The inspection took place on 30 November 2016 and was announced. This was to allow the registered manager time to prepare people for our visit as unexpected changes to routine and unfamiliar faces were difficult for some people to cope with. Botchill House provides care and accommodation for up to fifteen people with learning disabilities. On the day we visited ten people were living in the service. Everyone had been living at the service for several years and had moved in together from a nearby long stay hospital. Botchill House is part of the Havencare group which has other services in the region.

There was a registered manager in post. A registered manager is a person who has registered with the 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. The registered manager was also a registered manager at another Havencare service. They were supported at Botchill House by a service manager who had daily oversight of the service.

The house, whilst only 1.5 miles from Dawlish, is in a very rural setting and is set in extensive grounds. There is a large orchard next to the property, areas for growing vegetables and a chicken coop. On our arrival we were greeted by some of the people who lived at Botchill House and the registered manager. A social story had been created about our arrival and this was displayed on several walls in shared areas of the building. Social stories are short descriptions of particular events. They are used to support people with a learning disability or autism to understand what to expect in a specific situation.

There was a sense of activity as we arrived and some people were getting ready to go out. We were directed to the office and for some time the door was kept open which enabled people and staff to come in and out and meet us when they were ready to do so. Later the door was closed to enable some of the more sensitive discussions to happen but we were told that this was different to usual and people were used the office door being open. It was clear the door being closed was not people’s preference and it was good to experience their expectation that the office was open to all.

People’s medicines were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriate training and understood the importance of safe administration and management of medicines. People were supported to maintain good health through regular access to health and social care professionals, such as GP's, dentists and speech and language therapists.

People’s care records were detailed and personalised to meet individual needs. Staff understood people’s needs and responded when needed. People were not able to be fully involved with their care plans, and plans were underway to develop a more user friendly version of support plans to give people greater ownership of them. People’s preferences were sought and respected.

Risks were documented, monitored and managed well to ensure they remained safe. One person had recently been identified at being at increased risk to choking. The risk assessment had not been fully updated to reflect the change. Evidence to show staff had read new information contained in the communication book had not been signed as seen by all staff. Staff we spoke with were clear as to how to support the person safely and arrangements for input from other healthcare professionals were in place.

People lived full and active lives and were supported to access local areas and activities. Activities reflected people’s interests and individual hobbies. People were given the choice of meals, snacks and drinks they enjoyed whilst maintaining a healthy diet. People, when possible were encouraged to help prepare meals and drinks.

People’s needs in relat

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

The 12 people we met at Botchcill House had lived together for over 20 years, with one of the current staff having supported them throughout this time.

People had difficulty giving their views in detail about living at the home and the care they received because of communication needs due to their learning difficulties. We therefore spent some time with most of the people living at the home to enable us to see how they spent their time, if the environment was suitable for them and observing some of the support they received from staff. We spoke with one person’s visitors, the Registered Manager, deputy manager, cook and three care workers. We also looked at records relating to people’s care and the running of the home, as well as having a look around the building and its grounds.

Below is a summary of what we found. The summary is based on what people using the service, visitors and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Care was planned and delivered in a way that was intended to ensure people's safety and welfare. Risk assessments covered the support individuals needed as well as the environment, both inside and outdoors, with people able to visit garden areas as they wished and having regular outings in the local community.

People were cared for in an environment that was safe, clean and hygienic. A system of checklists, audits, maintenance, and regular involvement of specialist companies meant that the environment, including hygiene aspects, was monitored and maintained. Action was taken to address any issues identified through the monitoring systems.

Adaptations were in place or provided so that individuals’ needs could be met safely, even when their needs changed. This included a wet room to meet new mobility needs and bedroom door locks suited to individuals’ needs so they could use them as independently as possible.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications had needed to be submitted, by the service, under the safeguards. However, a policy and guidance was in place, with relevant staff trained to understand when an application should be made.

Is the service effective?

People looked content and at ease with the care and ancillary staff, approaching them freely. They appeared happily active, using the different areas at the home as they wished. We saw people enjoying activities such as puzzles and outings, with their care records showing they undertook them regularly in line with their care plan. Staff we spoke with evidenced that they understood people’s care and support needs, and that they knew their individual routines, likes and dislikes.

Is the service caring?

We observed that staff took time to listen to people and to engage in meaningful conversations with them. They did not appear to be in a rush when with people, ensuring information given and reassurances were sufficient for the person concerned. We saw that staff respected people’s personal space, including their bedrooms, and supported their independence as much as possible, which upheld their dignity.

Is the service responsive?

People’s needs had been assessed and reviewed. People were consulted about their care in care planning, and involved in reviews of their care plans. These were carried out regularly and if concerns were raised about a person’s care, such as when their needs changed. There was evidence of action to provide a highly person-centred service for individuals which met their various ongoing and changing needs

Is the service well-led?

A variety of quality assurance processes were in place. Effective systems were also in place to identify and manage risks to the health and welfare of people living at the home and others. These included risk assessments and audits, which were either carried out by the provider or were monitored and responded to by the provider. Staff told us they had a safe working environment in their opinion.

We saw that people had opportunities to give their views of the service through surveys and care reviews. Records and conversations with staff showed that people’s views were acted on to improve their service. Visitors we spoke with had not had to make a complaint, reporting that staff were very responsive to their comments or queries. Staff also told us that changes were made as a result of their views or suggestions. There was evidence of ongoing action to improve the service on the basis of quality assurance findings and risk assessments.

We observed and spoke with six of the twelve people who lived at Botchill House. We saw that people were supported to carry out activities in the house, and to go out with the support of care workers.

We spoke with the manager, deputy manager, cook and three care workers. We observed that all of the staff treated people with respect and protected their dignity.

People we spoke with told us they were happy at the home and enjoyed living together, which most had done for many years. We saw evidence that people ate a balanced diet. We saw that people made choices in relation to what they ate.

We saw that care workers respected people’s wishes and people told us they felt respected. We observed friendly conversations between people and care workers at the home.

We toured the home with the manager and looked at all areas of the home including bathrooms, toilets, bedrooms and communal areas. People told us that they had made choices about the personal effects and furniture in their rooms.

The provider had completed all required pre-employment checks on staff including references and Disclosure Barring Service (DBS) checks.

We saw that a monthly quality assurance audit was undertaken by a senior manager from the provider's head office. We saw that systems were in place to effectively monitor the quality of care and that feedback had been acted upon appropriately.

Prior to this visit concerns had been raised with the CQC about the care and welfare of people who lived at the service. We did not find any evidence to substantiate these concerns during our visit.

We observed eight of the twelve people who lived at Botchill House. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We saw that people were supported to carry out activities in the house, and to go out with the support of staff.

People had clear assessments of their needs and plans and strategies were in place to meet them. Information was communicated well within the staff team and people's care plans were reviewed regularly. The home had staff with a range of experience, skills and training to meet people's needs.

We saw staff interacting with people in a relaxed, friendly and respectful manner. Staff worked at the pace of each individual and encouraged independence. People had made friendships within the home and had access to social activities such as music, crafts and quizzes.

Staff had received training in safeguarding vulnerable adults and recognising abuse. The home had procedures in place for reporting and responding to any concerns.

The home had systems for quality assurance. We saw evidence that when improvements had been identified at Botchill House they were acted upon.

We spoke with or observed nine of the twelve people who live at Botchill House.

We saw that they were supported to carry out activities in the house, and to go out with the support of staff.

One person told us which staff they liked best, and that their favourite food and drink was cake and coke. Another told us they had enjoyed their holiday.

We saw that people could use the finger sensor locks that had been fitted to their bedroom doors, to enable them to have privacy and to secure their belongings.

People had Communication Boards in their rooms, with photos to help them remember the activities they would be doing during the week ahead.

One person had been shopping with a staff member, and was supported by them to prepare lunch for themself. Another was pleased to spend the morning working with the housekeeper.

A new vehicle had been provided, and people were pleased to be taken on outings.

Two people were away on holiday when we first arrived, being supported by two staff. ‘They enjoy the peace when they are away.’ Other staff told us that people get on well with each other, and miss each other when they are absent.

We saw that lunch was informal, with some people taking their meal to their room, and some spending time in the dining room enjoying their food, and the company.

We saw staff treating people at all times with dignity, respect and sensitivity. When a person wanted more food at the end of the meal, suitable additional food was provided.

People were pleased to show us the new chicken pen and duck pond. The freedom of the large garden and orchard is essential to some of the people who live at Botchill House.