y’n Dre was well-led and people’s relatives told us they were kept informed about any changes in the service. They told us they felt their comments were listened to and acted upon. The service had an open and positive culture with a clear focus on enabling and supporting people to become more independent.

We spoke with two people who used the service at the time of our inspection regarding their experiences of the care and treatment provided to them. All of the people we spoke with told us their experience had been positive and we judged that people were treated as individuals and received person centred care and support. Comments made by people we spoke with included; “I like it here” and one person remarked that staff were, “nice”.

We found the nutritional needs of people were met and there was a choice of food provided that was of a good quality.

Medications were managed safely and staff ensured people received their medication in a timely way and as per their prescriptions.

The home had an effective complaints system which identified, handled and responded appropriately to complaints and comments made by people who used the service.

We spoke with two of the four people who lived at Bos Y’n Dre to seek their views of the service provided. People were positive about the care and support they received.

The people we spoke with said they were happy with the care and the support they received. When we inspected the home it was clean and odour free.

Accommodation was homely and comfortable. At the time of the inspection staffing levels were satisfactory and there were satisfactory systems in place to ensure people received a good quality service.