Cromarty House is a small family run care home for a maximum of eight younger adults with physical and learning disabilities.

We carried out this inspection on 25 October 2017. At the last inspection, in October 2015, the service was rated Good. At this inspection we found the service remained Good.

People, and their relatives, told us they were happy with the care they received and believed it was a safe environment. Comments included, “I am safe here”, “[Person] is very happy at Cromarty”, “Really pleased with the home. Staff treat [Person] well” and “The home is exactly what I always wanted for [Person].”

There was a calm and homely atmosphere at the service. People, who were able to verbally communicate, happily chatted to us as they went about their day. Where people were unable to tell us about their experiences we observed they were relaxed and at ease with staff. People's independence and wellbeing was promoted because staff had developed positive and meaningful relationships with them. Staff interacted with people in an unhurried way and supported people at a time and pace convenient for them.

People were encouraged and felt confident to make decisions about their daily lives. People were able to take part in activities of their choice and staff supported people to develop interests. People were at the centre of every aspect of the service and routines were led by the people living at the service. It was clear the service was run for and by the people who lived there. The culture in the service was one where there were no unnecessary rules or routines, put in place to suit staff, rather than the people that used the service.

Risks in relation to people’s care and support were identified and when systems were put in place to manage any risks these were agreed with people. People were encouraged to be as independent as possible and where possible people managed their own risks with minimal intervention from staff.

Care plans were well organised and contained personalised information about the individual person’s needs and wishes. These had been developed with people and were reviewed regularly with the individual person’s involvement. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted. External professionals visiting the service fed-back that the service was consistently focused on providing a person centred service. A professional commented, “Staff support people with profound and multiple learning disabilities and their care for people is very good. They have a good understanding of people’s needs and how best to support them, ensuring that the care is person centred and not too medicalised.”

People had access to healthcare services to help them maintain good health. They saw their GP and attended other necessary appointments such as the hospital visits, dentists and opticians when they needed to. Staff supported people to access annual health screening checks to maintain their health. Specialist services such as speech and language therapists, physiotherapists and dieticians were used when required.

Safe arrangements were in place for the storage and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained.

Staff supported people with their food choices to help them maintain a balanced diet. People were involved in meal planning and preparation. Menus were planned in a way which combined healthy eating with the choices people made about their food. Where people had specific dietary needs staff supported them to plan meals that met those needs.

There were sufficient numbers of suitably qualified staff on duty. Staffing numbers were adjusted if people were unwell or to facilitate the activities people wanted to take part in. Staff completed a thorough recruitment process to help ensure they had the appropriate skills and knowled

We met with and spoke with all the people who lived at Cromarty House. People told us they were happy living at the home and liked the staff that assisted them. They said the home was comfortable and clean. We observed each person had individualised their own room to suit their personal taste. People told us they chose how they spent their time and had free choice about areas of their life such as when they went to bed and what choice of meals they had. We saw people coming and going from various activities during the day. People were happy to spend time socialising together, talking with staff or spending time in their own rooms. We saw people moved around the home with no restrictions.

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

We saw there was a choice of suitable and nutritious food and drinks, in sufficient quantities to meet people’s needs.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises

Staff said they had received enough training and support to enable them to carry out their roles competently.

Some of the people using the service were not able to comment in detail about the service they received. We spoke to two people who lived at Cromarty House. All the comments we received from people who lived at Cromarty House were positive. Comments from people included “I like it here, I get on well with the staff, it’s home, it’s better than anywhere else I have lived”. We saw people’s privacy and dignity being respected and staff being helpful. We saw that people were spoken with in an adult, attentive, respectful, and caring way.

People experienced care, treatment and support that met their needs and protected their rights.

We saw people actively contributing to the running of the home. We saw one person prepare a cake mixture and another was pleased to have completed the cleaning of a bedroom.

People we spoke with said that they enjoyed the food they received. We were told the food was of a good standard, and usually cooked to order. This meant that people could choose, individually, what they wanted each day.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The inspection took place on 6 and 8 October 2015 and was unannounced. This service was also inspected on 18 November 2014 but, due to unforeseen circumstances, we were unable to complete a report for that inspection.

Cromarty House provides care and accommodation for up to eight people who have a learning disability. The service had 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 and staff were relaxed throughout our inspection. There was a lively, friendly and homely atmosphere. People, where able, told us they enjoyed living in the home and relatives confirmed they were happy with the care and support people received, saying "We think the place is wonderful."

Care records were personalised and gave people control over all aspects of their lives. Staff responded quickly to people’s change in needs. People, as far as able, were involved in regularly reviewing their needs and how they would like to be supported. People’s preferences were identified and respected.

Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and practice was person focused and not task led. Staff were highly motivated, creative in finding ways to overcome obstacles that restricted people’s independence, and had an in-depth appreciation of how to respect people’s individual needs around their privacy and dignity.

People’s risks were managed well and monitored. People were promoted to live full and active lives and were supported to be as independent as possible. Activities were meaningful, reflected people’s interests and individual hobbies and helped to develop new skills.

People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, social workers, community psychiatric nurses and speech and language therapists.

People told us they felt safe. Comments included, “I feel safe”. All staff had undertaken training on safeguarding vulnerable adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be taken seriously and acted upon.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment. Relatives and friends were always made to feel welcome and people were supported to maintain relationships with those who mattered to them.

People, where able, and those who mattered to them knew how to raise concerns and make complaints. Nobody told us of any concerns or complaints they had made, and no written complaints had been received by the service.

Staff described the management as supportive and approachable. Staff talked positively about their jobs. Comments included: "I really enjoy it!" Staff received a comprehensive induction programme. There were sufficient staff to meet people’s needs. Staff were trained and had the correct skills to carry out their roles effectively.

Staff understood their role with regards to the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards. Applications were made and advice was sought to help safeguard people and respect their human rights.

There were effective quality assurance systems in place. Incidents were recorded and analysed. Learning from incidents was used to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the service.