Downshire House is a care home without nursing which is registered to provide a service for up to eight people with learning disabilities and some with physical disabilities. Some people had other associated difficulties such as being on the autistic spectrum. There were eight people living in the service on the day of the visit. All accommodation is provided within a detached three story house near to local amenities and the centre of the town of Reading.

At the last inspection in 7 December 2015 the service was rated Good overall with Requires Improvement in Safe (No breach). We found that some fire doors were being propped open which had the potential to put people at risk in the event of a fire.

This unannounced inspection took place on 10 January 2018. At this inspection we found the service remained Good overall. Further steps had been taken to address the previous concerns and we found that improvements had been made. However, we found that the recruitment processes were not always sufficiently robust and had the potential to put people at risk of unsuitable staff. Therefore the service remains Requires Improvement in Safe.

Why the service is rated Good overall:

There is a registered manager running 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.

People’s safety was contributed to by staff who had been trained in safeguarding vulnerable adults and health and safety policies and procedures. Staff understood how to protect people and who to alert if they had any concerns. General risks and risks to individuals were identified and appropriate action was taken to reduce them.

There were enough staff on duty at all times to meet people’s diverse, individual needs safely. The service had a stable staff team. The service required improvements to its recruitment procedures. References were not always pursued from previous employers and full work histories were not always obtained. People were given their medicines safely, at the right times and in the right amounts by trained and competent staff.

The service remained effective. Staff were well-trained and able to meet people’s health and well-being needs. They were able to respond effectively to people’s current and changing needs. The service sought advice from and worked with health and other professionals to ensure they met people’s needs.

People were encouraged 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 practise.

The service continued to be caring and responsive. The committed, attentive and knowledgeable staff team provided care with kindness and respect. Individualised care planning ensured people’s equality and diversity was respected. People were provided with a wide variety of activities, according to their needs, abilities, health and preferences.

The registered manager was well thought of and respected. The quality of care the service provided continued to be assessed, reviewed and improved, as necessary.

This inspection took place on the 7 December 2015 and was unannounced.

Downshire House is a care home which is registered to provide care (without nursing) for up to seven people with a learning disability. The home is a large detached building within a residential area close to Reading town centre. People have their own bedrooms and use of communal areas that included an enclosed private garden. The people living in the home needed care from staff at all times and have a range of care needs.

There is a full-time 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.

People’s safety had been placed at risk as wooden wedges were used to prop open doors, in particular where a dorgard had been fitted. A dorgard is a wireless fire door retainer that automatically closes on the sound of the alarm, delaying the spread of fire. The provider had taken immediate action on the day of our visit to ensure people’s safety was not compromised by removing the wedges and replacing dorgards that were defective.

The recruitment and selection process helped to ensure people were supported by staff of good character. There was a sufficient amount of qualified and trained staff to meet people’s needs safely. Staff knew how to recognise and report any concerns they had about the care and welfare of people to protect them from abuse.

People were provided with effective care from a dedicated staff team who had received support through supervision, staff meetings and training. Their care plans detailed how they wanted their needs to be met. Risk assessments identified risks associated with personal and specific behavioural and or health related issues. They helped to promote people’s independence whilst minimising the risks. Staff treated people with kindness and respect and had regular contact with people’s families to make sure they were fully informed about the care and support their relative received.

The service had taken the necessary action to ensure they were working in a way which recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. DoLS provide a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm.

Staff were supported to receive the training and development they needed to care for and support people’s individual needs. People received good quality care. The provider had an effective system to regularly assess and monitor the quality of service that people received. There were various formal methods used for assessing and improving the quality of care.

Downshire House supports people with a range of needs. We therefore used a number of different methods to help us understand the experiences of people who use the service. This included observation of care being delivered, talking with staff and looking at records in the home.

We spoke with two people who use the service about their experiences in the home. One person told us, "I like it here. I have everything I need." Another said, "Nice staff." We spent time observing how staff were interacting with people who live there. People were relaxed and comfortable in the presence of staff. It was clear from talking with staff that they knew the needs of each individual well and were mindful of people's particular preferences and wishes. Self-care was prompted with sensitivity and patience.

We saw detailed person-centred care plans had been developed to reflect the particular needs, wishes and interests of people at the home. They contained information about how people wished to spend their time and how they wanted to be supported. Any risks to people had been fully assessed and there were guidelines in place to manage risks identified.

We spoke with staff about safeguarding. They were knowledgeable about protecting people from abuse and exploitation. They said they had plenty of opportunities to undertake training to enhance their knowledge and skills

There were appropriate policies in place to effectively manage and respond to complaints or suggestions people made.

During the inspection we spoke with five people using the service and five members of staff. The registered manager was on holiday at the time of the inspection.

People using the service were complimentary about the home. One person said 'staff helped' and another person said 'everyone was kind'. People commented that the the food was 'good' and that they enjoyed the activities that took place.

Staff involved people using the service in the running of the home and acted upon their wishes and preferences.

Staff assessed peoples' needs and documented the approaches that were needed to promote peoples' wellbeing. People using the service were involved in the development of person-centred care plans. Staff worked in partnership with other agencies to ensure that peoples' needs could be met.

The home was clean and well maintained. People were able to personalise their rooms if they wished.

Staffing levels met the needs of the people using the service. Staff described a 'really nice atmosphere' and said that they were well supported.

Systems were in place to seek peoples' views and their suggestions were acted upon. Information was provided in different formats to promote peoples' inclusion in the quality assurance of the home.

People told us that they liked living at the home. They said that the staff team were friendly, kind and caring. They said that there was always enough staff on duty during the day and at night. People said that there rooms were comfortable and they could come and go as they wished.

People said that they trusted the staff and felt safe at the home. They said that staff always had time to listen to them and provide the care they needed.