Carrick provides care and accommodation for up to five people who have autistic spectrum disorders. It is part of the Spectrum group who have several similar services in Cornwall. They are providers of specialist care for people with autistic spectrum disorders and learning disabilities. At the time of the inspection five people were living at the service.

We inspected Carrick on 31 May 2017, the inspection was unannounced. The service was last inspected in June 2015, we had no concerns at that time and the service was rated Good. At this inspection we found the service remained Good.

The service is required to have 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. There was no registered manager in post at the time of the inspection. The acting manager was in the process of making an application for the position.

We arrived at the service shortly before 10:00 am. There were two members of staff on duty at this time. The identified required number of staff at this time of day was three. Staff told us one member of staff had not turned up for their shift. They had contacted another employee to support them and they arrived at the service at 10:30. Records showed there were several occasions in the days preceding the inspection when staffing levels identified as necessary had not been met. We have made a recommendation about staffing levels in the report.

Daily records showed people were going out regularly. People had access to a range of activities both within the service and in the local community.

Recruitment practices helped ensure staff were suitable to work in the care sector. Staff had received training in how to recognise and report abuse. The service held money for people and kept receipts to evidence any expenditures. We checked the amount of cash held for people against the records and found there were some discrepancies. Although these were minor it is important accurate records are kept to protect people from the risk of financial abuse.

Risks were clearly identified and appropriate action taken to minimise risks and protect people from avoidable harm. Staff knew how to minimise risks and manage identified hazards in order to help keep people safe from harm or injury. People received their medicines as prescribed. Action was taken when a medicine error occurred and the systems in place improved to help ensure the errors did not re-occur.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). DoLS provide legal protection for vulnerable people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate. 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.

Staff communicated effectively with people. They adapted their approach to communication according to people’s individual needs. One person was occasionally agitated during the day and staff were understanding and worked with the person to alleviate their anxiety.

Care plans were well organised and up to date. The plans contained information about what was important to people as well as information regarding their health needs. Personal histories were recorded to help staff get a picture of the events and circumstances which may have impacted on who

We inspected Carrick on 2 June 2015, the inspection was unannounced. The service was last inspected in January 2014; we had no concerns at that time.

Carrick provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection five people were living at the service. There was a registered manager in post. 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 mainly relaxed and at ease with staff and each other. When one person became anxious staff spoke quietly to them and reassured them, supporting them to a quieter area of the house in order that they might have some privacy. Another person frequently asked for confirmation they would be going out and this was given with patience and humour. Staff used distraction techniques to deflect the person’s attention and demonstrated an understanding of how to support them well and maintain their emotional well-being.

Care documentation was informative, well organised and up to date. They contained information to enable staff to support people’s emotional well-being as well as their health needs. Risks had been clearly identified and there was guidance for staff on how to minimise any risk. Staff told us the detail and depth of information was useful.

Support was geared towards individual needs and communication preferences were recorded and taken into account. Staff were able to describe to us in detail how people communicated and we observed this was effective and meaningful. Care planning was done in partnership with people and staff identified creative methods of planning to ensure people could have real involvement in the process. People were supported to lead full and varied lives and access the local community. They took part in a range of activities which were geared to their individual interests, hobbies and backgrounds.

Staff showed by their actions and conversations with us that they valued people for their individuality and had high expectations for them. People’s goals and hopes were defined and recorded and their gifts and talents recognised and encouraged. Staff supported people to develop and maintain their independence.

There was a strong staff team in place who told us they felt well supported in the service and were able to approach the registered manager with any concerns they had or ideas for development. Training was up to date in areas defined as necessary for the service. Training more specific to the needs of people living at Carrick had not been updated for some time. However, we were told there were plans to address this in the near future.

The service at Carrick was well-led; there was an open and positive culture. Accidents and incidents were appropriately recorded and analysed monthly to identify any trends. Quality assurance systems were in place within the service and at provider level.

We spoke to one person who lived in the home. The conversation was general due to their communication needs. We did not speak directly to four people who lived at Carrick as they had complex communication needs. Instead we saw how the person interacted with staff. We saw people approach staff in a relaxed manner and staff responded to their approach.

We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We also spoke to two relatives and an advocate. All the people we spoke with told us they were “very impressed” with the care and support that people received at Carrick. No concerns were raised.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We examined people's care files and found the records were up to date and reviewed as the person's needs/wishes changed. We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cooking, cleaning and doing their laundry. During the visit we noted that people attended a variety of activities so that they had opportunities to pursue their interests.

People were protected from the risks of inadequate nutrition and dehydration.

People were cared for in a clean, hygienic environment.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We spoke to four people who lived in the home they told us that they liked living at Carrick. We saw written feedback form a relative which stated” I think the staff are excellent at defining what service users problems and difficulties are and work hard at what can be done to make their lives so much easier to cope with, this can then lead to them living better and happier lives.”

We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We saw that people's privacy and dignity was respected by the way that staff assisted people with their care.

We examined people’s care file and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cleaning and college attendance. The records showed they saw healthcare professionals when they needed to.

Staff said they had received sufficient training and support to enable them to carry out their roles competently and felt there was sufficient staff on duty.

Systems for safeguarding people from abuse were in place. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people’s rights.