This inspection took place on 29 and 30 October 2018 and was announced. This was to ensure someone would be available to meet with us and show us records.

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

California House provides respite care for up to five people who have a learning disability in one adapted building. 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. There was one person using the service at the time of our visit.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration of medicines.

Recent refurbishment work had been carried out at the home. The home was clean, spacious and suitable for the people who used the service. Appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. We have made a recommendation that the registered manager formally records what proof of identification has been checked when recruiting new staff.

Staff were suitably trained and received regular supervisions and appraisals.

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.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at California House.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

People’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had a complaints policy and procedure in place and people who used the service and family members were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Staff said they felt supported by the management team. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.

We carried out this announced inspection on 18 and 19 of May 2016. We last inspected this service on 4 September 2014. At that inspection we found that the provider was meeting all of the regulations that we assessed.

Carlisle Mencap Limited is the provider of respite care at California House for up to five people who have a learning disability. There were four people staying in California House at the time of our inspection.

The home is situated on the outskirts of the City of Carlisle. All the rooms are for single occupation and there are suitable toilets and bathrooms. There is a large sitting room with a conservatory that is used as a dining area. There is also a kitchen which people living in the home share. There is a large, well-kept garden to the rear and a smaller front garden The location provides easy access to the city centre by the home's mini bus or public transport.

There was a registered manager employed at this home. 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.

People were safe and lived in a safe environment because there were enough well trained staff to support people and appropriate recruitment checks were carried out before staff began working in the home.

The premises were well maintained and any safety issues were rectified promptly.

Identified risks to people's safety were recorded on an individual basis. There was guidance for staff to be able to know how to support people safely and effectively.

Medicines were managed and administered safely in the home and people received their medicines as prescribed.

People were supported effectively by staff who were skilled and knowledgeable in their work. All new members of staff completed a full induction and staff were supported well by the registered manager.

People were supported to eat and drink sufficient amounts and people's intake of food and drinks was monitored and recorded. Prompt action and timely referrals were made to relevant healthcare professionals when any needs or concerns were identified.

Staff in the home were caring and attentive. People were treated with respect and staff preserved people's dignity.

Assessments were completed prior to admission, to ensure people's needs could be met. People were involved as much as possible in planning their care and received care and support that was individual to their needs.

The service was well run and people's needs were being met appropriately. The manager was approachable and open to discussion. Communication between the staff, management and people living in the home was frequent and effective.

There were a number of effective systems in place in order to ensure the quality of the service provided was regularly monitored. Regular audits were carried out by the manager and the chief executive officer, in order to identify any areas that needed improvement.

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

used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

Hazards to people's safety and welfare had been identified within risk assessments and every effort had been made to minimise these risks.

Is the service effective?

Staff were knowledgeable about people's needs and had read their support plans.

Is the service caring?

People were cared for by warm and friendly staff. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare

Is the service responsive?

Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff had a good understanding of the ethos of the service and quality assurance processes were in place. People who used the service and staff had been consulted with about changes and they had been listened to. The manager provided leadership and was aware of areas that required improvement.

People we spoke to said they liked staying at California House. They said they enjoyed activities and the staff helped them when they were out of the house. We saw that there was a relaxed and homely atmosphere with a friendly rapport between staff and people living in the home.

Comments from the completed questionnaires recently sent to the provider included,

“He loves the food”.

“They do everything well and nothing needs changing”.

“I feel more confident”.

We saw that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Although this service provided respite care only, records were well kept and up to date. Risk assessments were in place which ensured people were supported by staff who understood the need to keep people safe at all times.

Staff were well trained and able to support people with complex physical and mental health needs.

The home had developed good links with healthcare professionals to ensure that people’s health needs were well met whilst they were staying in California House.

The home was well maintained and equipped to effectively and safely care for people with limited mobility and more complex healthcare needs.

During our visit we spoke with people living in California House and with the staff about the way in which care was provided and how involved people and their families were in any decisions made. We also asked people about the attitude of the staff and if they were happy with the way they were treated.

People told us,

"I really like it here but am hoping to move into a place of my own soon".

"I answer the phone in the office and work in a shop in Carlisle".

"I go watching rare birds with my support worker".

"We help with the shopping and are going to a disco tomorrow night".

People were observed communicating with staff and this was obviously a regular occurrence that they felt comfortable with. We observed staff interaction with those staying in the home on the day of our visit and found this to be warm and supportive.

People have good access to other services and advocates, and they are part of the

community. This means they are not isolated and it gives them opportunities to express themselves if they are unhappy or are concerned about the care they receive. Although communication may at times be difficult the staff appeared to know the residents well and were able to communicate in a variety of ways.

The improved care plans have helped people to develop new skills, and the risk assessments that are now in place support people to try out new activities.