This inspection took place on 5 October 2016 and was unannounced.

Consensus Support Services Limited - Shrewsbury is registered to provide accommodation with personal care to a maximum of 15 people who have a learning disability or autistic spectrum disorder. There were 13 people living at the home on the day of our inspection.

A registered manager was in post and was present for part of our inspection. 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 home was last inspected on 28 and 29 July 2015 where we gave it an overall rating of requires improvement. At the last inspection we asked the provider to make improvements to ensure staff understood how to support people to make decisions when they did not have capacity to make their own decisions. We also asked the provider to make improvements to ensure the quality systems they had in place were being consistently monitored and completed by staff. We found that these improvements had been completed.

Staff had received training in and understood how to protect people from any harm and abuse. Staff knew how to and were confident in reporting any concerns they may have about a person’s safety. Risks to people’s safety were assessed and monitored. Staff understood how to keep people safe and supported them to live their lives safely whilst respecting their freedom.

People were supported by sufficient numbers of staff on the day of our visit to safely meet their needs. When people needed help and support they were not kept waiting and staff responded quickly. The registered persons monitored how many staff were needed based on people’s individual needs.

People were involved in and supported to take their medicines safely and when they needed them. People’s medicines were managed safely by staff both within and outside the home.

Staff received training to give them the skills and knowledge needed to meet people’s needs. Training was focused on the specific health and medical conditions people had to enable staff to support people effectively. Staff were supported in their roles by managers and their colleagues.

People were asked for their consent and their right to make their own decisions respected. The registered manager consulted with other professionals when decisions needed to be made on people’s behalf to ensure their rights were upheld.

People were supported to have enough to eat and drink and to maintain a balanced diet. Staff worked with other professionals to make sure people’s healthcare needs were met and they had access to healthcare services when they needed them.

People were supported by staff who they had positive relationships with. People received care and support in a friendly and compassionate way by staff who knew them and their personalities well. Staff respected people’s privacy and encouraged them to identify and work towards goals to improve and maintain their independence.

People received care and support that was personal to them and responded to any changes in their needs. They were supported to spend their time as they wanted to and to pursue their own hobbies and interests.

The home had a positive and friendly culture where staff worked for the benefit of the people they supported. The provider had systems in place which assessed and monitored the quality of care that staff provided at the home.

We visited the service because we had received concerns about issues relating to care and welfare, infection control, staffing and supporting workers.

We used a number of methods to help us understand the experience of people who used the service, because most of the people we met were unable to share their views with us. We observed how people were being supported, spoke with two senior managers and a number of staff on duty and reviewed care records held for two people.

People appeared happy in their home and were comfortable with the staff and their surroundings. Staff demonstrated a clear understanding of the individual needs of the people whose care we looked at in detail. People's needs were assessed and care and support was planned and delivered in line with individual support plans. A member of staff told us, “People get first class care and we do our best”.

We toured most parts of both homes including all shared areas and a number of bedrooms and bathrooms. We were told people were involved in keeping their home clean and tidy as part of promoting their independence. An odour issue within one home was known to the provider and plans were in place to address this. However, we found further improvements were needed to ensure people lived in a clean and hygienic environment.

We found there were enough staff on duty to meet people’s individual needs. We saw staffing was planned in advance and that staffing levels were flexible dependent on people’s needs and activities.

Staff received a range of training to give them the skills and knowledge they needed to keep people safe and to meet their individual needs. Staff told us they enjoyed their work and most staff told us they were well supported in their work.

We used a number of different methods to help us understand the experiences of people using the service, because people had complex needs which meant they were not all able to tell us their experiences. We spoke with two people who were able to share their views. We observed interactions, spoke with six staff (including the manager) and reviewed two care and support plans. We also looked at outcomes of the service’s surveys and audits. These had been completed by people using the service, relatives and other stakeholders.

People lived very active lives with varying levels of support. People took part in a range of leisure and social activities, both at home and in the local community. The level of support people required varied and this was accommodated by the home.

People were involved in developing independent living skills as far as they were able. They told us that they liked doing things for themselves and staff were seen to encourage this.

People told us that they were very happy with the support they received. We were told that staff met all of their care and support needs in ways that they preferred. For those who were unable to share their preferences, detailed records gave staff the information that they required.

People were supported by a knowledgeable and well trained staff team who knew their care and support needs well. Staff were offered staff a range of training opportunities that were specifically designed to meet the needs of the people that they supported.

People were protected because staff were confident to recognise and report abuse. The home had implemented changes in response to incidents to keep people safe.

The home had systems in place to seek the views and opinions of people who received a service. Staff told us that the service was all about meeting people’s individual needs. Plans were in place to support people to enjoy their lives and staff were aware of risks, people’s rights and their responsibilities in order to enable people to do this.

Consensus had comprehensive quality monitoring tools to ensure that they maintained good quality and safe care.

The home effectively ensured that people’s views were considered and listened to in relation to the running of the service. Staff responded to verbal and non verbal communication methods to identify and respond to people’s requests.

The inspection was carried out on the 28 and 29 July and was unannounced.

Consensus Support Services Limited, Shrewsbury is registered to provide accommodation with personal care needs to 15 people who have a learning disability or autistic spectrum disorder. There were 12 people living at the home on the day of the inspection. People lived in two homes located on the same site on the edge of the village of Dorrington.

There was a registered manager in post who was present during our inspection. 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.

Our last inspection was carried out 10 February 2014. We asked the provider to make improvements to ensure people were protected against the risks associated with the prevention and control of infection and to send us an action plan telling how they how they would make these improvements. At this inspection we found that improvements had been made. The provider was now meeting the requirements of the regulation.

People’s ability to make decisions about their deprivation of liberty had not been properly assessed. Where decisions had been made on people’s behalf there were no records to show why these decisions were in their best interests.

People felt safe and staff knew how to protect them from harm and abuse. Staff were aware of who to report concerns to and had access to detailed information that allowed them to care and support people safely.

People were supported to take their medicines as prescribed and medication was stored safely. Where people required medication as and when they required it, there were clear guidelines in place for staff to follow.

People were supported to access health care as and when needed. People’s nutritional needs were assessed and monitored. Some people required support with eating and drinking and staff supported them in a calm and respectful manner.

People were involved in decisions about their daily care and support and were encouraged to make their own choices. Staff were kind and helpful and spoke with people in a kind and caring manner. People were treated with dignity and respect and their independence was promoted.

People were actively involved in pursuing their interests and hobbies. Where people had changed their mind and decided not to take part in activities previously arranged their choice was respected.

There was a positive working culture at the home, people, relatives and staff were encouraged to provide feedback to drive improvements.