This inspection took place on 14 and 21 November 2017 and was announced. This was to ensure someone would be available to speak with us and show us records.

Education and Services for People with Autism Limited - 35-37 Portland Avenue is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Education and Services for People with Autism Limited - 35-37 Portland Avenue accommodates up to four people in one building. On the day of our inspection there were three people using the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

We last inspected the service in October 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Family members said their relatives were safe at Education and Services for People with Autism Limited - 35-37 Portland Avenue. There were sufficient numbers of staff on duty to keep people safe and the provider had an effective recruitment and selection procedure in place.

Accidents and incidents were appropriately recorded and analysed monthly to identify any trends. Risk assessments were in place for people who used the service and staff.

The registered manager understood safeguarding procedures. Staff had a good knowledge of safeguarding and had been trained in how to protect vulnerable people.

Appropriate arrangements were in place for the safe administration and storage of medicines.

Staff were supported in their role and received regular supervisions and an annual appraisal. Staff mandatory training was up to date.

People’s needs were assessed before they started using the service and were continually assessed in order to develop support plans.

People were supported with their dietary needs and meals were planned weekly based on people’s likes and dislikes.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible.

People who used the service and family members were complimentary about the standard of care at the service. People were involved in making decisions about their care and the home they lived in, and were supported to be independent where possible.

Care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

People were protected from social isolation and had personalised activities timetables in place.

The provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Staff said they felt supported by the registered manager. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.

This inspection took place on 12 October 2015 and was unannounced. This meant the provider did not know we were carrying on the inspection on that day.

35-37 Portland Avenue provides accommodation and personal care for up to four people. The home is a pair of semi-detached bungalows, each with two bedrooms, a lounge and kitchen. They are set in their own gardens in a residential area, near to public transport routes and local shops.

There was a registered manager in place who had been in their present post at the home for over ten years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We found people were engaged in their care and the running of the home and staff helped people to express their wishes, likes and dislikes and the activities they wanted to do. People’s care plans were very person centred and written in a way that described their care, treatment and support needs. These were regularly evaluated, reviewed and updated. The care plan format was easy for people living at the home to understand and also included pictures and symbols.

People who used the service, and family members, were extremely complimentary about the standard of care provided.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. We found the registered provider was following legal requirements in relation to MCA.

Our observations during the inspection showed us that people were supported by sufficient numbers of staff. We saw staff were responsive to people’s needs and wishes and we viewed records that showed us staff were enabled to maintain and develop their skills through training and development activities. The staff we spoke with confirmed they attended training and development activities to maintain their skills. We also viewed records that showed us there were safe and robust recruitment processes in place.

Throughout the day we saw staff interacting with people in a very caring and professional way. The registered manager and staff that we spoke with showed genuine concern for peoples’ wellbeing and it was evident that all staff knew people at the home very well. This included their personal preferences, likes and dislikes and had used this knowledge to form very strong therapeutic relationships. We saw all of these details were recorded in people’s care plans. We found that staff worked in a variety of ways to ensure people received care and support that suited their individual needs and personality.

People were supported by well trained staff. The provider had its own training department which supported staff to gain the skills and knowledge they needed to meet the needs of people who used the service.

People were protected from the risk of abuse. The care staff we spoke with understood the procedures they needed to follow to ensure that people were safe. They had undertaken training and were able to describe the different ways that people might experience abuse. Staff were able to describe what actions they would take if they witnessed or suspected abuse was taking place.

People received a balanced diet. People at the home had specific diets and preferences and staff were very knowledgeable about these. We saw staff offered a selection of preferred meals and people chose what they wanted to eat. There were snacks and drinks available at all times as well as healthy options for people to choose from which staff encouraged.

We found that the registered manager had checks in place to make sure the building was clean and well-maintained. Improvements to the building and required maintenance was undertaken when required to ensure health and safety for people living and working at the home. There was a designated infection control champion at the home and we found that all relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.

We saw the provider had policies and procedures for dealing with medicines and these were followed by staff. Medicines were securely stored and there were checks and safeguards in place to make sure people received the correct treatment.

People were supported to take part in activities they were interested in and routines they preferred. Staff were constantly looking for more opportunities for people to try.

We found that the registered provider had comprehensive systems in place for monitoring the quality of the service. This included monthly audits of all aspects of the service, such as medication and learning and development for staff, which were used to critically review the home. We also saw the views of the people using the service, their advocates and relatives were regularly sought and used to make changes. The manager produced action plans, which clearly showed when developments were planned or had taken place.

There was a complaints policy at the home which provided people who used the service and their representatives with clear information about how to raise any concerns and how they would be managed. We saw pictures had been used to help people understand the information. The staff we spoke with told us they knew how important it was to act upon people’s concerns and complaints and would report any issues raised to the registered manager or provider.

We used a number of different methods, for example observing how people were supported to make decisions about their care, to help us understand the experiences of people using the service. This was because some people were unable to give us their comments directly about the care they received.

During our visit we found people were asked for their consent before they received any care or treatment and the provider acted in accordance with their wishes.

We found care and treatment was planned and delivered in a way which ensured peoples’ safety and welfare. One relative told us, “The home is very good; I can see people growing and developing.” And, “The staff know everything about my (relative), the care they need and the way they like things to be done. I think they are very good at what they do.”

The provider had made suitable arrangements to protect vulnerable people and respond appropriately to any allegation of abuse. One staff said, “We know each person very well so we can tell when they are not themselves and start to question to see if there is anything untoward.”

The provider had taken steps to make sure people at the home were protected from staff who were unsuitable to work with vulnerable people by carrying out thorough background checks.

We found people who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. Visiting relatives told us all staff and the manager were very good at communicating with them and they were “very happy with the service” provided at 35-37 Portland Avenue. They said things like, “We can talk to any of the staff,” and “We have every confidence in the service.”

We used a number of different methods, for example observing how people were cared for, to help us understand the experiences of people using the service. This was because we were unable to get people’s direct comments about the care they received. One person who lived at the home told us that they were, “hunky dory.” Another said that they were, “happy.”

The manager told us most people who lived at this home found it difficult to express their overall views about the service directly. To overcome this they had used their knowledge of peoples’ preferences, behaviour and responses to organise the support people needed in a way that was acceptable to them. They had also carried out a survey with people to see what they thought about life at the home. In the survey everyone said they liked living at Portland Avenue and they felt safe in their home. They said staff listened to them, were helpful and understood what was important to them and staff helped them to make choices about their lives.

The manager had also carried out surveys with peoples’ relatives and / or advocates. The most recent survey found that everyone was happy with the service their relative received at 35-37 Portland Avenue. Relatives said that the homes strengths were, good activities and holidays, dedicated staff and management, staff team work, training, and good staff ratio. One relative said, “He leads as independent a life as possible.” Another said, “(Persons name) values his privacy.” They also said the staff and the manager had a really good understanding of their relative’s likes and dislikes and the home supported people to have good healthcare.

Relatives made positive comments about the staff and the quality of the service. Comments included:

“Regular updates and contact from staff are always welcome.”

“I would recommend ESPA as a service provider.”

“My (relative) is happy with his life at ESPA.

“The shared bungalow is a bonus and well maintained.”

During our visit we saw staff respected people’s privacy and dignity. They were friendly and very polite. Staff waited for people to make decisions about how they wanted their care to be organised and closely followed their gestures and directions.