Botton is a small rural village in the North Yorkshire Moors run by the Camphill Village Trust; the provider. It is home to over 150 people of which 90 have a learning disability. The village includes biodynamic farms (farms using an holistic approach to organic farming methods), a village store, a creamery, a bakery, a weavery, a woodwork workshop and a coffee bar. These services are run and used by everyone who lives in the village. Botton Village Domiciliary Care Group is one of the services provided by the Camphill Village Trust and they provide personal care and support to 60 adults and older people with a learning disability, autistic spectrum disorder or mental health conditions living in houses in Botton village.

Some people lived as part of a shared lives model of support which meant that staff and their families lived together with people who used the service and supported them on behalf of Botton Village Domiciliary Care Group. Other people had a domiciliary care model of support where staff employed by Botton Domiciliary Care Group went into their house to give care and support over a 24 hour period but did not live there. All of the staff were employed by Botton Village Domiciliary Care Group.

At the last inspection on 19 March 2015, the service was rated Good. At this inspection we found the service remained Good.

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

Recruitment was robust and there were sufficient staff on duty to meet people’s needs. Staff received training to support their roles although some training updates were due. They received supervision and support from senior staff.

Staff were aware of how to safeguard people and report concerns.

Risks to people’s health and safety were identified with clear management plans in place. Medicines were managed appropriately and staff received training in administering medicines.

People had access to healthcare services when necessary. People were supported to choose what foods they wished to eat and they received a nutritious diet.

Staff were described by people and their relatives as caring and kind.

People were encouraged to have control of their lives. They were involved in all aspects of the service and contributed to decisions. They knew how to complain and there were clear policies and procedures in place in written and easy read format. Care plans were personalised and reflected people's needs. They were reviewed regularly.

People took part in a variety of activities both within and outside the village.

There was a registered manager employed at the service. They used a quality monitoring system to identify where improvements to the service could be made using audits.

Surveys of people who used the service were sought through a ‘My Life’ survey. People who used the service helped to devise this survey.

This inspection took place on the 19 March 2015 and was announced. At our last inspection on 23 July 2013 this service met all the regulations against which we had inspected

Botton is a small village in the North Yorkshire Moors. The village includes five biodynamic farms; this is a farm using organic farming methods, a gift shop, a village store and a coffee bar. These services were run and used by everyone who lives in the village. Botton Village was formed in 1955 when attitudes towards learning disability and mental health conditions were less enlightened. The village provided a rural location where people could live safely. Over the years some people have chosen to leave Botton Village and access different models of care but a high number chose to stay. The Botton Village Domiciliary Care Group which is one of the services provided by the Camphill Village Trust supported 95 adults with a learning disability living in houses in the village.

Some people lived as part of a life sharing model of support which meant that staff, known in the village as co-workers, and their families lived together with people who used the service and supported them on behalf of Botton Village Domiciliary Care Group. Other people had a supported living model of support where staff employed by Botton Village Domiciliary Care Group went into some houses to provide personal care and support over a twenty four hour period but did not live there. Botton Village Domiciliary Care Group is registered by the Care Quality Commission to provide personal care for adults with learning disabilities, autistic spectrum disorder and mental health conditions who live in the village. Botton Village Care Group are proposing to change  the services they provide to different models of care.

The inspection was set against a background of conflict between the staff following the life sharing model of support and others who support this model (who have a collective name of Action for Botton, (A4B)) and The Camphill Village Trust Ltd. The conflict has arisen because The Camphill Village Trust wish to change the way in which Botton Village Domiciliary Care Group is managed and how care is delivered and this is believed by A4B to be in conflict with the way that people live.  This had generated a lot of anxiety for the people who used the service and the impact on people who used the service was considered as part of the inspection in order to be able to make a judgement about the way in which the service was run.

North Yorkshire County Council was the commissioner of services for 77 people who used the service and fifteen other local authorities also commissioned services. There was a voluntary agreement in place between North Yorkshire County Council and Botton Village Care Group which meant that Botton Village Care Group had agreed not to provide services to any additional people.

There was a registered manager at this service. 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.

This service was safe and people told us that they felt safe. Care plans highlighted the areas of support needed in detail and had associated risk assessments. Medicines were managed safely.

There was sufficient staff to meet people’s needs and they had been recruited safely. They understood what was meant by safeguarding and had been trained in safeguarding adults and children.

People were provided with care by people that knew them well and who supported them to live as independently as possible.

Training had not always been carried out for staff in different methods of communication but because of the detailed communication plans in care plans this had a minimal effect on how people were able to communicate with each other. We have recommended that the provider look into training around peoples communication needs.

Staff were following the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards when they cared for anyone who lacked the mental capacity to make their own decisions.

People told us that the service was caring and we observed staff to be caring. All of the houses we visited were warm and welcoming.

Staff were respectful when speaking with people and maintained their dignity.

Advocates were available to help people to support people in expressing their views.

We found that the service was responsive to people’s individual needs and the care plans were person centred and up to date.

There were very detailed descriptions about peoples care needs and how staff should support those needs. We saw that staff responded promptly when people required assistance.

People who used the service were engaged in meaningful activity to support their wellbeing.

The service was well led. There was a registered manager employed at this service. The registered manager was open and transparent in their dealings with the inspection team and was able to answer all of our questions.

Audits had been completed which looked at medicines, care provided, and management of finances of people who used the service, mealtimes, choice and involvement and collected comments from people who used the service. A report from recent questionnaires sent to people who used the service, staff, family and friends and professionals had been written which was generally positive about the care and support provided by staff.

We spoke with twenty people who lived at Botton Village. They all told us that they liked living at Botton; they particularly enjoyed living in a village where they could be independent. They told us they could move safely around the village with minimal support.

People who lived at Botton told us they would speak with their house co-ordinator, one of the care and support managers or the manager if they did not feel safe. One person said “Yes I feel safe living here” and “I like learning how to do different weaving and I am getting good support” and “I don’t want to change anything”.

People also told us "I have a support plan -we talked about the future and what I wanted to do. I was very much involved in that." Another person told us "I was involved in my support plan and risk assessments and I can see my support plan at any time", and "I have two support plans one for when I am working on the farm and one for my social life".

We saw that tenants had a care plan and were involved in the development of their plan. We saw that the plan was reviewed regularly to ensure it stayed up to date.

Proper recruitment processes were followed for people who worked at Botton Village. They also received training and support to ensure they had the skills needed to do their job.

We saw that a system was in place for checking the quality of the service provided. This helped the service develop and to ensure it was meeting the needs of the tenants.

We spoke with seven people who used the service and seven members of staff to help us in reaching a judgement about the care provided. People told us that they liked living at Botton, one person told us "I have lived at Botton since 1988 and I love it here, I am very happy". They told us that they felt safe and if the had a complaint they would tell their house co-ordinator or a care manager.

We saw that people were encouraged to make their own decisions about what to wear, how they spent their time and when they weren't working they could follow their own interests. One person said they enjoyed reading and they could watch football on their TV. Another person was involved with the drama group and was looking forward to their next production.

We saw that people's care files contained detailed information about the individual and the help and support they need. The care files looked at the person as a whole and not just as the support they need.

Staff were properly checked to ensure they were suitable to work with vulnerable people prior to the commencement of their employment. People who used the service were involved in the selection process and recorded their opinion for those on the interview panel. The staff were friendly and respectful, one person said they appeared gentle by nature.

The manager had identified some areas that required improvement and had a clear plan to ensure this work was implemented.

We carried out this inspection because we had made several compliance actions when we lasted visited the service in August 2011. The inspection team was led by Care Quality Commission (CQC) inspectors and were joined by an 'expert by experience', these are people who have experience of using services (either first hand or as a family carer) and who can provide that perspective.

People who live at Botton told us that they liked living there. Several people we spoke with told us that they enjoyed the activities that they attended during the day. The activities varied from working in the different workshops such as printing, woodwork, weavery or dolls workshop to carrying out work in the house. People spoken with knew they had a care plan and said that co-workers kept them involved with any care planning. When people were asked if co-workers went through care plans with them, people said “Yes, loads of times.” and “(House parents name) does it with me.”

People living at Botton told us that they felt safe. One person said “It is nice here”. When we asked if people knew what to do if they had a problem or if someone was hurting them, one person told us “Yes I often talk to (named person)” when they had a problem. They also said “We have to tell someone, someone like (named person).” Another person told us that they had a ‘Botton Buddy’ and would speak with them or councillor that visits. One person told us that that the organisation does listen. The example given was that they had discussed having a television in their room and this was going ahead.

We spoke with representatives of the Local Authority who told us that they were currently working with this service and would keep us informed of any concerns.

People who live at Botton told us that they enjoy the freedom of being able to live in a community where they can move around without fear of being abused, or shouted at. Several people said they particularly enjoyed working on the farm, whilst another person said they had been able to slow down because of their age. People also said they were disappointed they hadn't been able to watch the world cup last year on their own TV. Another person said they go in to the nearby village and watch the football in the local pub. Everyone spoken with said that the house co-ordinators were supportive and friendly.

Co-workers spoken with expressed their concerns that any changes would mean the ethos of the village changing.