This unannounced inspection took place on 24 and 25 April 2017. The service was last inspected in January 2015 when it was given a rating of Good.

Foundation House provides long-term residential and nursing care for people who live with physical and learning disabilities and acquired brain injuries. It is available to people either as a home for life or as a stepping stone towards further independence. The service is registered to provider care for up to 11 people. At the time of the inspection 11 people lived in the main home. People living in separate flats on site were not, at the time of the inspection, receiving personal care from the service. The service is run by the National Star Foundation and people who live at Foundation House have access to some of the facilities at the National Star College, which is located close to Cheltenham in Gloucestershire. The service has been fully adapted to accommodate people with the above needs and is located in a residential area near to the centre of Gloucester City. People told us this made it an ideal location for them to be able to access various activities, shops and places to eat and drink.

The manager had worked for the National Star Foundation for 15 years and was registered with the Care Quality Commission (CQC). 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.

Many people, although not all, had transitioned from the National Star College to begin their adult life at Foundation House. Wherever people had moved from their needs had been comprehensively assessed. This involved the person, their relatives, care and health professionals (including representatives of the funding authority) to ensure Foundation House was the appropriate place for them to live. Prior to moving in, people and their relatives or representatives could visit the service, obtain the views of those who were already living there and meet the staff.

During the admission process and later when planning people’s care and support, staff were particularly skilled at supporting people to make their own choices and to discuss what was essentially important to them. Where people had complex needs and where engagement in this process was difficult staff worked hard to help them have a voice. Integral to the success of the service was the staffs’ ability to include, consult with and listen to people and their relatives or representatives. This approach kept the person receiving care consistently at the centre of all care planning and decision making. People’s care and support was therefore personalised and tailored around their personal needs, preferences and wishes. People were given control. A comment made by one person summed up the impact this approach had on them. They said, “Foundation House gives me freedom…. I’ve got control of my life now and I’m going to keep control.”

People told us about the social activities they took part in and they were proud of the work they were involved in. Links with the wider community had been opened up and improved so people were supported to become confident in using and contributing to their community. People wanted to be as independent as possible and there was a strong focus on supporting them to achieve this. Staff had a good understanding about what was needed to achieve this safely. Staff had helped people to recognise potential risks and to manage these safely. There were sufficient staff to provide people with the support they needed. The management staff consistently reviewed their staffing arrangements to ensure staff were available at the times people needed them to be. Staff were committed to supporting people in the best possible way and there were examples of where staff

This inspection was unannounced and took place over two days on the 19 and 20 January 2015. Foundation House was registered by the Care Quality Commission in September 2014 and this is the first inspection of the service. Foundation House is owned and managed by the National Star Foundation and has close links with the National Star College based near Cheltenham.

Foundation House provides long term accommodation and care for 11 people with a physical disability and/or learning disability. There were 11 people living at Foundation House at the time of our inspection. Personal care is also provided by Foundation House for one person living in a flat on the first floor. There are an additional two flats on the first floor but people do not receive personal care from staff at Foundation House.

People have rooms with en-suites which include showers. Rooms are provided with overhead tracking to assist with people’s moving and handling needs. A sensory bath is provided. People share a dining room and lounge on the ground floor. There is also a kitchen, dining room and lounge on the first floor. Lifts provide access to the first floor. Grounds around the home are accessible to everyone.

There was 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 and associated Regulations about how the service is run. The registered manager was registered to oversee four locations owned and managed by National Star Foundation. To support her at Foundation House a manager had been appointed.

People had been fully involved prior to the home opening in deciding who they wished to live with and choosing the décor of the environment. Two people had their accommodation designed specifically for their individual needs. Other people had adaptations made to their rooms to make sure their independence was promoted. If they needed equipment this was provided. Where changes were needed to make sure the environment continued to promote their independence this was arranged. Referrals were made to the appropriate health care professionals to ensure adaptations and equipment matched their individual needs.

People had voted for representatives to help manage and monitor the quality of service provided. During our inspection one person discussed with the cook new menus and another person reported environmental issues which needed addressing. The views of people, their relatives, staff and other professionals were sought to monitor the quality of the service provided. Their feedback was used to make improvements where needed.

People’s care and support reflected their routines, likes and dislikes and future goals. Staff had an exceptional understanding of people’s needs and how to deliver care respectfully and sensitively. People’s dignity and confidentiality were promoted. People enjoyed the company of each other and staff. People were involved in developing their care plans and expressing how they wished to be supported and cared for. Innovative methods of communication were used to enable people to express themselves. Developing life skills to maintain and increase their independence was part of their daily routine. They had access to a range of activities which reflected their interests both in their local community and at home. A relative commented, “We can see (name) is happy, well looked after, mentally and physically. Everyone is so caring and positive.”

People were supported to stay well. A nursing team monitored their health and wellbeing on a day to day basis. Medicines were administered safely and at times when people wished to have them. Nutritional needs were considered and if people were at risk of malnutrition their food was fortified with supplements to maintain their weight. People were involved in discussions about their health and wellbeing.

Staff had access to a robust training programme to equip them with the skills and knowledge to support people. Individual meetings with the manager and annual appraisals gave them the opportunity to reflect on their performance and to identify future training needs. They had a good understanding of how to keep people safe and how to support them to make decisions. Managers were open and accessible and staff were confident they would listen and respond to any concerns they raised.

People gave feedback about the service they received and this was used to shape developments and improvements. The provider ensured managers had the support and resources they needed to maintain and develop standards at Foundation House.