This inspection took place on 16 August 2016 and was unannounced.

Dunsland provides accommodation, care and support for up to 14 people living with a learning disability. At the time of our inspection there were 11 people living in the home.

The manager has been in post since January 2016. 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 cared for in a safe way. Steps had been taken to identify and mitigate any risks to people’s wellbeing and safety and in the environment of the home. Risk assessments were detailed and gave clear guidance for staff on how to manage risk. People were supported by staff who knew how to protect people from harm. Staff were knowledgeable in their work and had received training appropriate for their role. There were enough staff to support people effectively.

There were safe recruitment practices in place which ensured that appropriate checks had been carried out on staff before they started working in the home.

Medicines were managed and stored safely in the home. Staff had the necessary training in order to administer people’s medicines in a safe way.

People had not received a mental capacity assessment so it was not clear what decisions people could make for themselves, and what decisions they needed support with. Therefore, there was not clear why people needed support in certain areas.

People’s support plans were person centred and reflected people’s wishes around how they wanted their care to be delivered. Staff knew how to promote people to be as independent as possible and people were supported to pursue their interests and hobbies as well as play an active part in the running of the home.

Prompt referrals were made to relevant healthcare professionals where concerns were raised regarding a person’s health or wellbeing. People were also supported to eat and drink sufficient amounts. People were consulted on what food they preferred and the menus were devised according to people’s preferences.

Staff who worked in the home were caring. People were consistently treated with dignity and respect and their right to privacy was upheld. Staff knew how to support people with their individual care needs and asked people about their preferences. People were able to have their relatives and friends visit the home.

People’s care needs were constantly reviewed and people’s support plans were updated to reflect any changes required in their care.

There was an appropriate complaints procedure in place and staff knew how to support people in the event that they wanted to make a complaint. An easy read version of the complaints procedure was placed in a communal area so people could easily access it. Where concerns had been raised, appropriate action was taken.

The service was being well run and people’s needs were being met appropriately. Staff felt supported by the manager and there was frequent and effective communication between the manager, staff and people living in the home. The manager was approachable and encouraged staff to put forward new ideas about how the service could improve.

There were a number of systems in place to monitor and asses the quality of the service. Regular audits were carried out by the manager. These identified any areas for improvement and any remedial action that was needed.

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 caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on our discussions with four people who used the services and three staff members. In addition we looked at two people's care and support plans.

Is the service safe?

Risk assessments were in place to ensure that as far as possible people were safe in the home and that staff were safe in their working environment. Where risks to people had been identified measures had been taken to minimise or remove them. Appropriate vetting of staff combined with on-going support and appraisal meant that the provider took reasonable steps to ensure that vulnerable adults were protected from the risk of abuse. We looked at staff rotas and found that there were enough qualified, skilled and experienced staff to meet people's needs throughout the day and night.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to all care services. At the time of the inspection no applications had needed to be submitted. Proper policies and procedures were in place so that people who could not make decisions for themselves were protected. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service caring?

People we spoke with said that staff treated them with respect and consideration. They felt that staff listened to them and took time to explain things. People also told us that they were consulted about the care and support they received.

People’s needs were assessed and care and support was planned and delivered in line with their individual care plans. The care plans we looked at were personalised and detailed and provided a good level of information for the staff providing the care.

During the inspection we observed that staff were kind and caring in their interactions with people.

Is the service responsive?

The provider had a system of dealing with complaints. We found that people’s complaints had been dealt with in a timely manner. People knew how to make a complaint if they were unhappy. The complaints process was displayed in the entrance hall,making it easily accessible to people and visitors. Where shortfalls or concerns were raised these were addressed by the provider.

People told us that the provider responded to their changing needs in a timely manner. People's needs were assessed and reviewed on a monthly basis or as and when needed. Where changes occurred, the service referred to health professionals for advice and guidance if required. All changes were well documented and recorded.

People who used the services and their family members or representatives, were asked for their views about the care provided and these were acted on by the provider.

Is the service effective?

People using the services that we spoke with said, or indicated to us, that the care and support provided was of good quality. From our observations we saw that care and support was effective and consistent.

People were supported to be as independent as possible. One person told us, "I like to help in the kitchen if I can. But only when someone is there to help me."

We saw that staff knew the people they were supporting and caring for and that the people receiving the care and support were happy. We noted that if something was not right that staff responded quickly to resolve matters.

People told us, or indicated to us, that they liked living at Dunsland and that staff were kind and caring.

Staff explained how they were able to communicate with people who were not able to express themselves verbally.

Is the service well led?

Views of people using the services and, where possible, of their families were obtained and opportunities were in place for social gatherings where further views and opinions of the services, and staff, could be gained.

Staff told us that they felt supported and had received sufficient training to carry out their role effectively. They added that if they felt they needed further or additional training or support that they were confident this would be arranged by the provider.

There were quality monitoring systems in place and regular audits and spot checks took place to ensure that people received a good service.

Staff were clear about their roles and responsibilities. They spoke of how they worked as a team with the needs of the person central to the work they did.

People we spoke with told us that they had been involved in choosing colours and soft furnishings as part of the current refurbishment of the home.

One person told us that they particularly enjoyed helping around the house and we observed other people also undertaking various household tasks as they wished. We observed people choosing and preparing what they wanted for lunch and saw that staff empowered people by assisting when needed or when asked, rather than ‘doing for’ people.

Staff spoke respectfully with people living in the home and consistently included them in conversations and friendly banter.

Care records contained sufficient information, that was easy to follow, to ensure people received individually tailored care and support.

Assessments took into account the risks to which people were exposed but they also reflected people’s wishes and independence in a balanced way.

There were policies in place to safeguard people living in Dunsland and the manager had kept the Care Quality Commission informed of any safeguarding issues. We saw examples that assured us that the manager and provider had responded appropriately to any suspicion or allegation of abuse.

Staffing levels were sufficient to meet people’s needs appropriately.

The manager provided us with all the records we asked to see during this inspection and we saw that these were kept securely, were accurate and fit for purpose.

Dunsland had experienced some complex issues during the last 12 months, with no permanent manager in post for some months. A new manager had only been in post for two months at the time of this inspection but they were able to demonstrate a good knowledge of each person living in the home and provided us with a brief but detailed overview of their support needs.

We saw that a number of improvements had already been made since the manager started working in the home and we acknowledged further areas for improvement that were 'work in progress'.

We saw that where one person required one-to-one support 24 hours a day, this was provided appropriately by staff who showed good knowledge and understanding of the person's support needs.

We noted from minutes of the most recent 'residents' meeting that people had been involved in making choices with regard to the menu options and were supported to understand the positive aspects of 'healthy eating'.

We did not speak directly with people living in the home about safeguarding. However, our observations showed people to be relaxed and comfortable with the staff and we noted positive and friendly interactions between the staff and people being supported.

We found the home to be clean and hygienic, with a homely atmosphere and noted that people had individual rooms, which either had been or were being decorated and furnished in accordance with their preferences and choices.

The people we spoke with told us about the activities they were engaged in during our visit. One person was drawing and showed us the pictures they had made. Another person was in their room, playing music. One person told us about how they liked to grow rhubarb and they were busy with a member of staff measuring out the ground for a greenhouse. They said they were going to grow tomatoes in the greenhouse to eat at the home and they were also planning planting other vegetables to grow for the table.

People were engaged in their activity and they spoke freely to staff. We saw that people spoke to staff as their friends and the conversations were warm, friendly and full of laughter.

We visited Dunsland care home during the morning of 12 December 2011 and spoke with five people who live there.

The comments were generally positive about the care, comfort and support they receive.

One person told us "I think the staff are marvelous, they help me when I want to go out and do some lovely food." Another person said "I like living here because the staff are very nice."

We saw that staff spoke kindly to people and responded with patience when they required support.