Boulevard House is a care home which is registered for 15 people. When we undertook our inspection there were 12 people living in the home. The majority of people are younger adults some of whom may experience difficulties with communication due to their learning disability. The location is split into two houses. One housing three people and the rest in the main house. Each has its own facilities of communal areas, kitchens and gardens. There is car parking at both houses.

At the last inspection, the service was rated good.

At this inspection on 11 and 17 May 2017, which was unannounced we found the service remained good.

People were protected from abuse and avoidable harm because staff were aware of individuals' needs and what was a potential risk for them. Sufficient numbers of staff were employed to ensure people’s needs were met. People’s medicines were managed so they received them safely and they were stored in a place which only certain suitably trained staff had access to.

Staff had the knowledge and skills to carry out their roles and responsibilities, which was based on best practice to ensure people received effective care. Consent to care and treatment was always sought and where people could not consent themselves a suitable advocate was found. People were supported to eat and drink and maintain a balanced diet and were encouraged to help with the preparation of meals. They had access to healthcare services and received on-going healthcare support by staff at the home and other local health and social care agencies.

Positive and caring relationships were developed with people using the service and staff ensured people had access to other family members and friends when they wished. People were supported to express their views by individual discussions with members of staff and in group house meetings. Each person was actively involved in making decisions about their care, treatment and support. Staff ensured people’s privacy and dignity was respected and promoted.

People received personalised care that was responsive to their needs. Staff ensured they routinely listened and learnt from people’s experiences, concerns and complaints. People were actively involved in putting together a care plan of their needs and where this was difficult for them staff involved their family members or other advocates.

The registered persons and registered manager always promoted a person-centred, open and inclusive culture. This ensured people would be empowered to take part in as much as of the running of the home as they wished. The registered manager and registered persons ensured they regularly met with people who used the service, family members, other advocates and visitors to the home to obtain their views of the quality of the services being provided. Any actions from quality assurance audits were passed on to staff to ensure they learnt from events and incidents.

The registered manager and registered persons continued to look for ways of improving the services it offered and how to ensure the views of people were incorporated into the running of the home. The home was currently meeting all relevant fundamental standards.

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.

Further information is in the detailed findings below.

The service provides care and support for up to 15 people, some of whom may experience difficulties with communication due to their learning disability. When we undertook our inspection there were 10 people living at the service.

There was not a registered manager in post. This was only for a number of days. A registered manager is a person who has registered with the Care Quality Commission (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 manager was in the process of submitting their application to include this location onto their current CQC manager’s registration.

At the last inspection on 27 June 2014 we asked the provider to make improvements for storage of medicines, the lack of auditing processes for administration of medicines and ensuring staff were trained to administer medicines. This action was completed.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection there was one person who had their freedom restricted. The necessary documentation was in place to show how the decision had been arrived at.

We found that people’s health care needs were assessed, and planned and delivered in a consistent way through the use of a care plan. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

During our inspection people had links with the local community to ensure their interests and hobbies were fulfilled. This also included holidays away from the area.

People received the medicines they had been prescribed. Staff were trained to administer medicines, which were stored safely.

People were happy with the service they received. They were treated with respect, kindness and compassion. People found the staff and manager approachable and that they could speak with them at any time if they were concerned about anything.

Staff had the knowledge and skills that they needed to support people. They received training to enable them to understand people’s diverse needs. Staff told us they had formal supervision and support.

The provider had systems in place to regularly monitor, and when needed take action to continuously improve the quality and safety of the service.

During the inspection, we spoke with the registered manager, two care staff, and five people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected.

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

There were some systems in place to protect people who lived at the home from abuse and avoidable harm. For example risk assessments were carried out to ensure vulnerable people were protected from harm and abuse when they were out in the community. Assessments were carried out to assess the ability of people to cross roads safely.

The registered manager undertook a monthly health and safety and environmental audit. We looked at the range of issues audited such as cleanliness, outstanding maintenance and fire alarm testing. This demonstrated the service was being proactive to isolate problems before they could become a risk to people.

However we found that procedures and practice for the administration of medicines was inadequate and placed people at risk. Our observations led the manager to make a safeguarding referral and a notification to the Care Quality Commission.

Is the service effective?

We looked at three people's care plans and found they included clear instructions to enable staff to carry out effective care. All aspects of people's personal and health care needs had been assessed and were reviewed on a monthly basis. This meant staff had up-to-date guidance on how to support each individual.

It was clear from what we saw and from speaking with staff that they understood people's care and support needs and they knew them well.

Is the service caring?

Care plans had been regularly reviewed to ensure there was up-to-date information on the person's needs and how these were to be met. Staff we spoke with demonstrated they were aware of the needs of the people they supported and their individual personalities and preferences.

People were very comfortable, well dressed and clean which demonstrated staff took time to assist people with their personal care needs.

The atmosphere throughout the home was relaxed and we saw staff took time to talk to people.

Is the service responsive?

Peoples’ care, treatment and support at the home achieved good outcomes and promoted a good quality of life for the people that lived there. People told us they were happy with the care provided at the home and their care and support needs were being met.

From our observations and from speaking with staff and people who lived at the home we found staff knew people well and were aware of peoples care and support needs. We also found staff had received appropriate training to meet peoples’ needs.

We saw evidence of the service accessing health care professionals to ensure people with unmet needs were cared for appropriately.

Is the service well-led?

We found the service had some effective quality assurance systems in place and any identified actions had led to improvements in the service that people received. We found some inadequacies in the auditing of medicines which the provider is urgently addressing.

People who used the service and staff were asked for their views about care and treatment. We saw evidence that these had been acted upon. We looked at the way the home gathered information about the service they provided. Records of audits and meetings confirmed that a programme was in place. We found the service was well-led.

Everyone we spoke with talked positively about the staff and felt they fully supported their care needs. People told us the staff respected their daily routines. One person said, "Staff remind me when I need to do my chores." Another person told us how staff explained to them what an advocate was and said, "I am asked if I want one but X(named a staff member) helps me when I need it."

The people we spoke with told us their care was personalised to their needs. They knew staff kept records on them and had seen those records and discussed the content. One person said, "My key worker goes over my care plan with me each month."

People who used the service told us they felt safe at the home and liked living there. If they were concerned they told us they would approach a staff member. One person said, "I love it here."

Details were in the care plans and on display about the types of activities people were involved in. People who used the service told us there were always enough staff on duty to ensure their needs were attended to and they could take part in a variety of social activities. One person said, "I enjoy dancing and staff can always come with me."

The people who used the service told us they were involved in meetings with staff who asked them how they liked living in the home and what they wanted to do. One person said, "We have talks about holidays." People knew meetings were recorded.