82 Chaucer Road provides accommodation and personal care for up to eight people with learning disabilities and autistic spectrum disorders. It is situated in Bedford, close to local amenities. On the day of our inspection there were eight people living in the service.

The inspection took place on 10 and 15 May 2017.

The service had a registered manager. 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.

Staff had been trained to recognise signs of potential abuse and keep people safe. People felt safe living at the service. People had risk assessments in place to enable them to be as independent as they could be whilst remaining safe. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient numbers of staff who had the right skills and knowledge to meet people’s needs. Effective recruitment processes were in place and followed by the service. Staff were not employed until satisfactory checks had been completed. Systems were in place to ensure people’s medicines were managed in a safe way.

Staff received a robust induction programme. They were provided with on-going training to update their skills and knowledge to effectively support people with their care and support needs.

Staff understood the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). People were supported to eat and drink sufficient amounts to ensure their dietary needs were met. Staff supported people to attend healthcare appointments when required and liaised with their GP and other healthcare professionals as needed.

People were treated with compassion and kindness by staff. Each person was supported in a way that was individual to them and were encouraged to identify their own support networks in order to improve their independence. Staff supported people to fully engage in discussions about their care and worked proactively to help them to make choices and decisions about their care and lifestyle.

People's needs were comprehensively assessed and care records gave clear guidance on how people were to be supported. Staff were knowledgeable about how to meet people’s needs and understood how people preferred to be supported. There was an effective complaints system in place which was used to drive future improvement within the service.

People and staff were positive about the leadership of the service and the support they were able to provide for people with complex healthcare needs. The service's philosophy demonstrated a true passion and commitment to providing good quality care. We found the service had a positive culture that was person centred, inclusive and empowering. Ideas for change were always welcomed, and used to drive improvements and make positive changes for people.

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 safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive to people's needs?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

We found that the staffing ratio facilitated people to participate in activities of their choice and enjoy a good quality of life. One person told us, “I like living here; staff are kind to me and help me with what I need.” Another person told us how they were looking forward to the time when they cooked for the rest of the house. We found that people were protected from potential abuse because the staff ratios enabled them to effectively attend to people's support needs.

Is the service effective?

We observed staff talking with and assisting people throughout our time in the home, we found that this was done with the people's privacy and dignity in mind and emphasised staff's awareness of people's individual support needs. This was further reinforced in our conversations with staff, which emphasised their knowledge and understanding of people’s specific needs. It also reflected the support plans we viewed on the day. We found that staff had a good awareness of people’s individual dietary needs and supported them to maintain a healthy dietary intake, whilst enabling them to make independent choices. Within the care files we saw that people or their families, where appropriate, had been involved with, and agreed with the particular care needs that had been identified for them.

Is the service caring?

We found that people were satisfied with the care and support they received. We observed that people were offered support at a level which encouraged independence and assured their individual needs were met. The staff were friendly and courteous in their approach to people and interacted confidently with them. We noted that people were encouraged to express their views about the quality of care in the home. They were also involved in planning their care, making decisions about their support and treatment, and how they spent their time.

Is the service responsive to people's needs?

We found that people received person- centred care and support from appropriate people, when required. We noted that people's wishes were respected by care staff and taken into account when making best interest decisions and planning care and support. Records supported that the service engaged effectively with other professionals in ensuring that all areas of health and well-being were maintained.

Is the service well- led?

We found that the provider monitored the quality of the service provided to people and acted upon the feedback they were given. This showed that the service had an effective management structure and was responsive to concerns, making efforts to drive on-going improvement.

When we visited 82 Chaucer Road on 16 April 2013, we saw that people were happy and at ease, living in a calm, homely and relaxed atmosphere. The eight people who lived at this home had various levels of verbal communication. We therefore used different methods to help us understand people's experiences, and observed the interactions between people and the staff they were supported by.

Three people clearly communicated through their body language they were satisfied with the care and support they received. One person told us,"I like living here." Another person said,"I'm hoping to move on to another place but being here has helped me."

We observed that people were offered support that ensured their individual needs were met and independence encouraged. Staff were friendly and respectful in their approach to people and interacted confidently with them, respecting the individual's dignity and knowing how to communicate effectively with them. One member of staff told a person, "You have choices, it's up to you what you do."

We noted people were involved in planning their care and making decisions about their support and how they spent their time. Some people were going to the day centre at the time of our visit, and others were involved in personal development activities.

One person confirmed the different activities and entertainment they participated in and showed us through their gestures that they enjoyed this.

During our visit to the service on 19 June 2012 we met five of the eight people living there.

We found that people’s needs were assessed, and care and treatment was planned and delivered in line with their individual care plans. Due to the varying levels of communication that people living at 82 Chaucer Road experienced, it was difficult to always discuss their care with them in any depth. Therefore we also used a number of different methods including observations of care and communicating through staff to help us understand the experiences of people using the service.

One person said of the care provided, “they look after me well”. Another wanted us to know about the holiday they had booked with another resident and three staff. We observed that the people using the service all looked happy and well cared for.

We spent time with a group of people in the lounge when they returned from various activities and outings. We observed that they were relaxed in each others company and with the staff and all talked together about their day. Staff ensured that those with limited verbal communication were included in any discussions by using sign language or observing facial expressions.

Staff told us that medication was part of a person’s routine and no problems were experienced with the administration of medication to anyone. We were told that one of the people using the service was being supported to eventually self medicate.

When we talked to people about the environment in which they lived, one person said, “the new floors are really nice and I like the sofa, it is soft”. Another person confirmed that the decoration of their bedroom had been their choice. We were also told that the people using the service had been involved in choosing new furniture for the home and in decorating and painting wherever possible.

We saw that a person with restricted mobility was able to access all areas of the home easily and safely.

We observed that the people who used the service were happy and relaxed in the presence of the staff and that the staff understood their needs and supported them appropriately.

We were told that each of the people living at 82 Chaucer Road met weekly with a member of staff and were given the opportunity to discuss their experience. The manager told us that the member of staff speaking to a person was rotated. This ensured that people, particularly those people who were non-verbal, had the opportunity to communicate with a variety of care staff so that each different opinions were considered.

During our visit on 19 October 2011, the people we spoke with told us that the staff were kind and that they provided help when they needed it. One person told us that they were aware of the content of their care plan, and staff take them out to go shopping for their food. They told us they have asked for new furniture and redecoration of communal rooms. One person told us they are responsible reporting maintenance issues to head office with the support of the manager.

82 Chaucer Road is registered to provide accommodation and support for up to eight people with learning disabilities and complex needs. On the day of our visit, there were eight people living in the home.

Our inspection took place on 14 and 18 May 2015 and was unannounced. At the last inspection in April 2014, the provider was meeting the regulations we looked at.

The service had a registered manager. 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.

Staff had been trained to recognise signs of potential abuse and keep people safe. People felt safe living at the service.

Processes were in place to manage identifiable risks both for people and within the service.

There were sufficient numbers of staff who had the right skills and knowledge to meet people’s needs.

The service had a recruitment process which ensured that suitable staff were employed to look after people safely.

Systems were in place to ensure people’s medicines were managed in a safe way and that they got their medication when they needed it.

Staff received support and training to perform their roles and responsibilities. They were provided with on-going training to update their skills and knowledge.

Staff understood the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were provided with a balanced diet and adequate amount of food and drinks of their choice.

The service had developed positive working relationships with external healthcare professionals to ensure effective arrangements were in place to meet people’s healthcare needs.

People were looked after by staff that were caring, compassionate and promoted their privacy and dignity.

We saw that people were given regular opportunities to express their views on the service they received and to be actively involved in making decisions about their care and support.

Staff were knowledgeable about how to meet people’s needs and understood how people preferred to be supported.

There were effective systems in place for responding to complaints and people and their relatives were made aware of the complaints processes.

Quality assurance systems were in place and were used to obtain feedback, monitor service performance and manage risks.