This comprehensive inspection took place on 07 June 2018. We gave the provider two days’ notice of the inspection because it is a small service and the registered manager is often out of the home supporting people using the service and we needed to be sure that they would be in to help with the inspection. The last inspection of the service was 0n 29 July 2015 when we rated it as Good.

Cara Linn is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service accommodates three people in a large, adapted residential property. 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 provider is also the registered manager of the 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.

The provider operated effective systems to keep people safe. They assessed risks to people using the service and took action to mitigate any they identified. People received their medicines safely and as prescribed. People ate a balanced diet, had enough to eat and drink and were able to access the healthcare services they needed. There were infection control policies and procedures for care staff to refer to and staff had been trained in this area.

The provider carried out checks on new staff to make sure they were suitable to work with people using the service.

The provider assessed people’s care needs and delivered effective care and support to achieve good outcomes for people. Care staff had the training they needed to support people effectively.

The provider obtained people’s consent to the care and support they received and did not restrict people unlawfully.

People using the service, their relatives and health and social care professionals said the registered manager and care staff were kind and caring. People also told us that, as much as possible, care staff supported them to make their own choices and decisions. Care staff demonstrated a good knowledge of each person’s life history, significant people, dates and events.

The individualised and person-centred care and support people received had a positive impact on aspects of their lives. The registered manager and care staff placed people at the centre of their care and supported them to develop and grow in confidence. People’s care plans emphasised what they could do for themselves and where they needed support.

The registered manager was qualified, experienced and committed to providing high quality care and support to people using the service.

The provider involved people using the service, their families, care staff and health and social care professionals in reviewing and improving the service. The provider also had systems and processes to monitor quality in the service and make improvements.

This announced inspection took place on 29 July 2015.

Cara Linn is a three bed service providing support and accommodation to people with a learning disability. At the time of the inspection three people were living there. It is a large house in a residential area close to public transport and other services. The house does not have any special adaptations. People live in a clean and safe environment that is suitable for their needs.

The provider was also the registered manager for the 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 and associated Regulations about how the service is run.

Relatives were very positive about the service provided. One relative said, “It’s fantastic, five star.”

People were safe at the service. They were supported by kind, caring staff who treated them with respect. Systems were in place to support people to remain safe but also to be as independent as possible.

Staff were attentive and supportive. They spent time with people talking to them about what they were doing and what they would like to do.

People were cared for by staff who had the necessary skills and knowledge to meet their assessed needs, preferences and choices and to provide an effective service.

People were supported to make choices about what they did and what happened to them. They had a very busy social life and took part in a variety of activities of their choice in the community and in the service.

The staff team worked closely with other professionals to ensure that people were supported to receive the healthcare that they needed. People’s healthcare needs were robustly monitored and any concerns checked as soon as possible.

Systems were in place to ensure that people’s human rights were protected and that they were not unlawfully deprived of their liberty. When people did not have the capacity to make a decision about an aspect of the care this was discussed at a ‘best interests’ meeting and a collective decision reached on the action to be taken.

People were supported to eat and drink enough to meet their needs. They chose what they wanted to eat and said that they liked the food.

The provider monitored the quality of service provided to ensure that people received a safe and effective service that met their needs.

People who used the service and their relatives were asked for their feedback about the service and about what they wanted. They felt involved and listened to.

People we spoke with voiced positive opinions about the service. People said they were treated with respect and dignity, and that they could make choices over their daily lives. One person told us "I go to bed when I want to” and “I always choose what to wear." We found that care plans were in place for people, and that health care needs were being met. People had access to health care professionals and one person told us "I had my feet looked at today.”

We saw that staff treated people well, and they showed a good understanding of how to support people. We found that the service had effective systems to prevent and control the spread of infection and that staff had an awareness of their responsibilities in relation to this.

Staff had to provide references, complete an application form and undertake an interview before they began working at the service. We found that the manager regularly asked people about the care and support they received and people we spoke with confirmed this. A relative said "at least once a year we get a note saying what we think about the service. I’ve never had cause to complain.”

People we spoke with voiced positive opinions about the service. People said they were treated with respect and dignity, and that they could make choices over their daily lives. One person told us "I choose my own clothes to buy" and "I go to bed anytime, when I want to." We found that care plans were in place for people, and that health care needs were being met. People had access to health care professionals and one person told us "I had a flu jab last week." We saw that staff treated people well, and they showed a good understanding of how to support people.

We found that the service had a safeguarding vulnerable adults procedure, and that staff had an awareness of their responsibilities with regard to this. People told us that they felt safe living at the home. There were sufficient staff to meet people’s needs and that staffing levels were flexible to reflect busy times of the week. People told us that they liked the staff. One person said "yeah, the staff are fine." We found that the service had a complaints procedure, which had been produced in written and pictorial form. People told us they knew how to make a complaint if they wished to. One person said "I would tell Rita (the manager) if anything was wrong."